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Heller A, Zerdzitzki M, Hegner P, Song Z, Schach C, Hitzenbichler F, Kozakov K, Thiedemann C, Provaznik Z, Schmid C, Li J. Clinical Characterization of Pathogens, Risk Factors and Quality of Life in an Observational Study of Native vs. Prosthetic Aortic Valve Endocarditis Surgery. Life (Basel) 2024; 14:1029. [PMID: 39202771 PMCID: PMC11355113 DOI: 10.3390/life14081029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Background: Native (NVE) and prosthetic (PVE) aortic valve endocarditis (AVE) remain a surgical challenge with an ongoing trend towards more complex surgical procedures. Methods: First-time NVE was compared with PVE, focusing on pathogens, risk factors, perioperative course, postoperative follow-up, including recurrent infection, as well as health-related quality of life (HRQOL). Results: From 2007 to 2022, surgical intervention for AVE was necessary in 231 patients with 233 episodes of infective aortic valve endocarditis, i.e., there were only two cases of reinfection (NVE group). The study group consisted of 130 cases with NVE and 103 with PVE. Overall, a median of 40.3% of survivors were in NYHA class I or II. In-hospital mortality was higher in the PVE group with 13.3%. The most common pathogen was Staphylococcus aureus, with 24.9% across both groups. EuroSCORE II was higher in the PVE group (19.0 ± 14.3% total, NVE 11.1 ± 8.1%, PVE 27.8 ± 14.6%; p < 0.05), reflecting an older, more co-morbid patient cohort. Abscess formation was also more common in the PVE group, while vegetations were more common in the NVE group. The 5-year and 10-year survival rates did not differ significantly between NVE and PVE and were 74.4% and 52.2% for the NVE group, respectively, and 67.4% and 52.9% for the PVE group, respectively. The HRQOL as assessed by the Minnesota Living with HF Questionnaire (MLHFQ) demonstrated no significant difference between both groups. Conclusions: Long-term survival and QoL after surgical treatment of infective aortic valve endocarditis are excellent and do not depend on the type of replacement.
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Affiliation(s)
- Anton Heller
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Matthäus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
- Department of Vascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Philipp Hegner
- Department of Internal Medicine II—Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (P.H.); (C.S.)
| | - Zhiyang Song
- Institute of Mathematics, Ludwig-Maximilian University Munich, 80539 Munich, Germany
| | - Christian Schach
- Department of Internal Medicine II—Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (P.H.); (C.S.)
| | - Florian Hitzenbichler
- Department of Infectiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Kostiantyn Kozakov
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Claudius Thiedemann
- Department of Orthopedics and Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Jing Li
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
- Department of Occupational Medicine, University Medical Center Regensburg, 93053 Regensburg, Germany
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Pedersen EC, Lerche CJ, Schwartz FA, Ciofu O, Azeredo J, Thomsen K, Moser C. Bacteriophage therapy and infective endocarditis - is it realistic? APMIS 2024. [PMID: 39007242 DOI: 10.1111/apm.13455] [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: 02/19/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Infective endocarditis (IE) is a severe infection of the inner heart. Even with current standard treatment, the mean in-hospital mortality is as high as 15-20%, and 1-year mortality is up to 40% for left-sided IE. Importantly, IE mortality rates have not changed substantially over the past 30 years, and the incidence of IE is rising. The treatment is challenging due to the bacterial biofilm mode of growth inside the heart valve vegetations, resulting in antibiotic tolerance. Achieving sufficient antibiotic anti-biofilm concentrations in the biofilms of the heart valve vegetations is problematic, even with high-dose and long-term antibiotic therapy. The increasing prevalence of IE caused by antibiotic-resistant bacteria adds to the challenge. Therefore, adjunctive antibiotic-potentiating drug candidates and strategies are increasingly being investigated. Bacteriophage therapy is a reemerging antibacterial treatment strategy for difficult-to-treat infections, mainly biofilm-associated and caused by multidrug-resistant bacteria. However, significant knowledge gaps regarding the safety and efficacy of phage therapy impede more widespread implementation in clinical practice. Hopefully, future preclinical and clinical testing will reveal whether it is a viable treatment. The objective of the present review is to assess whether bacteriophage therapy is a realistic treatment for IE.
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Affiliation(s)
- Emilie C Pedersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Johann Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Oana Ciofu
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
| | - Joana Azeredo
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
- Department of Biological Engineering, University of Minho, Braga, Portugal
| | - Kim Thomsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
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Pham S, Heigle B, Gibbs C, Gebrehiwot WG, Pannu P. Complications of Infective Endocarditis: A Case Report of Intracerebral Hemorrhage Exacerbated by Enoxaparin. Cureus 2024; 16:e61235. [PMID: 38939272 PMCID: PMC11210433 DOI: 10.7759/cureus.61235] [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] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Infective endocarditis (IE) can cause life-threatening intracerebral hemorrhage via the transformation of an embolic ischemic stroke. Navigating anticoagulant therapy for IE patients is challenging due to this risk. Hospitalized patients often receive anticoagulation to minimize venous thromboembolism (VTE). Those at higher VTE risk may require full anticoagulation, particularly if there is an initial suspicion of a blood clot. A timely IE diagnosis is crucial but is often delayed during inpatient stays, with the patient potentially already on anticoagulants for other conditions. Our case discusses a hemorrhagic stroke in a patient with IE while receiving therapeutic enoxaparin. Clinical signs and symptoms, echocardiographic findings, laboratory workup and microbiological data, and possibly other imaging techniques such as cerebral magnetic resonance imaging (MRI) need to be employed in a timely manner in determining endocarditis as a cause of stroke.
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Affiliation(s)
- Steven Pham
- Internal Medicine, White County Medical Center, Searcy, USA
| | | | - Connor Gibbs
- Emergency Medicine, White County Medical Center, Searcy, USA
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Al-Makhamreh HK, Al Bakri FG, Shaf'ei M, Mokheemer E, Alqudah S, Nofal A, Matarwah H, Altarawneh TB, Toubasi AA. Epidemiology, microbiology, and outcomes of infective endocarditis in a tertiary center in Jordan. Wien Med Wochenschr 2024; 174:126-132. [PMID: 36781611 PMCID: PMC9924832 DOI: 10.1007/s10354-023-01004-w] [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: 06/20/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a relatively rare but serious and life-threatening disease with substantial mortality and morbidity despite progress in diagnostic and treatment techniques. The aim of this study is to investigate the epidemiology, clinical characteristics, microbiological profile, and outcomes of IE patients in a tertiary care facility in Jordan, the Jordan University Hospital (JUH). METHODS This is a retrospective case series study which was conducted at JUH. A total of 23 patients with either definite or possible IE according to the Modified Duke Criteria were included in the study. Medical records were reviewed, and relevant information was collected. Descriptive data analysis was performed. RESULTS Our study identified a total of 23 patients with infective endocarditis; 65.2% were males, with a mean age of 40.4 years. The majority of patients had an underlying cardiac disease (60.9%), with the most common being congenital heart diseases (17.4%). The most commonly affected valves were the left-side heart valves, with the mitral valve (52.2%) being the most common followed by the aortic valve (34.8%). The most common organism detected in blood culture was Streptococcus viridans (21.7%) followed by methicillin-resistant Staphylococcus aureus. The most common complications among the patients were heart failure and septic shock, and the mortality rate among the patients was 13%. CONCLUSION In patients with endocarditis, Streptococcus viridans is the most common culture-positive bacteria at JUH. One third of our patients needed surgical intervention and the mortality rate was 13%.
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Affiliation(s)
- Hanna K Al-Makhamreh
- Department of Cardiology and Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Faris G Al Bakri
- Department of Infectious Diseases and Internal Medicine, Jordan University Hospital, Amman, Jordan
- Infectious Disease and Vaccine Center, The University of Jordan, Amman, Jordan
| | - Moayad Shaf'ei
- School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | | | - Shahed Alqudah
- School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | - Amani Nofal
- School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | - Hanna Matarwah
- School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | | | - Ahmad A Toubasi
- School of Medicine, The University of Jordan, 11942, Amman, Jordan.
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Lee TTL, Chan SCL, Chou OHI, Lee S, Chan JSK, Liu T, Chang C, Wong WT, Lip GYH, Cheung BMY, Wai AKC, Tse G. Initiation of warfarin is associated with decreased mortality in patients with infective endocarditis: A population-based cohort study. Thromb Res 2024; 233:1-9. [PMID: 37979284 DOI: 10.1016/j.thromres.2023.11.009] [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: 07/07/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
IMPORTANCE The use of warfarin to prevent thromboembolism in patients with infective endocarditis (IE) remains controversial due to potentially increased bleeding risks. DESIGN Population-based retrospective cohort study. PARTICIPANTS Patients aged 18 or older and diagnosed with IE in Hong Kong between January 1st, 1997 and August 31st, 2020 were included. Patients with use of any anticoagulant 30 days before IE diagnosis were excluded. Patients initiated on warfarin within 14 days of IE diagnosis and patients without warfarin use were matched for baseline characteristics using 1:1 propensity score matching. EXPOSURE Warfarin use within 14 days of IE diagnosis. MAIN OUTCOMES AND MEASURES Patients were followed up to 90 days for the outcomes of ischemic stroke, all-cause mortality, intracranial hemorrhage, and gastrointestinal bleeding. Cox regression was used to determine hazard ratios (HRs) [95 % confidence intervals (CIs)] between treatment groups. Fine-Gray competing risk regression with all-cause mortality as the competing event was performed as a sensitivity analysis. In addition to 90-day analyses, landmark analyses were performed at 30 days of follow-up. RESULTS The matched cohort consisted of 675 warfarin users (57.0 % male, age 59 ± 16 years) and 675 warfarin non-users (53.5 % male, age 61 ± 19 years). Warfarin users had a 50 % decreased 90-day risk in all-cause mortality (HR:0.50 [0.39-0.65]), without significantly different 90-day risks of ischemic stroke (HR:1.04 [0.70-1.53]), intracranial hemorrhage (HR:1.25 [0.77-2.04]), and gastrointestinal bleeding (HR:1.04 [0.60-1.78]). Thirty-day landmark analysis showed similar results. Competing risk regression showed significantly higher 30-day cumulative incidence of intracranial hemorrhage in warfarin users (sub-HR:3.34 [1.34-8.31]), but not at 90-day (sub-HR:1.63 [0.95-2.81]). Results from Fine-Gray regression were otherwise congruent with those from Cox regression. CONCLUSIONS AND RELEVANCE Warfarin initiated within 14 days of IE diagnosis was associated with significantly decreased risks of mortality but higher risks of intracranial hemorrhage, with similar risks of ischemic stroke and gastrointestinal bleeding, compared with non-use of warfarin with 14 days of IE diagnosis. KEY POINTS Question: Is warfarin, initiated within 14 days of a diagnosis of infective endocarditis (IE), efficacious and safe? FINDINGS In this propensity score-matched, population-based, prospective cohort study from Hong Kong, warfarin use within 14 days of IE diagnosis was associated with a 50 % decrease in the risk of all-cause mortality, albeit with higher risk of intracranial hemorrhage, and without significant differences in the risk of ischaemic stroke and gastrointestinal bleeding. Meaning: In patients with IE, warfarin use within 14 days of diagnosis may have mortality benefits, despite increased risks of intracranial hemorrhage.
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Affiliation(s)
- Teddy Tai Loy Lee
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China; Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Sunny Ching Long Chan
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Oscar Hou In Chou
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Division of Clinical Pharmacology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Sharen Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Jeffrey Shi Kai Chan
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Tong Liu
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Carlin Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital and The University of Hong Kong, Hong Kong, China.
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Abraham Ka-Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
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6
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Zheng Z, Tu X, Jiang C, Liu F, Fan C. First case report of Candida guilliermondii native left-sided valve endocarditis. Front Cardiovasc Med 2023; 10:1273255. [PMID: 38111888 PMCID: PMC10725942 DOI: 10.3389/fcvm.2023.1273255] [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: 08/21/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Endocarditis, a life-threatening inflammation of the endocardium, is incited by bacteria, fungi, or other pathogenic microorganisms. Fungal endocarditis closely mirrors bacterial endocarditis in clinical signs and symptoms, leading to potential misdiagnoses. Here, we unveil the inaugural confirmed instance of native left-sided valve endocarditis attributed to Candida guilliermondii. Diagnosis was substantiated through valvular biopsies, blood and vegetative cultures. Treatment encompassed surgical excision of vegetations along with a six-week regimen of fluconazole administration (12 mg/kg/day), followed by 4 years of meticulous monitoring, resulting in sustained patient recovery.
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Affiliation(s)
- Zilong Zheng
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaokang Tu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chuanhao Jiang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Dvalishvili M, Ahmad S, Qavi AH, Ardhanari S. Unraveling a rare presentation of bivalvular infective endocarditis using POCUS. Clin Case Rep 2023; 11:e8260. [PMID: 38033689 PMCID: PMC10683036 DOI: 10.1002/ccr3.8260] [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: 07/18/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Infective endocarditis (IE) is rare, and involvement of two valves is rarer yet. We present a case of a 22-year-old male with liver failure who was found to have bivalvular IE. This case sheds light on the association between bivalvular IE and seemingly unrelated symptoms, emphasizing the need for early recognition.
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Affiliation(s)
- Mariam Dvalishvili
- Department of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Soban Ahmad
- Department of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Division of CardiologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Ahmed Hassaan Qavi
- Division of CardiologyEast Carolina Heart InstituteGreenvilleNorth CarolinaUSA
| | - Sivakumar Ardhanari
- Division of CardiologyEast Carolina Heart InstituteGreenvilleNorth CarolinaUSA
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Ozeri DJ, Peretz S, Brif B, Gueta I, Oppenheim A. The Differences in Clinical Manifestations and Prognosis of Infective Endocarditis Patients With Positive Serology to Antineutrophilic Cytoplasmic Antibody Compared to Negative Serology. Cureus 2023; 15:e51211. [PMID: 38283493 PMCID: PMC10819091 DOI: 10.7759/cureus.51211] [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] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Previous studies have established a relationship between bacterial proteins and autoimmune diseases through several mechanisms. Infective endocarditis is known for its immunological phenomena, and the presence of antineutrophil cytoplasmic antibodies (ANCA) antibodies has been previously demonstrated in several infectious diseases. This retrospective, comparative, and descriptive study examined the relationship between infective endocarditis and the presence of ANCA antibodies. Ninety infective endocarditis cases were included in the study and tested for ANCA antibodies. The prevalence of ANCA positivity was determined, along with the differences in characteristics and prognosis between infective endocarditis patients with positive and negative serology for ANCA antibodies. The results showed that the characteristics of endocarditis patients who underwent ANCA serology testing were similar to those who did not, except for a higher prevalence of central line and chronic kidney disease in patients with ANCA serology (6.7% compared to 1.1% and 25.6% compared to 12.9%, respectively). Of the 90 endocarditis patients tested for ANCA serology, 18% were ANCA-positive, consistent with other prospective studies. There were no statistically significant differences in the primary outcome, six-month and one-year mortality, between patients with positive and negative ANCA serology. Similarly, in the secondary outcomes of acute kidney injury, heart surgery, and days of hospitalization, there were no statistically significant differences between patients with positive and negative ANCA serology. However, there were statistically significant differences in certain characteristics between the two groups. Patients with positive ANCA serology were found to have a higher prevalence of Enterococcus involvement (29.4% compared to 9.6% with P-value 0.046) and Q fever (23.5% compared to 4.1% P-value 0.02%). In contrast, patients with negative ANCA serology had a higher prevalence of fever (73% compared to 41% P-value 0.033).
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Affiliation(s)
| | - Shani Peretz
- Internal Medicine A, Sheba Medical Center, Ramat Gan, ISR
| | - Bianca Brif
- Infectious Disease, Sheba Medical Center, Ramat Gan, ISR
| | - Itai Gueta
- Internal Medicine A, Sheba Medical Center, Ramat Gan, ISR
| | - Amit Oppenheim
- Internal Medicine A, Sheba Medical Center, Ramat Gan, ISR
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Mitov G, Kilgenstein R, Partenheimer P, Ricart S, Ladage D. Infective endocarditis: prevention strategy and risk factors in an animal model. Folia Med (Plovdiv) 2023; 65:788-799. [PMID: 38351762 DOI: 10.3897/folmed.65.e99682] [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: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Infective endocarditis is a serious infection of the endocardium, especially the heart valves, which is associated with a high mortality rate. It generally occurs in patients with altered and abnormal cardiac architecture combined with exposure to bacteria from trauma and other potentially high-risk activities with transient bacteremia.
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Affiliation(s)
- Gergo Mitov
- Danube Private University, Krems an der Donau, Austria
| | | | | | - Serge Ricart
- Danube Private University, Krems an der Donau, Austria
| | - Dennis Ladage
- Danube Private University, Krems an der Donau, Austria
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10
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Nedel W, Boniatti MM, Lisboa T. Endocarditis in critically ill patients: a review. Curr Opin Crit Care 2023; 29:430-437. [PMID: 37646776 DOI: 10.1097/mcc.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients. RECENT FINDINGS IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves. The presence of organ dysfunction, renal replacement therapies, or extracorporeal membrane oxygenation should be considered in the choice of drug and dosage in critically ill patients with suspected or confirmed IE. As highlighted for other severe infections, monitoring of therapeutic antibiotic levels is a promising technique to improve outcomes in critically ill patients with organ dysfunction. SUMMARY The diagnostic investigation of IE must consider the current epidemiological criteria and the diagnostic particularities that these circumstances require. A careful evaluation of these issues is necessary for the prompt clinical or surgical management of this infection.
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Affiliation(s)
- Wagner Nedel
- Hospital de Clinicas de Porto Alegre
- Hospital Nossa Senhora Conceição
| | - Marcio Manozzo Boniatti
- Hospital de Clinicas de Porto Alegre
- Programa de Pos-Graduação Cardiologia, UFRGS
- Universidade LaSalle, Canoas
| | - Thiago Lisboa
- Hospital de Clinicas de Porto Alegre
- Universidade LaSalle, Canoas
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
- Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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Jullian L, Davies J, Zafar M, Senthivel M, Alkhoury J. Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli. Cureus 2023; 15:e42718. [PMID: 37654960 PMCID: PMC10466259 DOI: 10.7759/cureus.42718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
A 43-year-old male with no history of valvular disease but ongoing intravenous drug use presented with acute confusion, pyrexia, and Osler's nodes. Transthoracic echocardiography uncovered a large 17 x 15 mm-sized vegetation on the aortic valve, causing moderate-to-severe aortic regurgitation. Subsequent multi-organ compromise and complexities regarding treatment adherence delayed surgical intervention; thus, six weeks of antibiotic therapy and medical optimisation, in close collaboration with cardiology, microbiology, and cardiothoracic teams, enabled definitive aortic valve repair to be performed. This case highlights the challenges encountered when managing this life-threatening condition and the obstacles of enacting the guidelines recommendations regarding the timing of surgical intervention. Our case portrays the effectiveness of medical management as bridge-to-surgery in patients not in a position to undergo immediate surgical repair.
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Affiliation(s)
- Lucas Jullian
- Cardiology, Conquest Hospital, East Sussex Healthcare National Health Service (NHS) Trust, St. Leonards-on-Sea, GBR
| | - Josh Davies
- Internal Medicine, Conquest Hospital, East Sussex Healthcare National Health Service (NHS) Trust, St. Leonards-on-Sea, GBR
| | - Mansoor Zafar
- Gastroenterology, General Internal Medicine, Conquest Hospital, East Sussex Healthcare National Health Service (NHS) Trust, St. Leonards-on-Sea, GBR
| | - Mithilaa Senthivel
- Internal Medicine, Conquest Hospital, East Sussex Healthcare National Health Service (NHS) Trust, St. Leonards-on-Sea, GBR
| | - Jad Alkhoury
- Cardiology, Conquest Hospital, East Sussex Healthcare National Health Service (NHS) Trust, St. Leonards-on-Sea, GBR
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Pavasini R, Sinning C, Campo G, Tan TC. ObsErvatioNal prospective multicenter stuDy tO characterize the cLinical ANd DiagnoStiC feAtures of endocarditis in the contemPorary Era (ENDO-LANDSCAPE study): rationale and design. J Cardiovasc Med (Hagerstown) 2023; 24:354-360. [PMID: 37021952 DOI: 10.2459/jcm.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Recent developments in the management of valvular heart disease and heart failure have resulted in a dramatic increase in percutaneous valve procedures and implanted devices. We hypothesize that this has impacted the epidemiology, diagnosis, and management of endocarditis. METHODS The obsErvatioNal prospective multicenter stuDy tO characterize the cLinical ANd DiagnoStiC feAtures of endocarditis in the contemPorary Era (ENDO-LANDSCAPE study) is an observational, multicenter, and international study aimed to examine the epidemiology of endocarditis in the contemporary era. The study will constitute of a retrospective arm for the determination of the sample size of the prospective arm, where cases of endocarditis between 2016 to 2022 at three tertiary referral institutions will be analyzed. The prospective arm will examine all consecutive patients referred for an echocardiography with a suspected or confirmed diagnosis of endocarditis, and their clinical course followed up over 12 months for adverse outcomes. The primary aim of the study will be to characterize the epidemiology of endocarditis, focusing on patients with prosthetic or implanted devices. The secondary aims would be: the appropriateness of the requests for first-line echocardiographic imaging in exclusion of endocarditis; the role of other imaging modalities in the diagnosis of endocarditis; and the impact of a specialized endocarditis team on outcomes. IMPLICATIONS The results of the ENDO-LANDSCAPE study will provide a contemporary update of the epidemiological trends in endocarditis. The data generated from this study would be useful in informing future clinical practice, potentially guiding future diagnostic and treatment algorithms in patients with endocarditis. CLINICALTRIALORG ID NCT05547607.
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Affiliation(s)
- Rita Pavasini
- UO Cardiologia, Azienda Ospedaliero Universitaria of Ferrara, Italy
| | - Christoph Sinning
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Gianluca Campo
- UO Cardiologia, Azienda Ospedaliero Universitaria of Ferrara, Italy
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney University
- Department of Cardiology, Westmead Hospital, Sydney University, Australia
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13
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Vobornik M, Timbilla S, Gofus J, Smolak P, Chek JL, Pojar M, Cermakova E, Zacek P, Vojacek J. Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes. Front Cardiovasc Med 2023; 10:1154129. [PMID: 37234378 PMCID: PMC10206113 DOI: 10.3389/fcvm.2023.1154129] [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: 01/30/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Background Invasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center. Methods From 2014 to 2021, 20 patients with double-valve endocarditis with structural damage of the aorto-mitral curtain underwent surgical reconstruction (Hemi-Commando procedure n = 16 and Commando procedure n = 4). Data were obtained retrospectively. Results In 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 min and the mean cross-clamp time was 186 ± 32 min. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55%) required surgical revision for bleeding. Thirty-day mortality was 30% (6 patients)-3 patients from the Hemi-Commando group (19%) and 3 patients from the Commando group (75%). Overall survival at 1, 3 and 5 years was 60%, 50% and 45% respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86%, 71% and 71% respectively. Conclusion Despite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure.
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Affiliation(s)
- Martin Vobornik
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Salifu Timbilla
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Jan Gofus
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Petr Smolak
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - James Lago Chek
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Marek Pojar
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Eva Cermakova
- Department of Medical Biophysics, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Pavel Zacek
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Jan Vojacek
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czechia
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14
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Ferro P, Boni R, Slart RH, Erba PA. Imaging of Endocarditis and Cardiac Device-Related Infections: An Update. Semin Nucl Med 2023; 53:184-198. [PMID: 36740487 DOI: 10.1053/j.semnuclmed.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/06/2023]
Abstract
IE is a deadly disease requiring prompt diagnosis for adequate patient's management. The diagnosis requires the integration of clinical signs, microbiology data and imaging data and proper discussion within a multidisciplinary team, the endocarditis team. Since the introduction of 18F-FDG-PET/CT and WBC SPECT/CT in the diagnostic algorithm of PVE the nuclear medicine imaging specialists is active part of the Endocarditis Team, requiring proper knowledge of dedicated imaging acquisition protocols, expertise for imaging reading and interpretations to select the best test or combination of tests for each specific clinical situation. In this manuscript, we will review the main technical aspects of each imaging procedure, the most recent literature with specific regards to special challenging populations and provide clinical examples.
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Affiliation(s)
- Paola Ferro
- Nuclear Medicine Unit, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Riemer Hja Slart
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine and Surgery, University of Milan Bicocca and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
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15
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Esmail R, Ober C, Dunn C, Casadesus D. A Fatal Case of Staphylococcus capitis Endocarditis in a Patient With Transcatheter Aortic Valve Replacement. Cureus 2023; 15:e35333. [PMID: 36994272 PMCID: PMC10042522 DOI: 10.7759/cureus.35333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved to become a standard management modality for high-risk, moderate, and even low-risk patients with symptomatic aortic stenosis. Infective endocarditis (IE) after a TAVR is rare and difficult to diagnose. Typical sonographic characteristics observed with an echocardiogram in native valve endocarditis may not be present in TAVR-IE cases. Enterococcal species are identified to be the most frequent causative agents. Coagulase-negative staphylococci (CoNS) can infrequently lead to a fatal course of endocarditis in the TAVR population. There are only seven previously reported cases of Staphylococcus capitis (S. capitis) prosthetic valve endocarditis noted in the literature. Here we present a man in his 60s who presented to our facility for evaluation of fever and shortness of breath. He was subsequently diagnosed with S. capitis TAVR-IE. He was not considered a surgical candidate and was treated medically for IE with a fatal outcome.
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16
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Lisi M, Flamigni F, Russo M, Cameli M, Mandoli GE, Pastore MC, Mele D, Campo G, Henein MY, Rubboli A. Incidence and mortality of infective endocarditis in the last decade: a single center study. J Cardiovasc Med (Hagerstown) 2023; 24:105-112. [PMID: 36574285 DOI: 10.2459/jcm.0000000000001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a significant disease characterized by high mortality and complications. The aim of this study was to evaluate the incidence/100 000 inhabitants and the in-hospital mortality/100 000 inhabitants of IE during the last 10 years in the province of Ravenna. METHODS AND RESULTS We reviewed the public hospitals discharge database from January 2010 to December 2020 using the international classification of disease codification (ICD-9) for IE. We used the Italian national statistical institute (ISTAT) archive to estimate the number of Ravenna inhabitants/year. In 10 years, we identified a total of 407 patients with diagnosis of IE.The incidence of IE increased significantly from 6.29 cases/100 000 inhabitants in 2010 to 19.58 cases/100 000 inhabitants in 2020 ( P < 0.001). Also, the in-hospital mortality from IE increased over the same number of years, from 1.8 deaths/100 000 inhabitants in 2010 to 4.4 deaths/100 000 inhabitants in 2020 ( P < 0.001). The mortality rate (%) of IE over the years did not increase ( P = 0.565). Also, over the years there was no difference in the site of infection ( P = 0.372), irrespective of the valve localization or type, native valve ( P = 0.347) or prosthetic valve ( P = 0.145). On logistic regression analysis, age was the only predictor of in-hospital mortality (odds ratio 1.045, 95% confidence interval: 1.015; 1.075, P = 0.003). CONCLUSIONS Ravenna-based data on IE showed increased disease incidence but unchanged mortality rate over 10 years of follow-up. Age remains the sole predictor of population-based mortality, irrespective of the nature of the valve, native or substitute, and the organism detected on microbiology.
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Affiliation(s)
- Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Filippo Flamigni
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
- Cardiology Unit and LTTA Centre, University of Ferrara, Ferrara
| | - Michele Russo
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianluca Campo
- Cardiology Unit and LTTA Centre, University of Ferrara, Ferrara
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Andrea Rubboli
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
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Abstract
The use of positron emission tomography imaging with 18F-fluorodeoxyglucose in the diagnostic workup of patients with suspected prosthetic valve endocarditis and cardiac device infection (implantable electronic device and left ventricular assist device) is gaining momentum in clinical practice. However, in the absence of prospective randomized trials, guideline recommendations about 18F-fluorodeoxyglucose positron emission tomography in this setting are currently largely based on expert opinion. Measurement of aortic valve microcalcification occurring as a healing response to valvular inflammation using 18F-sodium fluoride positron emission tomography represents another promising clinical approach, which is associated with both the risk of native valve stenosis progression and bioprosthetic valve degeneration in research trials. In this review, we consider the role of molecular imaging in cardiac valvular diseases, including aortic stenosis and valvular endocarditis, as well as cardiac device infections.
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Affiliation(s)
- Jason M Tarkin
- Heart and Lung Research Institute, University of Cambridge, UK (J.M.T.)
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, UK (M.R.D.)
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
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18
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Thoresen T, Jordal S, Lie SA, Wünsche F, Jacobsen MR, Lund B. Infective endocarditis: association between origin of causing bacteria and findings during oral infection screening. BMC Oral Health 2022; 22:491. [PMCID: PMC9664784 DOI: 10.1186/s12903-022-02509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Oral streptococci represent the causing microorganism for infective endocarditis (IE) in many patients. The impact of oral infections is questioned, and it has been suggested that bacteraemia due to daily routines may play a bigger part in the aetiology of IE. The aim of this study was to examine the association between oral health and infective endocarditis caused by oral bacteria in comparison with bacteria of other origin than the oral cavity.
Methods
A retrospective study was conducted at Haukeland University Hospital from 2006- 2015. All consecutive adult patients admitted to hospital for treatment of IE and subjected to an oral focus screening including orthopantomogram, were included. The clinical, radiological and laboratory characteristics of the patients, collected during oral infectious focus screening, were analysed. Patient survival was calculated using Kaplan–Meier and mortality rates were compared using Cox-regression.
Results
A total of 208 patients were included, 77% (n = 161) male patients and 23% (n = 47) female, mean age was 58 years. A total of 67 (32%) had IE caused by viridans streptococci. No statistically significant correlation could be found between signs of oral infection and IE caused by viridans streptococci. The overall mortality at 30 days was 4.3% (95% CI: 1.6–7.0). There was no statistical difference in mortality between IE caused by viridans streptococci or S. aureus (HRR = 1.16, 95% CI: 0.57–2.37, p = 0.680).
Conclusion
The study indicates that the association between origin of the IE causing bacteria and findings during oral infection screening might be uncertain and may suggest that the benefit of screening and elimination of oral infections in patients admitted with IE might be overestimated. However, the results should be interpreted with caution and further studies are needed before any definite conclusions can be drawn.
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Berger T, Dees D, Siepe M, Pingpoh C, Fagu A, Zeh W, Beyersdorf F, Neumann FJ, Czerny M, Kreibich M. Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic Valve Endocarditis. Thorac Cardiovasc Surg 2022. [PMID: 36257543 DOI: 10.1055/s-0042-1757600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Invasive coronary angiography (ICA) is essential to detect significant coronary artery disease (CAD) but is generally not recommended in patients with infective aortic valve endocarditis. This study aimed to evaluate the risks and benefits of preoperative ICA in patients before aortic valve replacement. METHODS Between March 2008 and September 2020, 232 patients were surgically treated for infectious endocarditis of the aortic valve. Sixty-seven (29%) of them underwent preoperative diagnostic ICA and were compared with the patients without preoperative ICA. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the ICA data. The intraoperative data and clinical outcomes after ICA and after surgery were evaluated. RESULTS ICA revealed a CAD in the majority of our patients (n = 36; 54%): One-vessel disease n = 19 (28%), two-vessel disease n = 6 (9%), and three-vessel disease n = 11 (16%). We observed no adverse events following preoperative diagnostic ICA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischemia were detected. During surgical aortic valve replacement, concomitant coronary artery bypass grafting was performed in 20 patients (30%). In patients with preoperative ICA, postoperative in-hospital mortality was significantly lower (n = 8 [12%] vs. n = 30 [18%]; p < 0.001), while the incidence of postoperative bleeding was higher (n = 18 [27%] vs. n = 22 [13%]; p = 0.022). The new-onset stroke incidence was 5% in each group. CONCLUSION Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications.
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Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Dees
- Department of Cardiology and Angiology, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albi Fagu
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Zeh
- Department of Cardiology and Angiology, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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20
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Philip J, Bond MC. Emergency Considerations of Infective Endocarditis. Emerg Med Clin North Am 2022; 40:793-808. [DOI: 10.1016/j.emc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Liaqat W, Palaiodimos L, Li W, Karamanis D, Tahir A, Tzoumas A, Nagraj S, Tiwari N, Grushko M, Kokkinidis D, Gashi E, Leider J, Coyle C, Faillace RT. Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2022; 50:1349-1361. [PMID: 35614176 DOI: 10.1007/s15010-022-01846-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is paucity of data on the epidemiological, microbiological, and clinical characteristics of patients admitted with infective endocarditis (IE) in the Bronx, New York. PATIENT AND METHODS We conducted a retrospective study at Jacobi Medical Center, a tertiary care hospital in the Bronx. All adult patients who were hospitalized with a primary diagnosis of new-onset IE between January 1st, 2010 and September 30th, 2020 were included. The primary outcome was in-hospital mortality. A logistic regression model was used to identify baseline variables associated with in-hospital mortality. RESULTS 182 patients were included in this analysis (female sex: 38.5%, median age: 54 years). 46 patients (25.3%) reported intravenous drug use. 153 patients (84.1%) had positive blood cultures. Staphylococcus aureus (S. aureus) was the most common isolated pathogen (45.1% of monomicrobial IE). Nearly half of the cases secondary to S. aureus were methicillin resistant Staphylococcus aureus (MRSA) (34/69). 164 patients (90.1%) were diagnosed with native valve IE. The mitral valve was involved in 32.4% of patients followed by the aortic valve (19.8%). The in-hospital mortality was 18.1%. The mortality was higher in the cohort 2010-2015 compared to the cohort 2016-2020 (22.1% vs 14.6%). Increasing age, MRSA IE, and active malignancy were the only variables found to have significant association with in-hospital death. CONCLUSION S. aureus was the most common causative agent and MRSA accounted for about half of the S. aureus IE cases. The incidence of IE in patients with intravenous drug use increased over time, while the median age decreased. The in-hospital death rate was higher in 2010-2015 compared to 2016-2020.
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Affiliation(s)
- Wasla Liaqat
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Weijia Li
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dimitrios Karamanis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ, USA
- Department of Economics, University of Peiraeus, Attica, Greece
| | - Arooj Tahir
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andreas Tzoumas
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos Kokkinidis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eleonora Gashi
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason Leider
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina Coyle
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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22
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Thyagaturu HS, Bolton A, Thangjui S, Kumar A, Shah K, Bondi G, Naik R, Sornprom S, Balla S. Effect of leaving against medical advice on 30-day infective endocarditis readmissions. Expert Rev Cardiovasc Ther 2022; 20:773-781. [PMID: 35984240 DOI: 10.1080/14779072.2022.2115358] [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: 10/15/2022]
Abstract
BACKGROUND : The burden of against medical advice (AMA) discharges on the readmission rate of infective endocarditis (IE) patients has been largely ignored. METHODS We used the National Readmissions Database, years 2016 to 2019, to identify IE patients and categorized them into those who left AMA (IE AMA) and those who were discharged to home or skilled nursing facility (SNF)/other facility (IE non-AMA). The primary outcome was 30-day all-cause readmissions difference per AMA status. RESULTS Of 26,481 patients with IE who met the inclusion criteria, 4,310 (16.3%) left the hospital AMA. IE AMA patients were younger (mean years; 43.7 vs 34.2; p < 0.01) and had a higher prevalence of injection drug use (IDU) (89.4% vs 45.2%; p < 0.01) but fewer comorbidities compared to IE non-AMA. In adjusted analyses, IE AMA had higher hazards for 30-day readmissions compared to IE non-AMA [hazards ratio (HR): 3.1 (2.9 - 3.5); p < 0.01]. CONCLUSION IE AMA are at increased risk of 30-day readmissions and higher resource utilization at the time of readmission compared to IE non-AMA. Considering the high prevalence of IDU in IE AMA, the role of mental health to curb the burden of IE readmissions is an area of further research.
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Affiliation(s)
- Harshith S Thyagaturu
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Alexander Bolton
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sittinun Thangjui
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kashyap Shah
- Department of Internal Medicine, St Luke's University Hospitals, Allentown, Pennsylvania, USA
| | - Gayatri Bondi
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Riddhima Naik
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Suthanya Sornprom
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Sudarshan Balla
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
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Scantland J, Hendrix J, Schmitz A, Casciani T, Butty S. Clinical Efficacy of Percutaneous Vegetectomy in Tricuspid and Right-Heart Indwelling Device Infective Endocarditis. Angiology 2022:33197221121009. [DOI: 10.1177/00033197221121009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several studies have analyzed the efficacy of AngioVac for percutaneous intracardiac vegetectomy, but impact on surgical candidacy or clinical efficacy for infectious endocarditis (IE) is currently unknown. This is a single-arm, retrospective study on IE vegetectomy with impact on surgical risk scores. Analysis included 32 patients who underwent AngioVac vegetectomy for right heart IE at a single institution. The primary endpoint was improvement in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) scores. Secondary endpoints included technical success, improved leukocytosis, procedural safety, 30-day mortality, and 60-day mortality. Findings demonstrate 90.6% (n = 29) technically successful debulking. There was improvement in mean NSQIP scores from 34.6 to 27.9 ( P = .007). Zero cases of 30-day all-cause mortality. One patient experienced a major post-procedural complication of pneumothorax, a Class D Adverse Event. 20.5% (n = 5) of valvular vegetation patients went on to have surgical tricuspid valve repair. All indwelling intracardiac devices were removed. Findings suggest that percutaneous vegetectomy improves surgical candidacy, as measured by ACS NSQIP scores, in patients with IE and right heart vegetations and is associated with low complication rates.
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Affiliation(s)
- Joshua Scantland
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Justin Hendrix
- Medical Sciences Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam Schmitz
- Medical Sciences Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas Casciani
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sabah Butty
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
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24
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Newell CF, Bridwell RE, Inman BL, Long B. Tattoo associated native valve infective endocarditis: A case report. Am J Emerg Med 2022; 60:227.e5-227.e7. [PMID: 35902328 DOI: 10.1016/j.ajem.2022.07.022] [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: 03/29/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022] Open
Abstract
Infective Endocarditis (IE) is an uncommon illness in the emergency department (ED) with significant associated morbidity. Patients with IE typically possess risk factors predisposing them to bacterial invasion. These risk factors include intravenous drug use, valvulopathies, valve replacement, poor oral hygiene, immunocompromised state, and recent invasive procedures. A rarer condition is tattoo-associated IE. Diagnosis of IE includes multiple blood cultures and echocardiography. Therapeutic interventions include prolonged intravenous antibiotics and potential surgery. Complications from IE can be severe, including organ injury from septic emboli, heart failure, valvular insufficiency, bacteremia, and fulminant septic shock. Prompt identification and treatment are necessary to reduce patient morbidity and mortality.
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Affiliation(s)
- Cody F Newell
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Ave., Tacoma, WA 98341, United States
| | - Brannon L Inman
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Brit Long
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
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25
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Sebastian SA, Co EL, Mehendale M, Sudan S, Manchanda K, Khan S. Challenges and Updates in the Diagnosis and Treatment of Infective Endocarditis. Curr Probl Cardiol 2022; 47:101267. [DOI: 10.1016/j.cpcardiol.2022.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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26
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Kulahcioglu S, Sari M, Yilmaz C, Kizmaz YU, Adademir T, Ceyran H. Unexpected isolated native pulmonary valve endocarditis; really benign as thought? J Card Surg 2022; 37:2120-2123. [PMID: 35384061 DOI: 10.1111/jocs.16476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Isolated pulmonary valve endocarditis is extremely rare, accounting for <2% of cases. Major predisposing factors are intravenous drug use, implanted cardiac devices, congenital heart diseases, and central venous catheters. Most patients respond well to appropriate antibiotherapy. AIM We report a case with an isolated native pulmonary valve endocarditis due to methicillin-resistant staphylococcus-aureus infection which developed after a tooth abscess in a previously healthy non-drug user young male. After one week antibiotherapy, surgery was required due to acute severe pulmonary insufficiency and right heart-failure. After the operation, he had a multi-organ failure despite veno-arterial extracorporeal membrane oxygenation, antibiotherapy, and other supportive treatments, therefore the case concluded with mortality. DISCUSION AND CONCLUSION Our case showed that pulmonary valve endocarditis may occur in patients without risk factors in case of portal of entry for bacteremia and it may carry worse prognosis than previously known. Virulence of the microorganism and vegetation size are the major predictors of prognosis. Pulmonary valve endocarditis should be kept in mind even in patients without any known risk factors.
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Affiliation(s)
- Seyhmus Kulahcioglu
- Department of Cardiology, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Munevver Sari
- Department of Cardiology, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Cemalettin Yilmaz
- Department of Cardiology, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Yesim U Kizmaz
- Department of Infectious Diseases and Clinical Microbiology, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Taylan Adademir
- Department of Cardiovascular Surgery, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Hakan Ceyran
- Department of Pediatric Cardiovascular Surgery, Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
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27
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Smeltz AM, Coleman P, Mondal S. TEMPORARY REMOVAL: Pro – Acute normovolemic hemodilution (ANH) should be used in infective endocarditis (IE) patients coming for primary or redo cardiac surgery. J Cardiothorac Vasc Anesth 2022; 36:2811-2814. [DOI: 10.1053/j.jvca.2022.03.008] [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: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 01/28/2023]
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28
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Mikail N, Hyafil F. Nuclear Imaging in Infective Endocarditis. Pharmaceuticals (Basel) 2021; 15:ph15010014. [PMID: 35056069 PMCID: PMC8777992 DOI: 10.3390/ph15010014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110 Clichy, France;
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952 Schlieren, Switzerland
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 Rue Leblanc, 75015 Paris, France
- Correspondence: ; Tel.: +33-01-56-09-56-24
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29
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Kinthala S, Yarramneni A, Huang J, Yepuri N, Saththasivam P, Sattur S. Perioperative Evaluation of Infective Endocarditis Via Multimodality Imaging for the Surgical Management of Aortic Root Abscess. Cureus 2021; 13:e17817. [PMID: 34660027 PMCID: PMC8500339 DOI: 10.7759/cureus.17817] [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] [Accepted: 09/08/2021] [Indexed: 11/06/2022] Open
Abstract
Infective endocarditis (IE) is an infection of the endothelium of the heart, that typically affects heart valves. While echocardiography remains crucial in the diagnosis and management of IE, multimodality cardiac imaging helps obtain additional information for the management of complex cases. Alternative imaging modalities such as computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging (MRI) are playing an increasing role in the diagnosis and management of IE, especially for patients with prosthetic valve endocarditis (PVE). Here we present a case of a 60-year-old Caucasian male who was diagnosed with IE, complicated by aortic root abscess, and multiorgan failure. In this challenging case, multimodality cardiac imaging helped in the precise understanding of the extent of endocarditis, cannulation strategy, and direct the course of the surgical procedure that resulted in successful patient management.
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Affiliation(s)
| | - Akhila Yarramneni
- Department of Surgery, Division of Cardiac Surgery, Guthrie Robert Packer Hospital, Sayre, USA
| | - Jordan Huang
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
| | - Natesh Yepuri
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
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30
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Hove DT, Sinha B, Glaudemans AWJM, Gomes A, Swart LE, Tanis W, Budde RPJ, Slart RHJA. 18F-FDG-Uptake in Mediastinal Lymph Nodes in Suspected Prosthetic Valve Endocarditis: Predictor or Confounder? Front Cardiovasc Med 2021; 8:717774. [PMID: 34458343 PMCID: PMC8385671 DOI: 10.3389/fcvm.2021.717774] [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: 05/31/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Prosthetic valve endocarditis (PVE) is a serious disease affecting ~0.4% of prosthetic valve recipients per year. 18F-FDG-PET/CT has high sensitivity and specificity for PVE and is included as major criterion for the diagnosis in recent guidelines of the European Society of Cardiology. We addressed the question whether increased FDG-uptake in mediastinal lymph nodes could help to support the visual diagnostic assessment of PVE. Methods: In this sub-analysis of a previously published retrospective multicentre study, 160 unique patients were identified who underwent 18F-FDG-PET/CT for evaluation of suspected PVE. 18F-FDG-PET/CT was performed in adherence to the European Association of Nuclear Medicine guidelines of 2015 and scans were assessed for signs of mediastinal lymph node activity by 2 experienced nuclear medicine physicians who were blinded to clinical context. Clinical diagnosis of PVE had been established based on surgical findings or multidisciplinary consensus after a 1-year follow-up in 80 of 160 patients (50%). Results: In total, 52 patients showed increased mediastinal lymph node activity. Mediastinal lymph node activity on 18F-FDG-PET/CT did not increase diagnostic accuracy when added to the visual analysis of scans for signs of PVE: X 2: 0.118, p = 0.731). After excluding patients with known confounders for 18F-FDG-PET/CT, namely use of Bioglue® during prosthetic valve implantation and C-reactive protein levels below 40 mg/L, mediastinal lymph node activity was still not of additional diagnostic value compared to visual analysis alone (X2:0.129, p = 0.723). Discussion: Assessment of mediastinal lymph node activity did not improve 18F-FDG-PET/CT diagnostic accuracy for suspected PVE compared to visual assessment of the valve alone, as it seems to be a rather a specific finding, that might be caused by sternal wound or mediastinal infections or even by subclinical respiratory infections. Future studies might elucidate whether increased FDG active lymph nodes indicate a high-risk patient group and whether more detailed assessment of mediastinal lymph nodes could improve their additional diagnostic benefit.
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Affiliation(s)
- Derk Ten Hove
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anna Gomes
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Laurens E Swart
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - Wilco Tanis
- Department of Cardiology, HagaZiekenhuis, The Hague, Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
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31
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Van Camp G, Beles M, Penicka M, Schelfaut D, Wouters S, De Raedt H, Wyffels E, Spapen J, Nasser R, Balogh Z, Albano M, De Beenhouwer H, Van Vaerenbergh K, Van Praet F, Degrieck I, Stockman B, Casselman F, Collet C. Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis. J Clin Med 2021; 10:jcm10173832. [PMID: 34501278 PMCID: PMC8432016 DOI: 10.3390/jcm10173832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.
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Affiliation(s)
- Guy Van Camp
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
- Correspondence:
| | - Monika Beles
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Martin Penicka
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Dan Schelfaut
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Stijn Wouters
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Herbert De Raedt
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Eric Wyffels
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Jerrold Spapen
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Riwa Nasser
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Zsuzsanna Balogh
- Gottsegen Gyorgy National Institute of Cardilogy, Haller u. 29, 1096 Budapest, Hungary;
| | - Marzia Albano
- Cardiology Unit, S. Maria Nuova Hospital, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Hans De Beenhouwer
- Department of Microbiology, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (H.D.B.); (K.V.V.)
| | | | - Frank Van Praet
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Bernard Stockman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Filip Casselman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Carlos Collet
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
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32
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Yamashita S, Tago M, Motomura S, Oie S, Aihara H, Katsuki NE, Yamashita SI. Development of a Clinical Prediction Model for Infective Endocarditis Among Patients with Undiagnosed Fever: A Pilot Case-Control Study. Int J Gen Med 2021; 14:4443-4451. [PMID: 34413673 PMCID: PMC8370112 DOI: 10.2147/ijgm.s324166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Infective endocarditis (IE) may be diagnosed as fever of unknown origin due to its delusively non-descriptive clinical features, especially in outpatient clinics. Our objective is to develop a prediction model to discriminate patients to be diagnosed as “definite” IE from “non-definite” by modified Duke criteria among patients with undiagnosed fever, using only history and results of physical examinations and common laboratory examinations. Patients and Methods The study was a single-center case–control study. Inpatients at Saga University Hospital diagnosed with IE from 2007 to 2017 and patients with undiagnosed fever from 2015 to 2017 were enrolled. Patients diagnosed with definite IE according to the modified Duke criteria, except those definitely diagnosed with other disorders responsible for fever, were allocated to the IE group. Patients without IE among those defined as non-definite according to the modified Duke criteria were allocated to the undiagnosed fever group. We developed a prediction model to pick up patients who would be “definite” by modified Duke criteria, which was subsequently assessed by area under the curve (AUC). Results A total of 144 adult patients were included. Of these, 59 patients comprised the IE group. We developed the prediction model using five indicators, including transfer by ambulance, cardiac murmur, pleural effusion, neutrophil count, and platelet count, with a sensitivity 84.7%, a specificity 84.7%, an AUC 0.893 (95% confidence interval 0.828–0.959), a shrinkage coefficient 0.635, and a stratum-specific likelihood ratio 0.2–50.4. Conclusion Our prediction model, which uses only indicators easy to gain, facilitates prediction of patients with IE. These indicators can be acquired even at common hospitals and clinics, without requiring advanced medical equipment or invasive examinations. Trial Registration Number UMIN000041344.
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Affiliation(s)
- Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - So Motomura
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Satsuki Oie
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
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33
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Fernández-Hidalgo N, Escolà-Vergé L, Pericàs JM. Enterococcus faecalis endocarditis: what's next? Future Microbiol 2021; 15:349-364. [PMID: 32286105 DOI: 10.2217/fmb-2019-0247] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Enterococcus faecalis infective endocarditis (EFIE) is a complex entity in rapid evolution. Although largely relevant findings from recent studies have advanced the knowledge on EFIE and led to some changes in clinical guidelines, there are still a number of gaps to be filled. Coordinated, international, multicenter efforts are needed to obtain quality data that rend the health systems and scientific community prepared enough to understand and handle this infection. In this Perspective, some of the most relevant aspects concerning the epidemiology, clinical presentation and outcomes, diagnostic approaches and antibiotic therapy of EFIE are addressed. Also, several potential future clinical developments in the field are discussed.
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Affiliation(s)
- Núria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Laura Escolà-Vergé
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
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34
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Abstract
Infective endocarditis (IE) remains a rare condition but one with high associated morbidity and mortality. With an ageing population and increasing use of implantable cardiac devices and heart valves, the epidemiology of IE has changed. Early clinical suspicion and a rapid diagnosis are essential to enable the correct treatment pathways to be accessed and to reduce complication and mortality rates. In the current review, we detail the latest guidelines for the evaluation and management of patients with endocarditis and its prevention.
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Affiliation(s)
- Ronak Rajani
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John L Klein
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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35
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Rinaldi E, Sadeghi S, Lluri G, Salem M, Levi D, Aboulhosn J. Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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36
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McGrew KM, Garwe T, Jafarzadeh SR, Drevets DA, Zhao YD, Williams MB, Carabin H. Misclassification Error-Adjusted Prevalence of Injection Drug Use Among Infective Endocarditis Hospitalizations in the United States: A Serial Cross-Sectional Analysis of the 2007-2016 National Inpatient Sample. Am J Epidemiol 2021; 190:588-599. [PMID: 32997130 DOI: 10.1093/aje/kwaa207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
Administrative health databases have been used to monitor trends in infective endocarditis hospitalization related to nonprescription injection drug use (IDU) using International Classification of Diseases (ICD) code algorithms. Because no ICD code for IDU exists, drug dependence and hepatitis C virus (HCV) have been used as surrogate measures for IDU, making misclassification error (ME) a threat to the accuracy of existing estimates. In a serial cross-sectional analysis, we compared the unadjusted and ME-adjusted prevalences of IDU among 70,899 unweighted endocarditis hospitalizations in the 2007-2016 National Inpatient Sample. The unadjusted prevalence of IDU was estimated with a drug algorithm, an HCV algorithm, and a combination algorithm (drug and HCV). Bayesian latent class models were used to estimate the median IDU prevalence and 95% Bayesian credible intervals and ICD algorithm sensitivity and specificity. Sex- and age group-stratified IDU prevalences were also estimated. Compared with the misclassification-adjusted prevalence, unadjusted estimates were lower using the drug algorithm and higher using the combination algorithm. The median ME-adjusted IDU prevalence increased from 9.7% (95% Bayesian credible interval (BCI): 6.3, 14.8) in 2008 to 32.5% (95% BCI: 26.5, 38.2) in 2016. Among persons aged 18-34 years, IDU prevalence was higher in females than in males. ME adjustment in ICD-based studies of injection-related endocarditis is recommended.
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Botheras CL, Bowe SJ, Cowan R, Athan E. C-reactive protein predicts complications in community-associated S. aureus bacteraemia: a cohort study. BMC Infect Dis 2021; 21:312. [PMID: 33794783 PMCID: PMC8015062 DOI: 10.1186/s12879-021-05962-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. Methods In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. Results We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. Conclusions We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.
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Affiliation(s)
- Carly L Botheras
- School of Medicine, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia. .,School of Medicine, Faculty of Health, Deakin University, Geelong, Australia.
| | - Steven J Bowe
- Deakin Biostatistics Unit Faculty of Health, Deakin University, Geelong, Australia
| | - Raquel Cowan
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - Eugene Athan
- School of Medicine, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Australia
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Fleißner F, Tudorache I, Christgen M, Cebotari S. Cardiac Phlegmon: Infectious Endocarditis Causing Ventricular Wall Rupture. Thorac Cardiovasc Surg Rep 2020; 9:e51-e54. [PMID: 33154880 PMCID: PMC7605974 DOI: 10.1055/s-0040-1716391] [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: 12/03/2019] [Accepted: 01/24/2020] [Indexed: 10/28/2022] Open
Abstract
Background Rupture of the cardiac ventricular wall is a rare and essentially lethal complication of infectious endocarditis valvularis. Case Description We report a case of a 49-year-old female patient with infectious endocarditis of the aortic valve. Following aortic valve replacement, the patient developed a sudden free left ventricular wall rupture. Immediate reoperation was successful. Histopathology revealed a myocardial infarction due to septic thromboembolism causing a phlegmonlike myocardial appearance. Conclusion This is a rare case of a myocardial phlegmon with subsequent cardiac lateral wall rupture in the context of an infectious endocarditis with septic coronary embolism.
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Affiliation(s)
- Felix Fleißner
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Serghei Cebotari
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Aljassim NA, Almashraki N, Tageldein M, Tamimi O, Kabbani MS, Zahraa J, Alshehri M. Complicated community-acquired methicillin-resistant Staphylococcus aureus pancarditis with cardiac pseudoaneurysm in a healthy child: A case report. Int J Surg Case Rep 2020; 77:71-75. [PMID: 33157337 PMCID: PMC7644799 DOI: 10.1016/j.ijscr.2020.10.085] [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: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines. PRESENTATION OF CASE We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit. DISCUSSION Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes. CONCLUSION Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.
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Affiliation(s)
- Nada A Aljassim
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Nabeel Almashraki
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohamed Tageldein
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Omer Tamimi
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Mohamed S Kabbani
- Department of Cardiac Sciences, Division of Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, Ministry of National Guard, P.O. Box: 22490, Riyadh, 11426, Saudi Arabia.
| | - Jihad Zahraa
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohammed Alshehri
- Department of Pediatrics Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
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Zaqout A, Mohammed S, Thapur M, Al-Soub H, Al-Maslamani MA, Al-Khal A, Omrani AS. Clinical characteristics, microbiology, and outcomes of infective endocarditis in Qatar. Qatar Med J 2020; 2020:24. [PMID: 33282709 PMCID: PMC7684547 DOI: 10.5339/qmj.2020.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Infective endocarditis (IE) is a serious and potentially life-threatening disease. The epidemiology, treatment options, and outcomes have changed considerably over the last two decades. The aim of the study was to describe the epidemiology, clinical characteristics, and outcomes of patients with IE in Qatar. Methods: Patients were identified from Hamad Medical Corporation hospitals’ electronic records, the national referral center for the State of Qatar. We included those aged ≥ 18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017. Demographic and clinical data were retrieved. Descriptive statistics were performed, and logistic regression analysis was used to describe the relationship between patient characteristics and all-cause in-hospital mortality. All potentially relevant variables were included in the univariate analysis, while those with p < 0.1 in the univariate logistic regression model were included in the multivariate analysis. For the final model, we calculated odds ratios (OR) adjusted for each of the variables included, along with their 95% confidence intervals (95% CI). Data were analyzed using STATA software version 15 (StataCorp, College Station, Texas, USA). The study was approved by the Institutional Research Board with a waiver for informed consent. Results: Fifty-seven cases were included, of which 70% were males. The mean age was 51 years ( ± 16.8 years). Eleven (19%) were associated with prosthetic valves, and 6 (11%) with implantable cardiac devices. Fever (84%), dyspnea (46%), and heart failure (37%) were the most common presentations. Only 58% of patients had known preexisting valvular heart disease or an intracardiac device. Skin infections (10 patients, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery, and implantable cardiac devices. Staphylococci were implicated in 19 (34%) and Streptococcaceae in 9 (16%) patients, whereas 21 (37%) patients were culture negative. Left-side IE (49 patients, 86%) was predominant. Acute kidney injury (AKI) (17 patients, 30%) and heart failure (11 patients, 19%) were common complications. The majority of patients received targeted antimicrobial therapy with at least two active agents. Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock [OR 57.8, 95% CI 2.6–1360.2; p < 0.01] and AKI OR 33.9, 95% CI 2.9–398.1; p < 0.01) as the only risk factors independently associated with in-hospital mortality. Conclusion: Staphylococci are the most common microbiological cause of IE in Qatar. Surgical intervention is uncommon, and mortality is relatively high. Our findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encouraging early microbiological investigations and improving medical and surgical management.
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Affiliation(s)
- Ahmed Zaqout
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Shaban Mohammed
- Department of Pharmacy Hamad Medical Corporation, Doha, Qatar
| | - Maliha Thapur
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al-Soub
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ali S Omrani
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
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Yamashita S, Tago M, Tokushima M, Nakashima T, Katsuki NE, Anzai K, Yamashita SI. Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study. Int J Gen Med 2020; 13:547-557. [PMID: 32922065 PMCID: PMC7457800 DOI: 10.2147/ijgm.s264497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Our hospital’s department of general medicine is often involved in the diagnosis and treatment of diseases that are considered by other hospitals or other departments in our hospital to be difficult to diagnose correctly. Objective The aim of this study was to clarify how patients with infective endocarditis (IE) being admitted to our hospital’s department of general medicine were examined and treated and to elucidate their prognosis compared with patients admitted to other departments. Materials and Methods Inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were divided into 2 groups: those admitted to the general medicine department (the GM group) and those admitted to other departments (the non-GM group). Results Seventy-four patients were included; 17 (23%) were admitted to the general medicine department. In the GM group, the percentage of patients diagnosed with definite or suspected IE was lower (0% vs 32%, p=0.008), as was the rate of patients with echocardiographic findings that fulfilled the major modified Duke’s criteria (71% vs 98%, p≤0.001), preadmission. The GM group had higher percentages of patients with back or joint pain (41% vs 9%, p=0.001) and complications, including pyogenic spondylitis (35% vs 2%, p≤0.001), deep-seated abscesses (24% vs 5%, p=0.024), pyogenic arthritis (18% vs 0%, p=0.001), and glomerulonephritis (77% vs 37%, p=0.004) than did the non-GM group. Mortality within 30 days of admission to our hospital (12% vs 14%, p=0.753) and overall in-hospital mortality (12% vs 18%, p=0.570) did not significantly differ. Conclusion The general medicine department could have accurately diagnosed IE, given appropriate treatments, and obtained similar prognoses to those of IE patients treated by other departments, including cardiology and cardiovascular surgery, even in patients for whom diagnosing IE was more difficult or who had less typical echocardiographic findings preadmission.
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Affiliation(s)
- Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Keizo Anzai
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
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Mosseler K, Materniak S, Brothers TD, Webster D. Epidemiology, Microbiology, and Clinical Outcomes Among Patients With Intravenous Drug Use-Associated Infective Endocarditis in New Brunswick. CJC Open 2020; 2:379-385. [PMID: 32995724 PMCID: PMC7499377 DOI: 10.1016/j.cjco.2020.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Within the context of Canada's opioid crisis, medical complications associated with intravenous drug use (IVDU) are increasing. Infective endocarditis (IE) is a serious complication of IVDU, and understanding the characteristics of these patients could aid health systems, clinicians, and patients in the optimization of treatment and prevention of IVDU-IE. METHODS At a tertiary care hospital in southern New Brunswick, we conducted a retrospective chart review to identify patients with IVDU-IE admitted between January 1, 2013, and December 31, 2017. We collected data related to the epidemiology, microbiology, clinical manifestations, echocardiography, complications during hospital admission, and outcomes. RESULTS Forty-two cases of IVDU-IE met inclusion criteria. The rate of IVDU-IE increased from 2.28 per 100,000 population in 2014 to 4.00 in 2017, which, although not statistically significant, reflects patterns in other jurisdictions. Most patients (72.4%) were male, and the mean age was 38.3 (±11.5) years. Most patients (79.3%) injected opioids. The most common clinical sign was fever (90.5%), and Staphylococcus aureus (61.9%) was the most common microorganism. The tricuspid valve was most commonly infected (58.5%), 50% of cases had heart failure as a complication during admission, and 45.2% of cases required valve replacement or repair. The 2-year survival rate after admission for initial IVDU-IE episode was 62.0% (95% confidence interval: 36.5-79.7). CONCLUSION IVDU-IE is common in New Brunswick and may be increasing. Despite the relatively young age of this patient population, IVDU-IE is associated with significant morbidity and mortality. Expanding effective harm reduction and addiction treatment strategies for this cohort is recommended.
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Affiliation(s)
- Kimiko Mosseler
- Medical School, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Stefanie Materniak
- Centre for Research, Education and Clinical Care of At-Risk Populations, Saint John, New Brunswick, Canada
- Health Authority, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Thomas D. Brothers
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Duncan Webster
- Medical School, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Centre for Research, Education and Clinical Care of At-Risk Populations, Saint John, New Brunswick, Canada
- Health Authority, Horizon Health Network, Saint John, New Brunswick, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Hidalgo-Tenorio C, Gálvez J, Martínez-Marcos FJ, Plata-Ciezar A, De La Torre-Lima J, López-Cortés LE, Noureddine M, Reguera JM, Vinuesa D, García MV, Ojeda G, Luque R, Lomas JM, Lepe JA, de Alarcón A. Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis. BMC Infect Dis 2020; 20:160. [PMID: 32085732 PMCID: PMC7035751 DOI: 10.1186/s12879-020-4895-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 μg/mL to MRSA. Methods Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41–7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14–7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64–9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985–1999) (OR 8.391; 95% CI (2.82–24.9); 2000–2009 (OR 6.4; 95% CI 2.92–14.06); active neoplasm (OR 6.63; 95% CI 1.7–25.5) and sepsis (OR 2.28; 95% CI 1.053–4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). Conclusion MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas n° 2, 18014, Granada, Spain.
| | - Juan Gálvez
- Infectious Disease Service, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Antonio Plata-Ciezar
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | - José M Reguera
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - David Vinuesa
- Infectious Disease Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - Maria Victoria García
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Guillermo Ojeda
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rafael Luque
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Manuel Lomas
- Infectious Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Antonio Lepe
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arístides de Alarcón
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Tamura Y, Nomura A, Yoshida S, Tada H, Sakata K, Iino K, Furusho H, Takamura M, Takemura H, Yamagishi M, Kawashiri MA. Quick sepsis-related organ failure assessment score as a possible predictor for in-hospital adverse events in infective endocarditis. Acute Med Surg 2019; 6:138-144. [PMID: 30976439 PMCID: PMC6442521 DOI: 10.1002/ams2.393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/12/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Infective endocarditis (IE) can be life‐threatening because of various associated adverse events. The quick Sepsis‐related Organ Failure Assessment (qSOFA) score is a straightforward useful method for predicting in‐hospital mortality in patients with suspected infections. However, few data exist regarding the clinical impact of the qSOFA score on predicting adverse events in IE during hospitalization. We studied the usefulness of qSOFA score for predicting in‐hospital adverse events in patients with IE. Methods We retrospectively analyzed 104 consecutive patients diagnosed with IE on the basis of modified Duke criteria. We defined in‐hospital adverse events as occurrence of any of the following events during hospitalization: death, embolism, hemorrhage, or abscess formation. The high qSOFA group was defined as those with a qSOFA score ≥2. We used Cox regression analysis to estimate the hazard ratio for high qSOFA score on in‐hospital adverse events adjusted for age, sex, and Staphylococcus aureus infection. Results We analyzed 83 patients (57 men, mean age 61 ± 18 years) from the total cohort of 104 patients enrolled. Among these, 12 (14.5%) had high qSOFA scores. The high qSOFA group had higher in‐hospital mortality compared to the low qSOFA group (50.0% vs. 4.2%, P < 0.01). In the Cox proportional hazards model, high qSOFA was significantly associated with in‐hospital adverse events (adjusted hazard ratio, 2.29; confidence interval, 1.02–5.12; P = 0.044). Conclusion These results showed that high qSOFA score was significantly associated with in‐hospital adverse events in IE patients, although further prospective study is necessary to confirm our results.
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Affiliation(s)
- Yudai Tamura
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Akihiro Nomura
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan.,Innovative Clinical Research Center Kanazawa University (iCREK) Kanazawa Japan
| | - Shohei Yoshida
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Hayato Tada
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Kenji Sakata
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Hiroshi Furusho
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan
| | | | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Masakazu Yamagishi
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Masa-Aki Kawashiri
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
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Karasahin O, Yildiz Z, Unal O, Arslan U. A rare cause of healthcare-associated infective endocarditis: Enterobacter cloacae. IDCases 2018; 12:18-20. [PMID: 29560314 PMCID: PMC5857739 DOI: 10.1016/j.idcr.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/03/2018] [Accepted: 03/03/2018] [Indexed: 11/27/2022] Open
Abstract
We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae. The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae-associated infective endocarditis.
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Affiliation(s)
- Omer Karasahin
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Zıya Yildiz
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Onur Unal
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Umit Arslan
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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