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Epprecht J, Ledergerber B, Frank M, Greutmann M, van Hemelrijck M, Ilcheva L, Padrutt M, Stadlinger B, Özcan M, Carrel T, Hasse B. Increase in Oral Streptococcal Endocarditis Among Moderate-Risk Patients: Impact of Guideline Changes on Endocarditis Prevention. JACC. ADVANCES 2024; 3:101266. [PMID: 39290812 PMCID: PMC11406034 DOI: 10.1016/j.jacadv.2024.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/20/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024]
Abstract
Background The well-established connection between oral bacteria and infective endocarditis (IE) has prompted discussions about using antibiotic prophylaxis (AP) before invasive dental procedures. In 2007/2008, guidelines restricted AP from moderate and high-risk to exclusively high-risk patients. Objectives The authors aimed to assess whether the proportion of oral streptococcal IE increased in moderate-risk patients using University Hospital Zurich data from 2000 to 2022. Methods Adult IE patients were categorized into risk groups based on European Society of Cardiology and Swiss guidelines. The investigation focused on analyzing the proportion of oral streptococcal IE across different risk groups in two distinct periods (1: 2000-2008; 2: 2009-2022). Logistic regression models, adjusted for various factors, were employed. Results Of 752 IE cases, 163 occurred in period 1, and 589 in period 2. Oral streptococci caused 22% of cases. Proportions of streptococcal IE in period 1 versus period 2 were 24% versus 16% in high-risk, 24% versus 39% in moderate-risk, 33% versus 7% in low-/unknown-risk, and 18% versus 14% in no-risk patients. Compared to the other risk groups, the moderate-risk group had a 22% higher chance of oral streptococcal IE in period 2. After multivariable adjustment, moderate-risk patients had twice the risk of oral streptococcal IE compared to period 1 (OR: 2.59 [95% CI: 1.16-5.81]). Among moderate-risk conditions, congenital valve anomalies were associated with oral streptococcal IE (unadjusted OR: 2.52 [95% CI: 1.71-3.71]). Conclusions Oral streptococcal IEs increased in the moderate-risk group of patients after the AP guideline change. Exploring the potential necessity for expanding AP indications to certain patient groups with congenital valve anomalies may be warranted.
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Affiliation(s)
- Jana Epprecht
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maria Padrutt
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Masticatory Disorders and Dental Biomaterials, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Barbara Hasse
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Milligan R, Stewart V, Beresford A, Marley J. An audit of pre-operative dental radiographs in patients who received no pre-operative dental input before cardiovalvular surgery. Br Dent J 2024:10.1038/s41415-024-7851-4. [PMID: 39304790 DOI: 10.1038/s41415-024-7851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 09/22/2024]
Abstract
Purpose To radiographically characterise dental disease burden and related characteristics of referred patients awaiting cardiovalvular surgery (CVS) in the context of infective endocarditis (IE) risk.Methods Radiographic evidence of dental disease levels was assessed for patients referred for dental assessment pre-CVS using available orthopantomographs (OPTs) prescribed by the cardiology team. This group did not receive any pre-CVS dental intervention or treatment.Results The majority of OPTs were Quality Standard 2 (87.5%). There was radiographic evidence of dentoalveolar disease in those patients proceeding to CVS. Periodontal disease was most prominent, with 79% of patients having advanced bone loss. The mean number of apical lesions was 0.71. Overall decayed, missing, and filled teeth score was 16.4, along with mean missing teeth scores of 7.9. None of the patients have so far developed IE at a minimum of six-month follow-up.Conclusions In our context, the quality of the radiographs requested by non-dental clinicians and delivered by non-dental-school-based radiographic departments is suboptimal and needs to be addressed. This audit should help to inform the debate around the timing and delivery of evidence-based, specialist dental care for CVS patients.
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Affiliation(s)
| | | | | | - John Marley
- School of Dentistry, Belfast, Northern Ireland, UK
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Reisinger M, Kachel M, George I. Emerging and Re-Emerging Pathogens in Valvular Infective Endocarditis: A Review. Pathogens 2024; 13:543. [PMID: 39057770 PMCID: PMC11279809 DOI: 10.3390/pathogens13070543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Infective endocarditis (IE) is a microbial infection of the endocardial surface, most commonly affecting native and prosthetic valves of the heart. The epidemiology and etiology of the disease have evolved significantly over the last decades. With a growing elderly population, the incidence of degenerative valvopathies and the use of prosthetic heart valves have increased, becoming the most important predisposing risk factors. This change in the epidemiology has caused a shift in the underlying microbiology of the disease, with Staphylococci overtaking Streptococci as the main causative pathogens. Other rarer microbes, including Streptococcus agalactiae, Pseudomonas aeruginosa, Coxiella burnetti and Brucella, have also emerged or re-emerged. Valvular IE caused by these pathogens, especially Staphylococcus aureus, is often associated with a severe clinical course, leading to high rates of morbidity and mortality. Therefore, prompt diagnosis and management are crucial. Due to the high virulence of these pathogens and an increased incidence of antimicrobial resistances, surgical valve repair or replacement is often necessary. As the epidemiology and etiology of valvular IE continue to evolve, the diagnostic methods and therapies need to be progressively advanced to ensure satisfactory clinical outcomes.
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Affiliation(s)
- Maximilian Reisinger
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Mateusz Kachel
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
- Center for Cardiovascular Research and Development, American Heart of Poland, 40-028 Katowice, Poland
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
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Petkovic A, Menkovic N, Petrovic O, Bilbija I, Nisevic M, Radovanovic NN, Stanisavljevic D, Putnik S, Maksimovic R, Ivanovic B. Imaging in Infective Endocarditis-Current Opinions and Trends in Cardiac Computed Tomography. Diagnostics (Basel) 2024; 14:1355. [PMID: 39001245 PMCID: PMC11241025 DOI: 10.3390/diagnostics14131355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of cardiac computed tomography (CCT) in the diagnostic algorithm of IE are rising, which indicates its importance in detection of IE-related lesion along with the exclusion of coronary artery disease. The latest 2023 European Society of Cardiology Guidelines in the management of IE classified CCT as class of recommendation I and level of evidence B in detection of both valvular and paravalvular lesions in native and prosthetic valve endocarditis. This review article provides a comprehensive and contemporary review of the role of CCT in the diagnosis of IE, the optimization of acquisition protocols, the morphology characteristics of IE-related lesions, the published data of the diagnostic performance of CCT in comparison to echocardiography as the state-of-art method, as well as the limitations and future possibilities.
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Affiliation(s)
- Ana Petkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nemanja Menkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
| | - Ilija Bilbija
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Nisevic
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nikola N. Radovanovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branislava Ivanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
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Becker JB, Moisés VA, Guerra-Martín MD, Barbosa DA. Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis. Infect Prev Pract 2024; 6:100343. [PMID: 38371885 PMCID: PMC10874726 DOI: 10.1016/j.infpip.2024.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background The prevalence of healthcare-associated infective endocarditis in Brazil is poorly known. Aim To analyze the epidemiological, clinical and microbiological characteristics, and the prognosis of healthcare-associated infective endocarditis (HAIE) compared with community-acquired infective endocarditis (CIE) and identify the associated factors with hospital mortality. Method A historical cohort study was carried out, with a data collection period from January 2009 to December 2019 at the Federal University of São Paulo. Data were collected from medical records of patients with infective endocarditis (IE) hospitalized during the study period. Patients were classified into three groups: CIE, non-nosocomial HAIE (NN-HAIE) and nosocomial HAIE (NHAIE). Results A total of 204 patients with IE were included; of these, 127 (62.3%) were cases of HAIE, of which 83 (40.7%) were NN-HAIE and 44 (21.6%) were NHAIE. Staphylococcus spp. Were the main causative agents, especially in HAIE groups (P<0.001). Streptococcus spp. were more prevalent in the CIE group (P<0.001). In-hospital mortality was 44.6%, with no differences between groups. Independent risk factors for in-hospital mortality were age ≥ 60 years (odds ratio (OR): 6.742), septic shock (OR 5.264), stroke (OR 3.576), heart failure (OR 7.296), and Intensive Care Unit admission (OR 7.768). Conclusion HAIE accounted for most cases in this cohort, with a higher prevalence of non-nosocomial infections. Staphylococcus spp. were the main causative agents. Hospital mortality was high, 44.6%, with no difference between groups.
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Affiliation(s)
| | | | | | - Dulce Aparecida Barbosa
- Federal University of São Paulo, Nursing School, Clinical and Surgical Nursing Department, Brazil
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Becher PM, Goßling A, Fluschnik N, Schrage B, Seiffert M, Schofer N, Blankenberg S, Kirchhof P, Westermann D, Kalbacher D. Temporal trends in incidence, patient characteristics, microbiology and in-hospital mortality in patients with infective endocarditis: a contemporary analysis of 86,469 cases between 2007 and 2019. Clin Res Cardiol 2024; 113:205-215. [PMID: 36094574 PMCID: PMC10850016 DOI: 10.1007/s00392-022-02100-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by high morbidity and mortality rates, despite recent improvements in diagnostics and treatment. We aimed to investigate incidence, clinical characteristics, and in-hospital mortality in a large-scale nationwide cohort. METHODS Using data from the German Federal Bureau of Statistics, all IE cases in Germany between 2007 and 2019 were analyzed. Logistic regression models were fitted to assess associations between clinical factors and in-hospital mortality. RESULTS In total, 86,469 patients were hospitalized with IE between 2007 and 2019. The mean age was 66.5 ± 14.7 years and 31.8% (n = 27,534/86,469) were female. Cardiovascular (CV) comorbidities were common. The incidence of IE in the German population increased from 6.3/100,000 to 10.2/100,000 between 2007 and 2019. Staphylococcus (n = 17,673/86,469; 20.4%) and streptococcus (n = 17,618/86,469; 20.4%) were the most common IE-causing bacteria. The prevalence of staphylococcus gradually increased over time, whereas blood culture-negative IE (BCNIE) cases decreased. In-hospital mortality in patients with IE was 14.9%. Compared to BCNIE, staphylococcus and Gram-negative pathogens were associated with higher in-hospital mortality. In multivariable analysis, factors associated with higher likelihood of in-hospital mortality were advanced age, female sex, CV comorbidities (e.g., heart failure, COPD, diabetes, stroke), need for dialysis or invasive ventilation, and sepsis. CONCLUSIONS In this contemporary cohort, incidence of IE increased over time and in-hospital mortality remained high (~ 15%). While staphylococcus and streptococcus were the predominant microorganisms, bacteremia with staphylococcus and Gram-negative pathogens were associated with higher likelihood of in-hospital mortality. Our results highlight the need for new preventive strategies and interventions in patients with IE.
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Affiliation(s)
- Peter Moritz Becher
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology I, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
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Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
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Khalil MH, Wong A, Shih T, Garg A, Elias Y. Endovascular aspiration of native tricuspid valve vegetation using INARI catheter in a patient with methicillin-sensitive Staphylococcus aureus endocarditis. Radiol Case Rep 2024; 19:387-392. [PMID: 38033676 PMCID: PMC10682532 DOI: 10.1016/j.radcr.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023] Open
Abstract
A middle-aged man presented to the hospital with chief complaint of worsening chest pain and shortness of breath. He was found to have methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, acute hypoxic respiratory failure secondary to MSSA pneumonia and septic emboli. The patient underwent a transesophageal echocardiogram which revealed a large, mobile tricuspid valve vegetation secondary to endocarditis. The patient was initially managed conservatively with intravenous antibiotics and supportive measures. However, his respiratory status worsened due to persistence of a large tricuspid valve vegetation which progressed to bilateral septic pulmonary emboli with peripheral cavitary lesions identified on follow-up CT of the chest. In order to debulk the large tricuspid vegetation, the patient successfully underwent endovascular mechanical aspiration of tricuspid valve vegetation utilizing the 20-Fr INARI curved Flowtriever (INARI Medical, CA) catheter. This case highlights a new, minimally invasive technique and device employed in treating native valve vegetations caused by endocarditis as an alternative approach to surgery.
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Affiliation(s)
| | - Anthony Wong
- Carle Illinois College of Medicine, 807 S Wright St, Champaign, IL 61820, USA
| | - Timothy Shih
- Carle Foundation Hospital, 611 W Park St, Urbana, IL 61801, USA
| | - Anuj Garg
- Carle Foundation Hospital, 611 W Park St, Urbana, IL 61801, USA
| | - Youssef Elias
- Carle Foundation Hospital, 611 W Park St, Urbana, IL 61801, USA
- Carle Illinois College of Medicine, 807 S Wright St, Champaign, IL 61820, USA
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Whitehead T, Moore A, Agarwal A, Appleby J. Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use. BMJ Case Rep 2023; 16:e250098. [PMID: 37914175 PMCID: PMC10626919 DOI: 10.1136/bcr-2022-250098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, and Enterococcus faecalis on blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.
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Affiliation(s)
| | - Amber Moore
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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10
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Galeone A, Gardellini J, Di Nicola V, Perrone F, Boschetti V, Di Gaetano R, Onorati F, Luciani GB. Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1060. [PMID: 37374264 DOI: 10.3390/medicina59061060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient's age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient's age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis.
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Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Jacopo Gardellini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Venanzio Di Nicola
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Fabiola Perrone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Vincenzo Boschetti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Renato Di Gaetano
- Department of Cardiology, Azienda Sanitaria dell'Alto Adige, 39100 Bolzano, Italy
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
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Hammond-Haley M, Hartley A, Al-Khayatt BM, Delago AJ, Ghajar A, Ojha U, Marshall DC, Salciccioli JD, Prendergast BD, Shalhoub J. Trends in the incidence and mortality of infective endocarditis in high-income countries between 1990 and 2019. Int J Cardiol 2023; 371:441-451. [PMID: 36179905 DOI: 10.1016/j.ijcard.2022.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infective endocarditis (IE) remains a life-threatening disease with high morbidity and mortality. OBJECTIVES To describe temporal trends in IE incidence, mortality and survival over the last 30 years. METHODS Nineteen high-income countries (the 'EU 15+') were included. Age-standardised and sex-stratified incidence rates (ASIRs) and mortality rates (ASMRs) for IE were extracted from the Global Burden of Disease (GBD) database between 1990 and 2019, and mortality to incidence ratios (ASMIRs) were calculated. Trends were analysed using Joinpoint regression analysis. RESULTS ASIRs were higher in males than females and increased in both sexes in all countries between 1990 and 2019. A recent steep rise in ASIRs was noted in several countries including the UK, the USA and Germany. ASMRs increased for both sexes in all countries except Finland and Austria. The largest increase in ASMR was observed in females in Italy (+246%). ASMIRs were generally higher in females compared to males, with large increases in ASMIRs (indicating worsening survival) at the end of the 20th century, but more recent stabilisation or decline across the study cohort. CONCLUSIONS While the incidence and mortality of IE have increased over the last 30 years, recent data suggest that these trends have plateaued or reversed in most countries studied. However, a recent surge in incidence in several countries (including the USA and UK) is of concern, while unfavourable outcomes in females also merit attention. More encouragingly, this analysis provides the first indication of improving IE survival at population level, supporting recent advances in diagnosis and treatment.
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Affiliation(s)
- Matthew Hammond-Haley
- King's College Hospital NHS Foundation Trust, London, UK; Medical Data Research Collaborative, UK.
| | - Adam Hartley
- Medical Data Research Collaborative, UK; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Becker M Al-Khayatt
- Medical Data Research Collaborative, UK; Department of Cardiology, Croydon University Hospital, 530 London Road, London CR7 7YE, UK
| | - Augustin J Delago
- Medical Data Research Collaborative, UK; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Alireza Ghajar
- Medical Data Research Collaborative, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Utkarsh Ojha
- Medical Data Research Collaborative, UK; Royal Brompton & Harefield Hospitals, UB9 6JH, UK
| | - Dominic C Marshall
- Medical Data Research Collaborative, UK; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Joseph Shalhoub
- Medical Data Research Collaborative, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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13
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Popa-Fotea NM, Scafa-Udriste A, Iulia G, Scarlatescu AI, Oprescu N, Mihai C, Micheu MM. Increasing clinical impact and microbiological difficulties in diagnosing coagulase-negative staphylococci in infective endocarditis - a review starting from a series of cases. Curr Med Res Opin 2022; 38:2077-2083. [PMID: 36073863 DOI: 10.1080/03007995.2022.2122673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Coagulase-negative staphylococci (CoNS) are an emergent aetiology of infective endocarditis (IE) on native valves in previously healthy individuals, its presence is associated with prosthetic valves or with other cardiac implants. The identification of CoNS in cultures was customarily seen as contamination, but more recent epidemiological studies have revealed an increasing number of causative and virulent new CoNS species. Starting from two clinical cases of community-acquired CoNS IE on native valves, the review debates the difficulties in identifying CoNS as the causal pathogens, comprising differentiation of contamination from infection in IE, alongside the challenges raised by antibiotic resistance. Even if the risk of CoNS IE is more increased in subjects with prosthetic materials or other foreign devices and immunodeficiencies, native valve infections with these staphylococci are increasing and should be considered important pathogens in IE. Despite the lack of sensitive and specific tools to correctly differentiate contamination from infection in CoNS endocarditis, a comprehensive evaluation with clinical and paraclinical data accurately succeeds in establishing the diagnosis. The genetic profile of CoNS predisposes to antibiotic multi-resistance, making the treatment of IE challenging; the rapid identification of antibiotic susceptibility is essential to prescribe the appropriate therapy and improve outcomes.
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Affiliation(s)
- Nicoleta-Monica Popa-Fotea
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Emergency Clinical Hospital, Bucharest, Romania
| | - Alexandru Scafa-Udriste
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Emergency Clinical Hospital, Bucharest, Romania
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14
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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15
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Zhang X, Jin F, Lu Y, Ni F, Xu Y, Xia W. Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study. Infect Drug Resist 2022; 15:3179-3189. [PMID: 35754785 PMCID: PMC9215907 DOI: 10.2147/idr.s362601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups. Methods A total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50–65 y, and > 65 y. Results The mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). Streptococcus was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection. Conclusion CHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. Streptococcus is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection showed poorer in-hospital outcomes.
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Affiliation(s)
- Xiaohui Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fei Jin
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yanfei Lu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fang Ni
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yuqiao Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Wenying Xia
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
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16
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Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
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Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
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17
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Radjabaly Mandjee A, Filippetti L, Goehringer F, Duval X, Botelho-Nevers E, Tribouilloy C, Huguet R, Chirouze C, Erpelding ML, Hoen B, Selton-Suty C, Nelly A, Lefèvre B. Characteristics of patients with infective endocarditis and no underlying cardiac conditions. Infect Dis (Lond) 2022; 54:656-665. [PMID: 35604065 DOI: 10.1080/23744235.2022.2078404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) typically occurs in patients with underlying cardiac conditions (UCC). Little is known about IE in patients without UCC. We aimed to describe the clinical, microbiological and imaging characteristics, management, and in-hospital mortality of IE patients without UCC. METHODS We analysed the data of patients with definite IE included in an observatory between 1st January 2009 and 31st December 2019. We described patients without UCC compared to those with UCC. RESULTS Of 1502 IE patients, 475 (31.6%) had no UCC. They were younger (median 64.0 [19.0-101.0] vs. 70.0 [18.0-104.0] years, p < .001), more often on chronic haemodialysis (5.5% vs. 2.7%, p = .008), and had more often malignancy (22.5% vs. 17.3%, p = .017), immune deficiency (10.3% vs. 6.4%, p = .008), and an indwelling central venous line (14.5% vs. 7.0%, p < .001). They more often developed cerebral complications (34.7% vs. 27.5%, p = .004) and extracerebral embolism (48.6% vs. 36.1%, p < .001). Causative microorganisms were less often coagulase negative staphylococci (5.9% vs. 10.8%, p = .002) or enterococci (10.3% vs. 15.0%, p = .014) and more often group D streptococci (14.1% vs. 10.0%, p = 0.020). Vegetations were more common (92.8% vs. 77.0%, p < 0.001) and larger (14.0 [1.0-87.0], vs. 12.0 [0.5-60.0] mm, p = 0.002). They had more valve perforation or valve regurgitation (67.4% vs. 53.0%, p < 0.001) and underwent valve surgery more often (53.5% vs. 36.3%, p < 0.001). In-hospital mortality did not significantly differ between groups. CONCLUSION Patients with IE and no UCC were younger than those with UCC, had specific comorbidities and portals of entry, and a more severe disease course.
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Affiliation(s)
| | | | | | - Xavier Duval
- AP-HP, hôpital Bichat, centre d'investigations cliniques, IAME 1137, Inserm 1425, Paris, France.,Université Paris-Diderot, Inserm UMR1137, Paris, France
| | - Elisabeth Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France.,EA 7517, Jules Verne University of Picardie, Amiens, France
| | | | - Catherine Chirouze
- UMR 6249 CNRS-UFC Chrono-environnement, Service de Maladies Infectieuses, CHRU Besançon, Besançon, France
| | | | - Bruno Hoen
- Université de Lorraine, CHRU-Nancy, Infectious and Tropical Diseases, Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
| | | | - Agrinier Nelly
- CHRU-Nancy, INSERM, CIC-EC, Epidémiologie clinique, Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
| | - Benjamin Lefèvre
- Université de Lorraine, CHRU-Nancy, Infectious and Tropical Diseases, Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
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18
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Rutherford SJ, Glenny AM, Roberts G, Hooper L, Worthington HV. Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures. Cochrane Database Syst Rev 2022; 5:CD003813. [PMID: 35536541 PMCID: PMC9088886 DOI: 10.1002/14651858.cd003813.pub5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infective endocarditis is a severe infection arising in the lining of the chambers of the heart. It can be caused by fungi, but most often is caused by bacteria. Many dental procedures cause bacteraemia, which could lead to bacterial endocarditis in a small proportion of people. The incidence of bacterial endocarditis is low, but it has a high mortality rate. Guidelines in many countries have recommended that antibiotics be administered to people at high risk of endocarditis prior to invasive dental procedures. However, guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales states that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. This is an update of a review that we first conducted in 2004 and last updated in 2013. OBJECTIVES Primary objective To determine whether prophylactic antibiotic administration, compared to no antibiotic administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis, influences mortality, serious illness or the incidence of endocarditis. Secondary objectives To determine whether the effect of dental antibiotic prophylaxis differs in people with different cardiac conditions predisposing them to increased risk of endocarditis, and in people undergoing different high risk dental procedures. Harms Had we foundno evidence from randomised controlled trials or cohort studies on whether prophylactic antibiotics affected mortality or serious illness, and we had found evidence from these or case-control studies suggesting that prophylaxis with antibiotics reduced the incidence of endocarditis, then we would also have assessed whether the harms of prophylaxis with single antibiotic doses, such as with penicillin (amoxicillin 2 g or 3 g) before invasive dental procedures, compared with no antibiotic or placebo, equalled the benefits in prevention of endocarditis in people at high risk of this disease. SEARCH METHODS An information specialist searched four bibliographic databases up to 10 May 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: Due to the low incidence of bacterial endocarditis, we anticipated that few if any trials would be located. For this reason, we included cohort and case-control studies with suitably matched control or comparison groups. The intervention was antibiotic prophylaxis, compared to no antibiotic prophylaxis or placebo, before a dental procedure in people with an increased risk of bacterial endocarditis. Cohort studies would need to follow at-risk individuals and assess outcomes following any invasive dental procedures, grouping participants according to whether or not they had received prophylaxis. Case-control studies would need to match people who had developed endocarditis after undergoing an invasive dental procedure (and who were known to be at increased risk before undergoing the procedure) with those at similar risk who had not developed endocarditis. Our outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse effects of the antibiotics; and the cost of antibiotic provision compared to that of caring for patients who developed endocarditis. DATA COLLECTION AND ANALYSIS Two review authors independently screened search records, selected studies for inclusion, assessed the risk of bias in the included study and extracted data from the included study. As an author team, we judged the certainty of the evidence identified for the main comparison and key outcomes using GRADE criteria. We presented the main results in a summary of findings table. MAIN RESULTS Our new search did not find any new studies for inclusion since the last version of the review in 2013. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included in the previous versions of the review, but one case-control study met the inclusion criteria. The trial authors collected information on 48 people who had contracted bacterial endocarditis over a specific two-year period and had undergone a medical or dental procedure with an indication for prophylaxis within the past 180 days. These people were matched to a similar group of people who had not contracted bacterial endocarditis. All study participants had undergone an invasive medical or dental procedure. The two groups were compared to establish whether those who had received preventive antibiotics (penicillin) were less likely to have developed endocarditis. The authors found no significant effect of penicillin prophylaxis on the incidence of endocarditis. No data on other outcomes were reported. The level of certainty we have about the evidence is very low. AUTHORS' CONCLUSIONS There remains no clear evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in at-risk people who are about to undergo an invasive dental procedure. We cannot determine whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically, practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
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Affiliation(s)
- Samantha J Rutherford
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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19
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Diniz Freitas M, Alvarez Alvarez M, Vasallo Vidal FJ, Limeres Posse J, Diz Dios P, Fernandez Feijoo J. Oral amoxicillin/clavulanate for the prevention of bacteraemia following dental extractions. Oral Dis 2022. [PMID: 35467064 DOI: 10.1111/odi.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- M Diniz Freitas
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - M Alvarez Alvarez
- Department of Microbiology, Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-Universidade de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Sergas, Vigo, Spain
| | - F J Vasallo Vidal
- Department of Microbiology, Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-Universidade de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Sergas, Vigo, Spain
| | - J Limeres Posse
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - P Diz Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - J Fernandez Feijoo
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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20
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6564539. [DOI: 10.1093/ejcts/ezac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/16/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022] Open
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21
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Yang X, Chen H, Zhang D, Shen L, An G, Zhao S. Global magnitude and temporal trend of infective endocarditis, 1990-2019: results from the Global Burden of Disease Study. Eur J Prev Cardiol 2021; 29:1277-1286. [PMID: 34739047 DOI: 10.1093/eurjpc/zwab184] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/01/2021] [Indexed: 12/17/2022]
Abstract
AIMS To estimate the spatiotemporal patterns in infective endocarditis (IE) burden along with its attributable risk factors at the national, regional, and global levels, which is essential to optimize the targeted prevention, clinical practice, and research. METHODS AND RESULTS Based on all available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of IE in 204 countries and regions from 1990 to 2019 were reconstructed by Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We depicted the epidemiological characteristics of IE in detail by gender, region, and age. Globally, 1 090 527 incident cases, 66 322 deaths, and 1 723 594 DALYs of IE were estimated in 2019. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) increased from 9.91 and 0.73 to 13.80 and 0.87 per 100 000 person-years over the past 30 years, respectively. ASIR were consistently more pronounced in higher socio-demographic index (SDI) regions. The leading ASMR in 2019 appeared in the High SDI region, with the largest increase in the past three decades. The age-specific burden rate of IE among people over 25 years old usually increased with age, and the annual increasing trend was more obvious for people over 60 years of age, especially in higher SDI regions. CONCLUSION The incidence and mortality of IE have continued to rise in the past 30 years, especially in higher SDI regions. The patient population was gradually shifting from the young to the elderly.
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Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Dandan Zhang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Lin Shen
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Guipeng An
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Department of Cardiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Shaohua Zhao
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
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22
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Talha KM, Dayer MJ, Thornhill MH, Tariq W, Arshad V, Tleyjeh IM, Bailey KR, Palraj R, Anavekar NS, Rizwan Sohail M, DeSimone DC, Baddour LM. Temporal Trends of Infective Endocarditis in North America From 2000 to 2017-A Systematic Review. Open Forum Infect Dis 2021; 8:ofab479. [PMID: 35224128 PMCID: PMC8864733 DOI: 10.1093/ofid/ofab479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%. Conclusions The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Epidemiology, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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23
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Talha KM, Baddour LM, Thornhill MH, Arshad V, Tariq W, Tleyjeh IM, Scott CG, Hyun MC, Bailey KR, Anavekar NS, Palraj R, Sohail MR, DeSimone DC, Dayer MJ. Escalating incidence of infective endocarditis in Europe in the 21st century. Open Heart 2021; 8:e001846. [PMID: 34670832 PMCID: PMC8529987 DOI: 10.1136/openhrt-2021-001846] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe. METHODS A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence. RESULTS Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%. CONCLUSION Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase. TRIAL REGISTERATION NUMBER CRD42020191196.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin H Thornhill
- School of Clinical Dentistry, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Meredith C Hyun
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Dayer
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
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24
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Staedt H, Heimes D, Kämmerer PW. Antibiotika im Rahmen der Endokarditisprophylaxe – Risiko und Nutzen. WISSEN KOMPAKT : FORTBILDUNG FUR ZAHNARZTE 2021; 15:113-122. [PMID: 34426751 PMCID: PMC8374404 DOI: 10.1007/s11838-021-00134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Für die Effektivität und Effizienz einer antibiotischen Prophylaxe vor zahnmedizinischen Eingriffen zum Schutz vor einer infektiösen Endokarditis liegt nur eine geringe Evidenz vor, die keine Rechtfertigung zur generalisierten Therapie von Patienten mit einem erhöhten Endokarditisrisiko darstellt. Aktuelle Leitlinien empfehlen daher, Antibiotika im Rahmen der Endokarditisprophylaxe auf Patienten zu beschränken, die zum einen ein hohes Risiko für die Entstehung einer infektiösen Endokarditis aufweisen und die sich zum anderen zahnärztlichen Eingriffen mit höchstem Endokarditisrisiko unterziehen. Einen hohen Stellwert besitzen allerdings auch Mund- und Hauthygienemaßnahmen, die nicht nur auf Risikopatienten, sondern auch auf die Allgemeinbevölkerung angewendet werden sollten, da die Inzidenz der infektiösen Endokarditis bei Patienten ohne anamnestisch bekannte Herzerkrankung zunehmend ansteigt.
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Affiliation(s)
- H. Staedt
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
| | - D. Heimes
- Universitätsmedizin Mainz, Mainz, Deutschland
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie – plastische Operationen, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55131 Mainz, Deutschland
| | - P. W. Kämmerer
- Universitätsmedizin Mainz, Mainz, Deutschland
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie – plastische Operationen, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55131 Mainz, Deutschland
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25
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Tutarel O. Endocarditis prophylaxis in adult congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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