1
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. JACC Cardiovasc Imaging 2024; 17:669-701. [PMID: 38466252 DOI: 10.1016/j.jcmg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multisocietal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multifocal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Heart Rhythm 2024; 21:e1-e29. [PMID: 38466251 DOI: 10.1016/j.hrthm.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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3
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Karaçam K, Erdem RZ. The level of knowledge of medical and dental students regarding prophylaxis for infective endocarditis. J Dent Educ 2024. [PMID: 38634197 DOI: 10.1002/jdd.13553] [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: 12/20/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Infective endocarditis is a rarely seen disease, but has a high mortality rate. Therefore, it is extremely important that the guidelines are followed correctly. The main aim of this study was to evaluate and compare the level of knowledge and attitude of infective endocarditis of fourth- and fifth-year dentistry students in clinical residency and fifth- and sixth-year medical students. METHODS A 42-item questionnaire evaluating the type and dosage of antibiotics administered as infective endocarditis prophylaxis in medical conditions and dentistry procedures was delivered online to the study participants. The data obtained were examined using descriptive statistics and analyzed with the chi-square test. RESULTS The questionnaire was completed by a total of 332 participants. The statistical analyses showed a good level of knowledge in 55% of the dentistry faculty students and in 43.5% of the medical faculty students. CONCLUSIONS When considering that dental and medical faculty students are not expected to receive additional training on antimicrobial management after graduation, the findings of this study have raised significant attitude for the improvement of our education system in this field.
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Affiliation(s)
- Kübra Karaçam
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Rahime Zeynep Erdem
- Department of Restorative Dentistry, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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4
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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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5
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. J Nucl Cardiol 2024; 34:101786. [PMID: 38472038 DOI: 10.1016/j.nuclcard.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Clin Infect Dis 2024:ciae046. [PMID: 38466039 DOI: 10.1093/cid/ciae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Ito A, Miyagami T, Suzuki M, Nishina T, Naito T. A Case of Group A Streptococcus Bacteremia and Infective Endocarditis Caused by Right Ovarian Tube Endometriosis Where the Patient's Perspective Was Key to the Diagnostic Process. Cureus 2023; 15:e50081. [PMID: 38186451 PMCID: PMC10770437 DOI: 10.7759/cureus.50081] [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: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Group A streptococcus pyogenes (GAS) is a common organism that can cause upper respiratory infections. We encountered a case where GAS caused infective endocarditis (IE) due to an entry from the vagina. In this case, although echocardiography was negative, we were able to make a diagnosis of IE based on the 2023 Duke International Society for Cardiovascular Infectious Diseases Criteria, and we started antimicrobial therapy for IE. However, the patient subsequently developed persistent abdominal pain, which was atypical; hence, we reviewed the differential diagnosis. It is difficult to locate the primary site of infection because GAS rarely causes vaginal infections, and vaginal infections rarely cause IE. This case highlights the significance of revisiting medical history and the value of using a system 3 approach to refine diagnostic directions.
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Affiliation(s)
- Arisa Ito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN
| | - Taiju Miyagami
- General Medicine, Jyuntendo University Hospital, Tokyo, JPN
| | - Mayu Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN
| | - Tsubasa Nishina
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN
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8
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Comeaux S, Jamison K, Voeltz M. Contemporary Features and Management of Endocarditis. Diagnostics (Basel) 2023; 13:3086. [PMID: 37835829 PMCID: PMC10572623 DOI: 10.3390/diagnostics13193086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Infective endocarditis is a rare but devastating disease. Morbidity and mortality rates have failed to improve despite new technological advances. The disease has evolved over time with new significant populations at risk-most notably those with prosthetic valves or implantable cardiovascular devices. These devices pose new challenges for achieving a timely and accurate diagnosis of infection. While the modified Duke criteria is accepted as the gold standard for diagnosing native valve endocarditis, it has been shown to have significantly inferior sensitivity when it comes to identifying infections related to right-heart endocarditis, prosthetic valves, and indwelling cardiac devices. Additionally, prosthetic valves and cardiovascular implantable electronic devices can exhibit shadowing and artifact, rendering transthoracic echocardiography and transesophageal echocardiography results inconclusive or even normal. Having a keen awareness of the varying clinical presentations, as well as emerging valvular imaging modalities such as F-fluorodeoxyglucose cardiac positron-emission tomography plus computed tomography, promises to improve the evaluation and diagnosis of infective endocarditis. However, indications for appropriate use of these studies and guidance on modern clinical management are still needed.
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Affiliation(s)
- Shelby Comeaux
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Kiara Jamison
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Michele Voeltz
- Department of Cardiology, Northside Cardiovascular Institute, Lawrenceville, GA 30046, USA
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Charles K, Abraham A, Bassi R, Elsadek R, Cockey G. A Rare Case of Bartonella henselae Infective Endocarditis Causing an Embolic Cerebrovascular Accident. Cureus 2023; 15:e41364. [PMID: 37546133 PMCID: PMC10399704 DOI: 10.7759/cureus.41364] [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: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Bartonella is a facultative intracellular Gram-negative aerobic rod that is an important cause of culture-negative endocarditis that only accounts for 3% of all infective endocarditis (IE) cases. Throughout the literature, there have been very few documented cases of an embolic stroke caused by Bartonella henselae (B. henselae) IE. Following a comprehensive review of the literature, it appears that only a small number of articles have reported on the correlation between cerebrovascular accidents (CVAs) and Bartonella IE. Here, we present a case of a 42-year-old male with a cerebral embolic event as a complication of B. henselae IE.
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Affiliation(s)
- Kipson Charles
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Andrew Abraham
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Raghav Bassi
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Rabab Elsadek
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - George Cockey
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
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10
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QUAH KHK, FOO JS, KOH CH. Approach to Cardiac Masses Using Multimodal Cardiac Imaging. Curr Probl Cardiol 2023; 48:101731. [PMID: 37030421 DOI: 10.1016/j.cpcardiol.2023.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
Incidental cardiac masses can pose diagnostic challenges given the numerous differentials, and difficulty in obtaining tissue confirmation without invasive procedures. With recent advancements in cardiac imaging technology, non-invasive efforts to diagnose the intracardiac lesions have become more surmountable. In this paper, we report a case of a patient incidentally found to have an intra-cardiac mass during routine evaluation. Transthoracic echocardiography demonstrated a small mass attached to the tricuspid valve, which was not visualized on follow up cardiac magnetic resonance imaging. Here, we review the currently available cardiac imaging modalities and discuss their values and limitations. From this, we also propose a workflow in the approach to utilizing different imaging modalities to reach a conclusive diagnosis of undifferentiated cardiac masses.
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11
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Wahbah Makhoul G, Mustafa A, Ling J, Asogwa N, Elhosseiny S, Siddiqui FS, Khan S, Lafferty JC, Glaser A. Lactococcus endocarditis after Bentall procedure presenting with intracranial hemorrhage. IDCases 2023; 31:e01710. [PMID: 36845909 PMCID: PMC9945769 DOI: 10.1016/j.idcr.2023.e01710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Background Endocarditis is more common in patients with cardiac prostheses. A Bentall procedure entails surgical replacement of the aortic valve, aortic root, and ascending aorta with re-implantation of coronary arteries into the graft. Case 65-year-old male with history of atrial fibrillation on rivaroxaban, bicuspid aortic valve, and ascending aortic aneurysm with a history of a Bentall procedure two years prior, presented with headache and dysarthria for one day. National Institutes of Health Stroke Scale was 3 and CT head showed 2.7 cm left frontal hematoma with extension into the subarachnoid space. Andexanet alfa was given for rivaroxaban reversal followed by cerebral angiogram which showed 5 mm intracranial inferior MCA aneurysm and embolization and coil placement was done. Blood cultures grew Lactococcus garvieae and transesophageal echocardiogram revealed aortic valve thickening and vegetation on the non-coronary cusp. He was subsequently treated with six weeks of IV ceftriaxone and Gentamycin. Conclusion With increasing use of bioprosthetic valves, the possibility of infective endocarditis with uncommon pathogens should be kept in mind. Lactococcus commonly affects native valves, however it can affect bioprosthetic valves and can present with mycotic aneurysms.
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Affiliation(s)
- Gennifer Wahbah Makhoul
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
- Correspondence to: 475 Seaview Avenue, Staten Island 10305, NY, USA.
| | - Ahmad Mustafa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Joanne Ling
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Nnedindu Asogwa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Sherif Elhosseiny
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Fasih Sami Siddiqui
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Shahkar Khan
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - James C. Lafferty
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Allison Glaser
- Department of Infectious Diseases, Staten Island University Hospital, Staten Island 10305, NY, USA
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12
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Yu SY, Li HL, Tse YK, Li X, Ren QW, Wu MZ, Wong PF, Tse HF, Lip GYH, Yiu KH. Pre-admission and In-Hospital Statin Use is Associated With Reduced Short-Term Mortality in Infective Endocarditis. Mayo Clin Proc 2023; 98:252-265. [PMID: 36114025 DOI: 10.1016/j.mayocp.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/11/2022] [Accepted: 06/02/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate for potential protective effects of statin use among patients with infective endocarditis (IE) with consideration for underlying diseases and bacterial culture - variables which have prognostic implications and show considerable geographic variation yet are unappreciated in previous pharmacoepidemiological studies. PATIENTS AND METHODS Patients diagnosed with IE between January 1, 1996, and December 31, 2019, were identified. We estimated the effect on mortality of pre-admission statin use (≥90 cumulative days of use before index date) and in-hospital use (use beginning within 2 days of admission), compared with nonusers and discontinued users, respectively, through propensity score analytics. RESULTS Of 6700 IE patients (mean age, 58.0 years; 63.3% male [n=4251]), 776 patients had pre-admission statin use, with 626 continuing statin use following admission (in-hospital users). Pre-admission statin users had a 31% lower risk of 1-year mortality (HR, 0.69; 95% CI, 0.58 to 0.82) compared with nonusers. In-hospital users had a 48% lower risk of 1-year mortality (HR, 0.52; 95% CI, 0.34 to 0.78) compared with discontinued users. Subgroup analyses showed significant protective effects of statin use for patients with varying causative agents, underlying diseases, and with or without prosthetic valves. Results were consistent across different statins, and were dose-dependent. CONCLUSION In patients with IE, pre-admission and in-hospital use of statin, when compared with statin nonusers and discontinued users, respectively, were associated with a lower risk of 1-year mortality.
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Affiliation(s)
- Si-Yeung Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xue Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Pui-Fai Wong
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Sakata T, Harada K, Aoyama Y, Saito S, Narita K, Kario K. Infective Endocarditis Revealed after Resolution of COVID-19 Infection. Intern Med 2022; 61:3537-3540. [PMID: 36104198 PMCID: PMC9790774 DOI: 10.2169/internalmedicine.0307-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 34-year-old previously healthy Japanese woman was diagnosed with COVID-19 and treated with remdesivir and dexamethasone. She was discharge but returned the next day due to acute myocardial infarction. Conservative treatment was selected because of an embolic occlusion in the distal portion. Contrast-enhanced computed tomography and brain magnetic resonance imaging revealed a right renal infarction and multiple cerebral embolisms, respectively; she had a fever of 38.9°C that night. Blood culture was positive for methicillin-susceptible Staphylococcus aureus. Transthoracic echocardiography revealed an 11-mm vegetation on the posterior mitral valve leaflet. Native mitral valve infective endocarditis causing multiple embolizations was diagnosed. She underwent surgical mitral valve replacement.
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Affiliation(s)
- Tomohisa Sakata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Kenji Harada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Yutaka Aoyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Shunsuke Saito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Keisuke Narita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Japan
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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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15
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Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Warnqvist A, Krüger Weiner C, Naimi-Akbar A. Infective Endocarditis Among High-risk Individuals Before and After the Cessation of Antibiotic Prophylaxis in Dentistry: A National Cohort Study. Clin Infect Dis 2022; 75:1171-1178. [PMID: 35134867 PMCID: PMC9525079 DOI: 10.1093/cid/ciac095] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A few years after the publication of the British guidelines, national recommendations were published by the Swedish Medical Products Agency in October 2012, promoting the cessation of antibiotic prophylaxis in dentistry for the prevention of infective endocarditis (IE). The aim of this study was to evaluate whether the incidence of oral streptococcal IE increased among high-risk individuals after October 2012. METHODS This nationwide cohort study included all adult individuals (>17 years) living in Sweden from January 2008 to January 2018, with a diagnose code or surgical procedure code indicating high risk of IE. Cox proportional hazard models were performed to calculate adjusted ratios of oral streptococcal IE before and after October 2012 between high-risk individuals and references. RESULTS This study found no increased incidence of oral streptococcal IE among high-risk individuals during the 5 years after the cessation, compared with before. Hazard rate ratios were 15.4 (95% confidence interval [CI]: 8.3-28.5) before and 20.7 (95% CI: 10.0-42.7) after October 2012 for prevalent high-risk individuals. Corresponding ratios for incident high-risk individuals were 66.8 (95% CI: 28.7-155.6) and 44.6 (95% CI: 22.9-86.9). Point estimates for interaction with time period were 1.4 (95% CI: .6-3.5) and 0.8 (95% CI: .5-1.3) for prevalent and incident high-risk individuals, respectively. CONCLUSION The results suggest that the current Swedish recommendation not to administer antibiotic prophylaxis for the prevention of IE in dentistry has not led to an increased incidence of oral streptococcal IE among high-risk individuals.
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Affiliation(s)
- Niko Vähäsarja
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Bodil Lund
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Margareta Hultin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Carina Krüger Weiner
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
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16
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Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
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Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
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Amoateng R, Attah A, Ahmed I, Min Z, Paulson M. Staphylococcus aureus native mitral valve endocarditis associated with bed bug bites - A case report and review of the literature. IDCases 2022; 29:e01517. [PMID: 35663609 PMCID: PMC9160770 DOI: 10.1016/j.idcr.2022.e01517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus aureus is a leading cause of community acquired bacteremia and infective endocarditis. S. aureus is a part of the normal skin flora in approximately one third of the human population. Infective endocarditis due to S. aureus can cause several complications and is associated with increased mortality. A 48-year-old female with no significant medical history presented with S. aureus bacteremia and native mitral valve endocarditis. Multiple cutaneous skin lesions were identified, which she reported were due to recent bed bug bites. No source of infection was found except for the skin lesions. Her hospital course was complicated by pulmonary and cerebral septic emboli, left pleural empyema, and acute renal injury. We suspected the bed bug skin bites were the most likely source of bacteremia. Bed bugs carry many human pathogens but have not been shown to be a competent vector. We did not find any literature on endocarditis associated with bed bug bites; thus, our case will be a novel finding.
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Affiliation(s)
- Richard Amoateng
- Internal Medicine department, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Abraham Attah
- Internal Medicine department, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Ibrahim Ahmed
- Internal Medicine department, Mercy Catholic Medical Center, 1500 Landsowne Ave, Darby, PA 19023, USA
| | - Zaw Min
- Internal Medicine department, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Michelle Paulson
- Internal Medicine department, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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18
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Sousa C, Pinto FJ. Endocardite Infecciosa: Ainda mais Desafios que Certezas. Arq Bras Cardiol 2022; 118:976-988. [PMID: 35613200 PMCID: PMC9368884 DOI: 10.36660/abc.20200798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.
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Cleveland KO, Gelfand MS. Crying "FOWL": Streptococcus gallinaceous infective endocarditis and spinal infection in a chicken farmer. Am J Med Sci 2022; 364:131-133. [PMID: 35390307 DOI: 10.1016/j.amjms.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Kerry O Cleveland
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Michael S Gelfand
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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20
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Diab M, Lehmann T, Bothe W, Akhyari P, Platzer S, Wendt D, Deppe AC, Strauch J, Hagel S, Günther A, Faerber G, Sponholz C, Franz M, Scherag A, Velichkov I, Silaschi M, Fassl J, Hofmann B, Lehmann S, Schramm R, Fritz G, Szabo G, Wahlers T, Matschke K, Lichtenberg A, Pletz MW, Gummert JF, Beyersdorf F, Hagl C, Borger MA, Bauer M, Brunkhorst FM, Doenst T. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation 2022; 145:959-968. [PMID: 35213213 DOI: 10.1161/circulationaha.121.056940] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiac surgery often represents the only treatment option in patients with infective endocarditis (IE). However, IE surgery may lead to a sudden release of inflammatory mediators, which is associated with postoperative organ dysfunction. We investigated the effect of hemoadsorption during IE surgery on postoperative organ dysfunction. METHODS This multicenter, randomized, nonblinded, controlled trial assigned patients undergoing cardiac surgery for IE to hemoadsorption (integration of CytoSorb to cardiopulmonary bypass) or control. The primary outcome (change in sequential organ failure assessment score [ΔSOFA]) was defined as the difference between the mean total postoperative SOFA score, calculated maximally to the 9th postoperative day, and the basal SOFA score. The analysis was by modified intention to treat. A predefined intergroup comparison was performed using a linear mixed model for ΔSOFA including surgeon and baseline SOFA score as fixed effect covariates and with the surgical center as random effect. The SOFA score assesses dysfunction in 6 organ systems, each scored from 0 to 4. Higher scores indicate worsening dysfunction. Secondary outcomes were 30-day mortality, duration of mechanical ventilation, and vasopressor and renal replacement therapy. Cytokines were measured in the first 50 patients. RESULTS Between January 17, 2018, and January 31, 2020, a total of 288 patients were randomly assigned to hemoadsorption (n=142) or control (n=146). Four patients in the hemoadsorption and 2 in the control group were excluded because they did not undergo surgery. The primary outcome, ΔSOFA, did not differ between the hemoadsorption and the control group (1.79±3.75 and 1.93±3.53, respectively; 95% CI, -1.30 to 0.83; P=0.6766). Mortality at 30 days (21% hemoadsorption versus 22% control; P=0.782), duration of mechanical ventilation, and vasopressor and renal replacement therapy did not differ between groups. Levels of interleukin-1β and interleukin-18 at the end of integration of hemoadsorption to cardiopulmonary bypass were significantly lower in the hemoadsorption than in the control group. CONCLUSIONS This randomized trial failed to demonstrate a reduction in postoperative organ dysfunction through intraoperative hemoadsorption in patients undergoing cardiac surgery for IE. Although hemoadsorption reduced plasma cytokines at the end of cardiopulmonary bypass, there was no difference in any of the clinically relevant outcome measures. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03266302.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Thomas Lehmann
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany (W.B., F.B.)
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, Germany (P.A., A.L.)
| | - Stephanie Platzer
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Germany (D.W.)
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Germany (A.-C.D., T.W.)
| | - Justus Strauch
- Department of Cardiac and Thoracic Surgery, Bergmannsheil University Hospitals, Bochum, Germany (J.S.)
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control (S.H., M.W.P.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Albrecht Günther
- Department of Neurology (A.G.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Critical Care Medicine (C.S., M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I (M.F.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - André Scherag
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences (A.S.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Ilia Velichkov
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Miriam Silaschi
- Clinic and Polyclinic for Cardiac Surgery, University Hospital Bonn, Germany (M.S.)
| | - Jens Fassl
- Institute for Cardiac Anesthesiology, Dresden Heart Center, University Hospital at the Technical University Dresden, Germany (J.F.)
| | - Britt Hofmann
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany (B.H., G.S.)
| | - Sven Lehmann
- Department of Cardiac Surgery, Heart Center Leipzig, Germany (S.L., M.A.B.)
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R.S., J.F.G.)
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care and Pain Therapy, Heart Center Brandenburg, Immanuel Clinic Bernau, Germany (G. Fritz)
| | - Gabor Szabo
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany (B.H., G.S.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Germany (A.-C.D., T.W.)
| | - Klaus Matschke
- Department of Cardiac Surgery, Heart Center Dresden, Germany (K.M.)
| | - Artur Lichtenberg
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, Germany (P.A., A.L.)
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control (S.H., M.W.P.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R.S., J.F.G.)
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany (W.B., F.B.)
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Germany (C.H.).,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (C.H.)
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Germany (S.L., M.A.B.)
| | - Michael Bauer
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Department of Anesthesiology and Critical Care Medicine (C.S., M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Frank M Brunkhorst
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
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21
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Beshai R, Weinberg H. A Rare Case of a Failed AngioVac Procedure Used to Debride Tricuspid Vegetation Complicated by Ogilvie Syndrome. Cureus 2022; 14:e23584. [PMID: 35494958 PMCID: PMC9045840 DOI: 10.7759/cureus.23584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/05/2022] Open
Abstract
Ogilvie syndrome is a rare disorder characterized by dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. Its etiology is likely multifactorial with high mortality if left untreated. Here, we report for the first time a case of Ogilvie syndrome secondary to the AngioVac procedure. Because our patient had a high operative risk, we used the AngioVac system to debulk tricuspid valve vegetations to reduce bacterial load. Although AngioVac is considered safe overall, publications describing its side effects, safety, and efficacy are limited. Providers should be aware of this rare but potentially fatal complication and the importance of close clinical monitoring and serial abdominal examinations following AngioVac procedures.
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22
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Urina-Jassir M, Jaimes-Reyes MA, Martinez-Vernaza S, Quiroga-Vergara C, Urina-Triana M. Clinical, Microbiological, and Imaging Characteristics of Infective Endocarditis in Latin America: A Systematic Review. Int J Infect Dis 2022; 117:312-321. [PMID: 35181535 DOI: 10.1016/j.ijid.2022.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We aimed to describe the clinical, microbiological, and imaging characteristics of patients with infective endocarditis (IE) in studies from Latin America (LATAM). METHODS A systematic search through PubMed, EMBASE, LILACS, and SciELO from inception until February 2021 was conducted. We included observational studies that assessed adults with IE from LATAM and reported data on clinical, microbiological, or imaging characteristics. Data were independently extracted by 2 authors and the risk of bias was evaluated by study design with its respective tool. Findings were summarized using descriptive statistics. RESULTS Forty-four studies were included. Most cases were male (68.5%), had a predisposing condition including valve disease (24.3%), or had a prosthetic valve (23.4%). Clinical manifestations included fever (83.9%), malaise (63.2%), or heart murmur (57.7%). A total of 36.4% and 27.1% developed heart failure or embolism, respectively. Blood cultures were negative in 23.9% and S. aureus (18.6%) and the viridans group streptococci (17.8%) were the most common isolates. Most cases were native valve IE (67.3%) affecting mainly left-sided valves. Echocardiographic findings included vegetations (84.3%) and regurgitation (75.9%). In-hospital mortality was 25.1%. CONCLUSIONS This is the first systematic review that evaluated the characteristics of IE in LATAM patients. A lack of multicenter studies reflects the need for these studies in LATAM.
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Affiliation(s)
- Manuel Urina-Jassir
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Maria Alejandra Jaimes-Reyes
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Samuel Martinez-Vernaza
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Camilo Quiroga-Vergara
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Miguel Urina-Triana
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia; Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 59 # 59 - 65, Barranquilla, Atlántico, Colombia.
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23
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Talha KM, Dayer MJ, Thornhill MH, Tariq W, Arshad V, Tleyjeh IM, Bailey KR, Palraj R, Anavekar NS, Rizwan Sohail M, DeSimone DC, Baddour LM. Temporal Trends of Infective Endocarditis in North America From 2000 to 2017-A Systematic Review. Open Forum Infect Dis 2021; 8:ofab479. [PMID: 35224128 PMCID: PMC8864733 DOI: 10.1093/ofid/ofab479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%. Conclusions The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Epidemiology, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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24
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Talha KM, Baddour LM, Thornhill MH, Arshad V, Tariq W, Tleyjeh IM, Scott CG, Hyun MC, Bailey KR, Anavekar NS, Palraj R, Sohail MR, DeSimone DC, Dayer MJ. Escalating incidence of infective endocarditis in Europe in the 21st century. Open Heart 2021; 8:e001846. [PMID: 34670832 PMCID: PMC8529987 DOI: 10.1136/openhrt-2021-001846] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe. METHODS A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence. RESULTS Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%. CONCLUSION Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase. TRIAL REGISTERATION NUMBER CRD42020191196.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin H Thornhill
- School of Clinical Dentistry, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Meredith C Hyun
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Dayer
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
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25
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Desai AK, Bonura EM. Multi-valvular infective endocarditis from Gemella morbillorum. BMJ Case Rep 2021; 14:14/7/e242093. [PMID: 34301680 PMCID: PMC8311319 DOI: 10.1136/bcr-2021-242093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gemella morbillorum is increasingly implicated in infectious endocarditis. Our patient presented with anaemia and renal failure with evidence of infarcts and embolic disease. He was found to have endocarditis with an organism that could not speciate with standard culture methods requiring matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) for identification and susceptibilities. While involvement of mitral and aortic valves can be expected with Gemella, he had rare involvement of the pulmonic valve in a structurally normal heart. Although bacteriological cure was achieved, due to the locally destructive nature of Gemella, he ultimately required valve replacements for heart failure resolution. Workup for commonly implicated pathologies associated with G. morbillorum led to suspicion of gastrointestinal malignancy with findings of occult bleeding prompting an ongoing evaluation. With improved access to advanced diagnostics, G. morbillorum has been increasingly identified in infectious endocarditis. Given its destructive nature, it is important for clinicians to consider this organism is difficult to identify isolates.
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Affiliation(s)
- Anish Kumar Desai
- Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Murchan Bonura
- Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
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26
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Dagher MM, Eichenberger EM, Addae-Konadu KL, Dotters-Katz SK, Kohler CL, Fowler VG, Federspiel JJ. Maternal and fetal outcomes associated with infective endocarditis in pregnancy. Clin Infect Dis 2021; 73:1571-1579. [PMID: 34111290 DOI: 10.1093/cid/ciab533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is a rare but serious infection complicating pregnancy. Little is known about IE management and outcomes in this population. METHODS The National Readmissions Database was used to obtain data between October 2015 and October 2018. Billing codes identified admissions for IE in female patients of reproductive age. Demographic characteristics, comorbidities, and outcomes were compared between a) patients with maternity-associated and non-maternity associated IE, and b) obstetric patients who delivered with and without IE. Weighted regressions were used to examine outcomes in adjusted models. RESULTS We identified 12,602 reproductive-aged female patients with a diagnosis of IE, of which 382 (weighted national estimate: 748) were maternity-associated. Of these cases, 117 (weighted national estimate: 217) occurred during a delivery admission. Compared to patients with non-maternity-associated IE, maternity-associated infection was associated with younger age (mean 29.0 vs. 36.6 years, P < 0.001), Medicaid coverage (72.5% vs. 47.2%, P < 0.001), and drug use (76.2% vs. 59.8%, P < 0.001). Mortality was comparable (8.1% vs. 10.6%, aRR = 1.03, 95% CI 0.71-1.48). Compared to patients delivering without IE, IE complicating delivery was associated with worse maternal and fetal outcomes, including maternal mortality (17.2% vs. <0.01%, aRR = 323.32, 95% CI 127.74-818.37) and preterm birth (55.7% vs. 10.1%, aRR = 3.61, 95% CI 2.58-5.08). CONCLUSION Maternity-associated IE does not appear to confer additional risk for adverse outcome over non-maternity-associated infection. Patients delivering with IE have worse maternal and fetal outcomes than those whose deliveries are not complicated by IE.
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Affiliation(s)
- Michael M Dagher
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily M Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Kateena L Addae-Konadu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Celia L Kohler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jerome J Federspiel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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The emergence of Staphylococcus aureus as the primary cause of cardiac device-related infective endocarditis. Infection 2021; 49:999-1006. [PMID: 34089482 DOI: 10.1007/s15010-021-01634-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increasing use of cardiovascular implantable electronic devices (CIED), as permanent pacemakers (PPM), implantable cardioverter defibrillators (ICD), or cardiac resynchronization therapy (CRT), is associated with the emergence of CIED-related infective endocarditis (CIED-IE). We aimed to characterize CIED-IE profile, temporal trends, and prognostic factors. METHODS CIED-IE diagnosed at Rennes University Hospital during years 1992-2017 were identified through computerized database, and included if they presented all of the following: (1) clinical signs of infection; (2) microbiological documentation through blood and/or CIED lead cultures; (3) lead or valve vegetation, or definite IE according to Duke criteria. Data were retrospectively extracted from medical charts. The cohort was categorized in three periods: 1992-1999, 2000-2008, and 2009-2017. RESULTS We included 199 patients (51 women, 148 men, median age 73 years [interquartile range, 64-79]), with CIED-IE: 158 PPMs (79%), 24 ICD (12%), and 17 CRT (9%). Main pathogens were coagulase-negative staphylococci (CoNS: n = 86, 43%), Staphylococcus aureus (n = 60, 30%), and other Gram-positive cocci (n = 28, 14%). Temporal trends were remarkable for the decline in CoNS (P = 0.002), and the emergence of S. aureus as the primary cause of CIED-IE (24/63 in 2009-2017, 38%). Factors independently associated with one-year mortality were chronic obstructive pulmonary disease (COPD: hazard ratio 3.84 [1.03-6.02], P = 0.03), left-sided endocarditis (HR 2.25 [1.09-4.65], P = 0.03), pathogens other than CoNS (HR 3.16 [1.19-8.39], P = 0.02), and CIED removal/reimplantation (HR 0.41 [0.20-0.83], P = 0.01). CONCLUSIONS S. aureus has emerged as the primary cause of CIED-IE. Left-sided endocarditis, COPD, pathogens other than CoNS, and no CIED removal/reimplantation are independent risk factors for one-year mortality.
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mohamed M, Scholle T. Bilateral Central Retinal Artery Occlusion in Infective Endocarditis. JOURNAL OF VITREORETINAL DISEASES 2021; 5:261-265. [PMID: 37006508 PMCID: PMC9979040 DOI: 10.1177/2474126420960903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This report describes a patient with bilateral, sequential central retinal artery occlusions (CRAOs) due to infective endocarditis (IE). Methods: A case report is presented. Results: A 35-year-old man with IE who recently completed a course of intravenous antibiotic therapy presented with sudden right-eye vision loss. Examination revealed hand motion vision, a cherry-red spot in the macula in the right eye, and an embolus in the inferotemporal arcade of the left eye. The diagnosis of right-eye CRAO secondary to IE was made, with the presumed source being his dental caries. The patient was admitted with plans for aortic valve replacement and dental extraction. During his hospitalization, the patient suffered from a CRAO in his left eye, resulting in bilateral loss of vision. Conclusions: IE can have severe embolic complications; prompt diagnosis and treatment medically and surgically are necessary to reduce further morbidity and mortality.
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Affiliation(s)
- Mohamed Mohamed
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Tahira Scholle
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
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Kimmel SD, Walley AY, Linas BP, Kalesan B, Awtry E, Dobrilovic N, White L, LaRochelle M. Effect of Publicly Reported Aortic Valve Surgery Outcomes on Valve Surgery in Injection Drug- and Non-Injection Drug-Associated Endocarditis. Clin Infect Dis 2021; 71:480-487. [PMID: 31598642 PMCID: PMC7384313 DOI: 10.1093/cid/ciz834] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Injection drug use-associated infective endocarditis (IDU-IE) is rising and valve surgery is frequently indicated. The effect of initiating public outcomes reporting for aortic valve surgery on rates of valve surgery and in-hospital mortality for endocarditis is not known. METHODS For an interrupted time series analysis, we used data from the National Inpatient Sample, a representative sample of United States inpatient hospitalizations, from January 2010 to September 2015. We included individuals aged 18-65 with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of endocarditis. We defined IDU-IE using a validated combination of ICD-9 codes. We used segmented logistic regression to assess for changes in valve replacement and in-hospital mortality rates after the public reporting initiation in January 2013. RESULTS We identified 7322 hospitalizations for IDU-IE and 23 997 for non-IDU-IE in the sample, representing 36 452 national IDU-IE admissions and 119 316 non-IDU admissions, respectively. Following the implementation of public reporting in 2013, relative to baseline trends, the odds of valve replacement decreased by 4.0% per quarter (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99), with no difference by IDU status. The odds of an in-patient death decreased by 2.0% per quarter for both IDU-IE and non-IDU-IE cases following reporting (OR 0.98, 95% CI 0.97-0.99). CONCLUSIONS Initiating public reporting was associated with a significant decrease in valve surgery for all IE cases, regardless of IDU status, and a reduction in-hospital mortality for patients with IE. Patients with IE may have less access to surgery as a consequence of public reporting. To understand how reduced valve surgery impacts overall mortality, future studies should examine the postdischarge mortality rate.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,Massachusetts Department of Public Health, Boston, Massachusetts, USA.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bindu Kalesan
- Boston University School of Medicine, Boston, Massachusetts, USA.,Section of Preventative Medicine and Epidemiology, Department of Medicine Boston, Massachusetts, USA
| | - Eric Awtry
- Boston University School of Medicine, Boston, Massachusetts, USA.,Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center Boston, Massachusetts, USA
| | - Nikola Dobrilovic
- Boston University School of Medicine, Boston, Massachusetts, USA.,Section of Cardiac Surgery, Department of Surgery, Boston Medical Center Boston, Massachusetts, USA
| | - Laura White
- Department of Biostatistics, Boston University School of Public Health Boston, Massachusetts, USA
| | - Marc LaRochelle
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
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Yakut K, Ecevit Z, Tokel NK, Varan B, Ozkan M. Infective Endocarditis in Childhood: a Single-Center Experience of 18 Years. Braz J Cardiovasc Surg 2021; 36:172-182. [PMID: 33113327 PMCID: PMC8163273 DOI: 10.21470/1678-9741-2020-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
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Affiliation(s)
- Kahraman Yakut
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Zafer Ecevit
- Department of Pediatric Infectious Diseases, Baskent University School of Medicine, Ankara, Turkey
| | - Niyazi Kursad Tokel
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Birgul Varan
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Murat Ozkan
- Department of Cardiovascular Surgery, Baskent University School of Medicine, Ankara, Turkey
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Sousa C, Nogueira P, Pinto FJ. Insight into the epidemiology of infective endocarditis in Portugal: a contemporary nationwide study from 2010 to 2018. BMC Cardiovasc Disord 2021; 21:138. [PMID: 33726669 PMCID: PMC7962378 DOI: 10.1186/s12872-021-01937-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal. METHODS A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018. RESULTS 7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p < 0.001) and increased with age, peaking at patients 80 years old or older (40.62 per 100,000). In-hospital mortality rate significantly increased during the analyzed period, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, and acute renal failure. Younger age and cardiac surgery had a protective effect towards a fatal outcome. CONCLUSIONS In Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. Also, a significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.
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Affiliation(s)
- Catarina Sousa
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal. .,Serviço de Cardiologia, Centro Hospitalar Barreiro Montijo (CHBM), EPE, Barreiro, Portugal.
| | - Paulo Nogueira
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Instituto Medicina Preventiva E Saúde Publica, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon, 1649-028, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal.,Departamento Do Coração E Vasos, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
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Surgery for infective endocarditis-analysis of factors affecting outcome. Indian J Thorac Cardiovasc Surg 2021; 37:381-391. [PMID: 34220021 DOI: 10.1007/s12055-021-01137-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Despite advances in medical care, infective endocarditis (IE) has high mortality. Surgery for IE though recommended for complications of the disease is still not commonly offered due to conflicting reports in the literature. We reviewed our results of surgery for IE from the last 5 years to assess their outcome. Methods A retrospective review from a single center of consecutive patients who underwent surgery for infective endocarditis from September 2014 to December 2019 was done. Data was collected from hospital records and follow-up done up to May 2020. Outcomes evaluated were mortality, follow-up survival, and postoperative complications. Factors affecting mortality and survival were analyzed. Results Ninety-seven patients underwent surgery for IE during this period. Seventy-nine had native valve endocarditis (NVE) and 18 had prosthetic valve endocarditis (PVE). The overall postoperative mortality was 13%, with mortality for native valve endocarditis being 11% and that for prosthetic valve endocarditis being 22%, which was not statistically significant. Three-year survival for the overall group was 88.7% with 88.1% for NVE and 91.7% for PVE. Multivariate predictors of operative mortality were a high EuroSCORE II, diabetes mellitus, and the presence of Staphylococcus organism. Conclusion Surgery for infective endocarditis has a very acceptable early outcome and intermediate-term survival.
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The burden of infective endocarditis in Portugal in the last 30 years – a systematic review of observational studies. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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de Sousa C, Ribeiro RM, Pinto FJ. The burden of infective endocarditis in Portugal in the last 30 years - a systematic review of observational studies. Rev Port Cardiol 2021; 40:205-217. [PMID: 33648807 DOI: 10.1016/j.repc.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Infective endocarditis affects cardiac valves or devices and has a potentially uncertain prognosis. Little information is available on the epidemiology of this disease in Portugal. OBJECTIVE A systematic review of all evidence published in the last 30 years to assess epidemiological data in patients hospitalized with infective endocarditis in Portuguese hospital centers. METHODS Extensive search of all published evidence using Medline, Scopus, general search databases and in addition Portuguese medical journals was performed. All relevant studies in Portuguese or English that reported short- or long-term mortality were included. RESULTS Eighteen retrospective cohort studies (15 medical and three surgical series) were included with a total of 1872 patients assessed. The medical series included 1279 patients. Older males with predominant native left heart valve involvement were identified. Staphylococcus and streptococcus were the most frequent reported pathogens. Surgical intervention was performed on average in 29.8% of cases. The short-term mortality rate ranged from three to 37.2% (average 21.9%). Surgical cases involved older males with affected native left heart valves, emergent/urgent indication was dominant and short-term mortality ranged from 13.6 to 16%. CONCLUSIONS The current study provides a descriptive analysis of the published series of infective endocarditis in Portugal over the last 30 years. Therefore, it may serve as a starting point for the development and implementation of a multicentric prospective registry on infective endocarditis patients in Portugal that will allow a better and more accurate characterization of this special patient population.
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Affiliation(s)
- Catarina de Sousa
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Cardiologia, Centro Hospitalar Barreiro Montijo (CHBM), EPE, Barreiro, Portugal.
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Departamento Coração e Vasos, Centro Hospitalar e Universitário Lisboa Norte (CHULN), EPE, Lisboa, Portugal
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lucaj J, Paik P, Siddiqui N, Miller A, Patel K, Desai R, Krishnan S. Echocardiography to Diagnose an Evolving Sinus of Valsalva Fistula From Infective Endocarditis. J Cardiothorac Vasc Anesth 2021; 36:231-235. [PMID: 33563531 DOI: 10.1053/j.jvca.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jon Lucaj
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Peter Paik
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Nazia Siddiqui
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Ashley Miller
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Kinjal Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Healthcare, One Cooper Plaza, Camden, NJ
| | - Ronak Desai
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Healthcare, One Cooper Plaza, Camden, NJ
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
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Liu S, Bae M, Hao L, Oh JK, White AR, Min Y, Cisneros-Zevallos L, Akbulut M. Bacterial Antifouling Characteristics of Helicene-Graphene Films. NANOMATERIALS 2021; 11:nano11010089. [PMID: 33401616 PMCID: PMC7830421 DOI: 10.3390/nano11010089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2020] [Accepted: 01/01/2021] [Indexed: 12/12/2022]
Abstract
Herein, we describe interfacially-assembled [7]helicene films that were deposited on graphene monolayer using the Langmuir-Schaefer deposition by utilizing the interactions of nonplanar (helicene) and planar (graphene) π–π interactions as functional antifouling coatings. Bacterial adhesion of Staphylococcus aureus on helicene—graphene films was noticeably lower than that on bare graphene, up to 96.8% reductions in bacterial adhesion. The promising bacterial antifouling characteristics of helicene films was attributed to the unique molecular geometry of helicene, i.e., nano-helix, which can hinder the nanoscale bacterial docking processes on a surface. We envision that helicene—graphene films may eventually be used as protective coatings against bacterial antifouling on the electronic components of clinical and biomedical devices.
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Affiliation(s)
- Shuhao Liu
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, TX 77843, USA; (S.L.); (M.B.)
| | - Michael Bae
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, TX 77843, USA; (S.L.); (M.B.)
| | - Li Hao
- School of Chemistry and Chemical Engineering, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China;
| | - Jun Kyun Oh
- Department of Polymer Science and Engineering, Dankook University, 152 Jukjeon-ro, Suji-gu, Yongin-si 16890, Korea;
| | - Andrew R. White
- Department of Chemical and Environmental Engineering, University of California, Riverside, CA 92521, USA; (A.R.W.); (Y.M.)
| | - Younjin Min
- Department of Chemical and Environmental Engineering, University of California, Riverside, CA 92521, USA; (A.R.W.); (Y.M.)
| | - Luis Cisneros-Zevallos
- Department of Horticultural Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Mustafa Akbulut
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, TX 77843, USA; (S.L.); (M.B.)
- Correspondence:
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Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020; 76:2982-3021. [PMID: 33309175 PMCID: PMC7755038 DOI: 10.1016/j.jacc.2020.11.010] [Citation(s) in RCA: 4193] [Impact Index Per Article: 1048.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.
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Affiliation(s)
| | - George A Mensah
- National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA.
| | - Catherine O Johnson
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | | | - Noël C Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | | | - Emelia J Benjamin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Aimé Bonny
- District Hospital of Bonassama-University of Douala, Douala, Cameroon
| | - Michael Brauer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sumeet S Chugh
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California, USA
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Criqui
- University of California at San Diego, San Diego, California, USA
| | - Nicole DeCleene
- The University of Michigan Samuel and Jean Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Kim A Eagle
- The University of Michigan Samuel and Jean Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Sophia Emmons-Bell
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | - Gerry Fowkes
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - Scott M Grundy
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Feng J He
- Queen Mary University of London, London, United Kingdom
| | - George Howard
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Frank Hu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley Inker
- Tufts Medical Center, Boston, Massachusetts, USA
| | - Ganesan Karthikeyan
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Carl Lavie
- Ochsner Health, New Orleans, Louisiana, USA
| | - Donald Lloyd-Jones
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hong S Lu
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Antonio Mirijello
- IRCCS Casa Sollievo della Sofferenza Hospital, Department of Medical Sciences, San Giovanni Rotondo, Italy
| | - Awoke Misganaw Temesgen
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Ali Mokdad
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Andrew E Moran
- Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Muntner
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Neal
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | | | | | | | | | - Michael Pratt
- University of California at San Diego, San Diego, California, USA
| | - Sanjay Rajagopalan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Marissa Reitsma
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy Rigotti
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anthony Rodgers
- The George Institute for Global Health, Newtown, New South Wales, Australia; Imperial College of London, London, United Kingdom
| | - Craig Sable
- Children's National Hospital, Washington, DC, USA
| | - Saate Shakil
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | - Theo Vos
- University of Washington, Seattle, Washington, USA
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Magdi Yacoub
- Imperial College of London, London, United Kingdom
| | - Liesl Zuhlke
- University of Cape Town, Cape Town, South Africa
| | - Christopher Murray
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Mihos CG, Nappi F. A narrative review of echocardiography in infective endocarditis of the right heart. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1622. [PMID: 33437821 PMCID: PMC7791248 DOI: 10.21037/atm-20-5198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infective endocarditis (IE) is characterized by bacterial or fungal masses that form in the cardiac chambers and valves, and in severe cases invade the endocardium or intra-cardiac vessels. Right-sided IE accounts for 5% to 10% of cases, with a low mortality cited at 6%. A history of intravenous drug abuse (IVDU) is present in 90% of isolated right-sided IE cases, with normal intra-cardiac anatomy prior to infection in approximately 80%. Nevertheless, up to 50% of patients require early surgical intervention which is associated with significant peri-operative morbidity. Echocardiography is the gold standard for diagnosis with a sensitivity of 80% for the transthoracic modality and 95% for transesophageal studies; it provides important clinical information regarding the severity of infection and development of secondary complications. This includes identification of active infective vegetations, healed IE, prosthetic valve IE, and abscess formation and rupture. Prompt clinical, microbiologic, and imaging assessment of patients with suspected left or right-sided IE is of paramount importance and is reflected in the modified Duke criteria, the well-validated algorithm for accurate and timely diagnosis of IE. Data suggests the criteria sensitivity may be decreased in right-sided IE only, and thus, care must be taken to perform skilled and detailed echocardiographic assessments of the right heart in suspected cases. Herein we provide a review of IE of the right heart, with a focus on pathophysiology and its echocardiographic presentation and characteristics.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Impact of referral bias on prognostic studies outcomes: insights from a population-based cohort study on infective endocarditis. Ann Epidemiol 2020; 54:29-37. [PMID: 32950657 DOI: 10.1016/j.annepidem.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Prognostic studies derived from samples of patients managed in tertiary hospitals are subject to referral bias. We aimed to characterize this bias using the example of infective endocarditis. METHODS We analyzed data from a French population-based cohort, which included 497 patients with infective endocarditis. Patients were admitted directly to a tertiary hospital (Group T), admitted to a non-tertiary hospital and referred to a tertiary hospital (Group NTT) or not (Group NT). We compared patients' characteristics, survival rates and prognostic factors between groups. RESULTS Compared with Group T (n = 291), NTT patients (n = 144) were more often males (81.3% vs. 72.5%; P = .046), injection drug users (9.7% vs. 4.5%; P = .033), and had more frequent surgical indications (78.5% vs. 64.3%; P = .003). Compared with Group NT (n = 62), NTT patients were more often males (81.3% vs. 67.7%; P = .034) and had surgical indications more often (78.5% vs. 19.4%; P < .001). One-year survival was higher in NTT + T patients than in NT patients (73.0% vs. 56.1%; P = .01). Prognostic factors and hazard ratios estimates varied across groups. CONCLUSIONS When derived from samples mixing patients admitted directly and those referred to tertiary hospitals, validity of characteristics description, survival estimates, and hazard ratios is threatened by referral bias.
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Kousa O, Walters RW, Saleh M, Awad D, Qasim A, Guddeti RR, Smer A. Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database. J Card Surg 2020; 35:2611-2617. [PMID: 32720363 DOI: 10.1111/jocs.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although the standard treatment of infective endocarditis (IE) is antimicrobial therapy, surgical intervention is required in some cases. However, the optimal timing of surgery remains unclear. Hence, we conducted a population-based analysis using the National Inpatient Sample (NIS) database to assess the outcomes of early versus late surgery in patients with native valve IE. METHODS We queried the NIS database for all hospitalized patients between 2006 and 2016 with a primary diagnosis of IE who had cardiac surgery. We stratified surgery as early ≤7 or late >7 days of admission. Multivariable logistic regression models were used to assess in-hospital mortality and postoperative complications. Length of stay (LOS) and total hospital cost (HC) were evaluated using multivariable log-normal regression models. RESULTS A total of 13 056 patients (57.6% in the early group and 42.4% in the late group) were included. The in-hospital mortality rate in the early group was 5.0% compared to 5.4% in the late intervention group (adjusted odds ratio, 1.20, 95% confidence interval [CI] 0.79-1.81). Overall median LOS was reduced in the early group by 48.2% (95% CI, 46.5%-49.9%, 12.4 days in the early group and 25.9 days in late group), as well as HC which was reduced in the early group by 28.3% (95% CI, 26.0%-30.6%). CONCLUSION Among patients with native valve IE who needed cardiac surgery, the time of surgical intervention did not affect the in-hospital mortality. However, early surgery was associated with significantly shorter LOS and lower HC.
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Affiliation(s)
- Omar Kousa
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Division of Clinical Research and Evaluation Science, Creighton University School of Medicine, Omaha, Nebraska
| | - Mohammed Saleh
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Dana Awad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Abdallah Qasim
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Raviteja R Guddeti
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Aiman Smer
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
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Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc 2020; 9:e017293. [PMID: 32700630 PMCID: PMC7792231 DOI: 10.1161/jaha.120.017293] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
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Martin DR, Witten JC, Tan CD, Rodriguez ER, Blackstone EH, Pettersson GB, Seifert DE, Willard BB, Apte SS. Proteomics identifies a convergent innate response to infective endocarditis and extensive proteolysis in vegetation components. JCI Insight 2020; 5:135317. [PMID: 32544089 DOI: 10.1172/jci.insight.135317] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis is a life-threatening infection of heart valves and adjacent structures characterized by vegetations on valves and other endocardial surfaces, with tissue destruction and risk of embolization. We used high-resolution mass spectrometry to define the proteome of staphylococcal and non-staphylococcal vegetations and Terminal Amine Isotopic Labeling of Substrates (TAILS) to define their proteolytic landscapes. These approaches identified over 2000 human proteins in staphylococcal and non-staphylococcal vegetations. Individual vegetation proteomes demonstrated comparable profiles of quantitatively major constituents that overlapped with serum, platelet, and neutrophil proteomes. Staphylococcal vegetation proteomes resembled one another more than the proteomes of non-staphylococcal vegetations. TAILS demonstrated extensive proteolysis within vegetations, with numerous previously undescribed cleavages. Several proteases and pathogen-specific proteins, including virulence factors, were identified in most vegetations. Proteolytic peptides in fibronectin and complement C3 were identified as potential infective endocarditis biomarkers. Overlap of staphylococcal and non-staphylococcal vegetation proteomes suggests a convergent thrombotic and immune response to endocardial infection by diverse pathogens. However, the differences between staphylococcal and non-staphylococcal vegetations and internal variance within the non-staphylococcal group indicate that additional pathogen- or patient-specific effects exist. Pervasive proteolysis of vegetation components may arise from vegetation-intrinsic proteases and destabilize vegetations, contributing to embolism.
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Affiliation(s)
- Daniel R Martin
- Department of Biomedical Engineering, Lerner Research Institute
| | - James C Witten
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | - Carmela D Tan
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, and
| | - E Rene Rodriguez
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, and
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | | | - Belinda B Willard
- Proteomics and Metabolomics Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel S Apte
- Department of Biomedical Engineering, Lerner Research Institute
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Infective endocarditis in elderly and very elderly patients. Aging Clin Exp Res 2020; 32:1383-1388. [PMID: 31429005 DOI: 10.1007/s40520-019-01314-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
AIMS To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65-79 years, and 80 years or older. METHODS An observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017. RESULTS Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65-79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65-79 years (3.6%) than in younger (23.1%; p = 0.047) or older (38.9%; p = 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65-79 year age group [64.3% compared to 15.4% (p < 0.001) in the youngest group, and 33.3% (p = 0.04) in the oldest]. Surgical interventions were similar in patients aged 65-79 (50%) and under 65 years (42.3%), but less common in people over 80 years (16.7%; p = 0.022). CONCLUSIONS The characteristics of infective endocarditis are different in patients aged 65-79 years and in those over 80 years.
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Tagliari AP, Steckert GV, da Silveira LMV, Kochi AN, Wender OCB. Infective endocarditis profile, prognostic factors and in-hospital mortality: 6-year trends from a tertiary university center in South America. J Card Surg 2020; 35:1905-1911. [PMID: 32598521 DOI: 10.1111/jocs.14787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis (IE) remains an expressive health problem with high morbimortality rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries. AIM This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors. METHODS An observational, retrospective study of 167 patients, who fulfilled modified Duke's criteria during a six-year enrollment period, from January 2010 to December 2015. The primary outcome was defined as in-hospital mortality analyzed according to treatment received (clinical vs surgical). Multivariate analysis identified mortality predictors. RESULTS The median age was 60 years (Q1 -Q3 50-71), and 66% were male. Echocardiogram demonstrated vegetations in 90.4%. An infective agent was identified in 76.6%, being Staphylococcus aureus (19%), Enterococcus (12%), coagulase-negative staphylococci (10%), and Streptococcus viridans (9.6%) the most prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4% to 34.1%, in clinical and surgical patients, respectively (P = .047). On multivariate analysis, diabetes mellitus (odds ratio [OR], 2.5), previous structural heart disease (OR, 3.1), and mitral valve infection (OR, 2.1) were all-cause death predictors. Surgical treatment was the only variable related to a better outcomes (OR, 0.45; 95% Confidence Interval, 0.2-0.9). CONCLUSION This study presents IE profile and all-cause mortality in a large patient's cohort, comprising a 6-years' time window, a rare initiative in developing countries. Elderly and male patients predominated, while S. aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.
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Affiliation(s)
- Ana Paula Tagliari
- Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Cardiovascular Surgery Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | | | - Adriano Nunes Kochi
- Department of Internal Medicine, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
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Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Krüger Weiner C, Naimi-Akbar A. Incidence of infective endocarditis caused by viridans group streptococci in Sweden - effect of cessation of antibiotic prophylaxis in dentistry for risk individuals. J Oral Microbiol 2020; 12:1768342. [PMID: 33014311 PMCID: PMC7520904 DOI: 10.1080/20002297.2020.1768342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction In October 2012, the Swedish Medical Products Agency published new recommendations for the cessation of prophylactic antibiotics in dentistry for the prevention of infective endocarditis (IE). Previously, 2 g of amoxicillin per os would be administered 1 h before invasive dental procedures to patients with valve prosthesis, complicated heart valve disease, and to those with previous endocarditis. Objectives The aim of this study was to evaluate whether the total incidence of IE caused by oral viridans group streptococci (VGS) or IE caused by staphylococci, increased in Sweden after the introduction of the new recommendations. Methods The incidence of IE in Sweden before and after October 2012 was calculated and compared using an interrupted time series analysis. Separate analyses were conducted for the total incidence of IE, and IE caused by VGS or Staphylococcus aureus. Cases of IE were identified using the Swedish national registry of IE, which has existed since 1995 and contains data from all Swedish hospital clinics specialising in infectious disease. All cases with hospital admission date from the 1st of Jan 2008, to the 31st of Dec 2017 were included. The incidence calculations were corrected for annual changes in population size using data from the Swedish government agency Statistics Sweden. Results The results show no statistically significant increase in the slope of the trend line of the total incidence of IE, IE caused by VGS or S. aureus in the Swedish general population after October 2012, compared to before. Conclusion The results suggest that the recommended cessation of prophylactic antibiotics for the prevention of IE in dentistry has not led to an increased incidence of IE caused by oral streptococci among the Swedish population.
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Affiliation(s)
- Niko Vähäsarja
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukelands University Hospital, Bergen, Norway
| | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, Unit for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Carina Krüger Weiner
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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Shah ASV, McAllister DA, Gallacher P, Astengo F, Rodríguez Pérez JA, Hall J, Lee KK, Bing R, Anand A, Nathwani D, Mills NL, Newby DE, Marwick C, Cruden NL. Incidence, Microbiology, and Outcomes in Patients Hospitalized With Infective Endocarditis. Circulation 2020; 141:2067-2077. [PMID: 32410460 PMCID: PMC7306256 DOI: 10.1161/circulationaha.119.044913] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology, and outcomes of infective endocarditis and the effect of changes in national antibiotic prophylaxis guidelines on incident infective endocarditis. Methods: Using a Scotland-wide, individual-level linkage approach, all patients hospitalized with infective endocarditis from 1990 to 2014 were identified and linked to national microbiology, prescribing, and morbidity and mortality datasets. Linked data were used to evaluate trends in the crude and age- and sex-adjusted incidence and outcomes of infective endocarditis hospitalizations. From 2008, microbiology data and associated outcomes adjusted for patient demographics and comorbidity were also analyzed. An interrupted time series analysis was performed to evaluate incidence before and after changes to national antibiotic prophylaxis guidelines. Results: There were 7638 hospitalizations (65±17 years, 51% females) with infective endocarditis. The estimated crude hospitalization rate increased from 5.3/100 000 (95% CI, 4.8-5.9) to 8.6/100 000 (95% CI, 8.1–9.1) between 1990 and 1995 but remained stable thereafter. There was no change in crude incidence following the 2008 change in antibiotic prophylaxis guidelines (relative risk of change 1.06 [95% CI, 0.94–1.20]). The incidence rate in patients >80 years of age doubled from 1990 to 2014 (17.7/100 000 [95% CI, 13.4–23.3] to 37.9/100 000 [95% CI, 31.5–45.5]). The predicted 1-year age- and comorbidity-adjusted case fatality rate for a 65-year-old patient decreased in women (27.3% [95% CI, 24.6–30.2] to 23.7% [95% CI, 21.1–26.6]) and men (30.7% [95% CI, 27.7–33.8] to 26.8% [95% CI, 24.0–29.7]) from 1990 to 2014. Blood culture data were available from 2008 (n=2267/7638, 30%), with positive blood cultures recorded in 42% (950/2267). Staphylococcus (403/950, 42.4%) and streptococcus (337/950, 35.5%) species were most common. Staphylococcus aureus and enterococcus had the highest 1-year mortality (adjusted odds ratio 4.34 [95% CI, 3.12–6.05] and 3.41 [95% CI, 2.04–5.70], respectively). Conclusions: Despite changes in antibiotic prophylaxis guidelines, the crude incidence of infective endocarditis has remained stable. However, the incidence rate has doubled in the elderly. Positive blood cultures were observed in less than half of patients, with Staphylococcus aureus and enterococcus bacteremia associated with worse outcomes.
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Affiliation(s)
- Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom.,Usher Institute of Population Health Sciences and Informatics (A.S.V.S., N.L.M.), University of Edinburgh, United Kingdom
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom (D.A.M., J.A.R.P.)
| | - Peter Gallacher
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Federica Astengo
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | | | - Jennifer Hall
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Atul Anand
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Dilip Nathwani
- Academic Health Sciences Partnership in Tayside, Ninewells Hospital and Medical School, Dundee, United Kingdom (D.N.)
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom.,Usher Institute of Population Health Sciences and Informatics (A.S.V.S., N.L.M.), University of Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom
| | - Charis Marwick
- Population Health and Genomics, School of Medicine, University of Dundee, United Kingdom (C.M.)
| | - Nicholas L Cruden
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (N.L.C.)
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L'Angiocola PD, Donati R. Cardiac Masses in Echocardiography: A Pragmatic Review. J Cardiovasc Echogr 2020; 30:5-14. [PMID: 32766100 PMCID: PMC7307625 DOI: 10.4103/jcecho.jcecho_2_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.
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Affiliation(s)
| | - Roberto Donati
- Department of Cardiology, Giovan Battista Grassi Hospital, Rome, Italy
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