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Lovelock T, du Plessis M, van der Westhuizen C, Janson JT, Lawrence C, Parker A, Pecoraro A, Prozesky H, von Gottberg A, Taljaard J. Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases. S Afr J Infect Dis 2024; 39:539. [PMID: 38444885 PMCID: PMC10913159 DOI: 10.4102/sajid.v39i1.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/08/2023] [Indexed: 03/07/2024] Open
Abstract
Background Classical toxin-mediated respiratory diphtheria has become less common because of widespread effective vaccination globally but invasive disease as a result of non-toxigenic strains of Corynebacterium diphtheriae is not prevented by vaccination and may result in severe disease, including infective endocarditis (IE). Objectives To describe the outbreak and subsequent investigation of a cluster of five cases of non-toxigenic C. diphtheriae endocarditis. Method A retrospective observational case series of five cases of non-toxigenic C. diphtheriae endocarditis identified in the rural West Coast district of the Western Cape province of South Africa between May 2021 and June 2021. Results Non-toxigenic C. diphtheriae IE had an aggressive clinical course with high mortality in this cohort. Only one of five patients survived to hospital discharge. The surviving patient received a prompt diagnosis with early surgical intervention but still had a complicated clinical course. Notably, only one case had a pre-existing risk factor for IE, namely a prosthetic valve. Whole genome sequencing of clinical isolates confirmed that all isolates were of the same novel sequence type of non-toxigenic C. diphtheriae but despite a thorough investigation no epidemiological link was ever found between the cases. Conclusion Non-toxigenic strains of C. diphtheriae are less well known but may be highly virulent and cause severe invasive disease. Contribution This is the largest cluster of non-toxigenic C. diphtheriae IE ever described in South Africa and expands the body of literature on this unusual but possibly emerging infection.
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Affiliation(s)
- Tamsin Lovelock
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clinton van der Westhuizen
- Department of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Microbiology and Immunology, Department of Pathology, Tygerberg Hospital/Stellenbosch University, Cape Town, South Africa
| | - Jacques T Janson
- Division of Cardiothoracic Surgery, Department of Surgery, Tygerberg Hospital/Stellenbosch University, Cape Town, South Africa
| | - Charlene Lawrence
- Western Cape Government, Department of Health and Wellness, Emergency and Clinical Services Support, Service Priorities Coordination, Communicable Disease Control and Outbreak Response, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Alfonso Pecoraro
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Hans Prozesky
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Cappelli EA, do Espírito Santo Cucinelli A, Simpson-Louredo L, Canellas MEF, Antunes CA, Burkovski A, da Silva JFR, Mattos-Guaraldi AL, Saliba AM, dos Santos LS. Insights of OxyR role in mechanisms of host-pathogen interaction of Corynebacterium diphtheriae. Braz J Microbiol 2022; 53:583-594. [PMID: 35169995 PMCID: PMC9151940 DOI: 10.1007/s42770-022-00710-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
Corynebacterium diphtheriae, the leading causing agent of diphtheria, has been increasingly related to invasive diseases, including sepsis, endocarditis, pneumonia, and osteomyelitis. Oxidative stress defense is required not only for successful growth and survival under environmental conditions but also in the regulation of virulence mechanisms of human pathogenic species, by promoting mucosal colonization, survival, dissemination, and defense against the innate immune system. OxyR, functioning as a negative and/or positive transcriptional regulator, has been included among the major bacterial coordinators of antioxidant response. OxyR was first reported as a repressor of catalase expression in C. diphtheriae. However, the involvement of OxyR in C. diphtheriae pathogenesis remains unclear. Accordingly, this work aimed to investigate the role of OxyR in mechanisms of host-pathogen interaction of C. diphtheriae through the disruption of the OxyR of the diphtheria toxin (DT)-producing C. diphtheriae CDC-E8392 strain. The effects of OxyR gene disruption were analyzed through interaction assays with human epithelial cell lines (HEp-2 and pneumocytes A549) and by the induction of experimental infections in Caenorhabditis elegans nematodes and Swiss Webster mice. The OxyR disruption exerted influence on NO production and mechanism accountable for the expression of the aggregative-adherence pattern (AA) expressed by CDC-E8392 strain on human epithelial HEp-2 cells. Moreover, invasive potential and intracytoplasmic survival within HEp-2 cells, as well as the arthritogenic potential in mice, were found affected by the OxyR disruption. In conclusion, data suggest that OxyR is implicated in mechanisms of host-pathogen interaction of C. diphtheriae.
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Affiliation(s)
- Elisabete Alves Cappelli
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Andrezza do Espírito Santo Cucinelli
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Liliane Simpson-Louredo
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Eurydice Freire Canellas
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Camila Azevedo Antunes
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil ,grid.5330.50000 0001 2107 3311Microbiology Division, Department of Biology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Burkovski
- grid.5330.50000 0001 2107 3311Microbiology Division, Department of Biology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Jemima Fuentes Ribeiro da Silva
- grid.412211.50000 0004 4687 5267Department of Histology and Embryology, Roberto Alcantara Gomes Biology Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Luíza Mattos-Guaraldi
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Alessandra Mattos Saliba
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Louisy Sanches dos Santos
- grid.412211.50000 0004 4687 5267Department of Microbiology, Immunology and Parasitology, Faculty of Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Zhang Y, Verdecia J, Mgbemena O, Ravi M, Sands M. Bartonella Endocarditis: A Missed Diagnosis in Medical Practice. Cureus 2021; 13:e19309. [PMID: 34900484 PMCID: PMC8647862 DOI: 10.7759/cureus.19309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/17/2022] Open
Abstract
Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight loss. Further workup revealed Bartonella endocarditis of the aortic valve. After six weeks of antibiotics, a follow-up transthoracic echocardiogram showed a decrease in the size of vegetation. Serologic testing based on epidemiologic history should be obtained for the workup of blood culture-negative endocarditis.
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Affiliation(s)
- Yixin Zhang
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jorge Verdecia
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Okechukwu Mgbemena
- Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Malleswari Ravi
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Michael Sands
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Shanmugam L, Priyadarshi K, Kumaresan M, Sivaradjy M, Upadhyay P, Elamurugan TP, Sastry AS. A Rare Case Report of Non-toxigenic Corynebacterium diphtheriae Bloodstream Infection in an Uncontrolled Diabetic With Peripheral Vascular Disease. Cureus 2021; 13:e14947. [PMID: 34123644 PMCID: PMC8189935 DOI: 10.7759/cureus.14947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/05/2022] Open
Abstract
Corynebacterium diphtheriae usually causes respiratory diphtheria, which is considered as a disease of toxemia but never bacteremia. Over the last few decades, cutaneous diphtheria has been increasingly reported owing to the emergence of the non-toxigenic strain, which causes locally necrotic and ulcerative lesions. Bacteremia is very rare, but the existing evidence in the literature suggests that the organism can rarely cause invasive infections such as septicemia, endocarditis, and osteoarthritis. Here, we present a rare case of C. diphtheriae causing bloodstream infections in an elderly diabetic with peripheral vascular disease, which was diagnosed incidentally on routine blood culture owing to automated identification systems viz matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) confirmed with conventional methods, and susceptibility was performed using automated VITEK 2 system (BioMérieux, Marcy-l'Étoile, France), which has aided in the timely management.
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Affiliation(s)
- Lakshmi Shanmugam
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ketan Priyadarshi
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mahalakshmi Kumaresan
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Monika Sivaradjy
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Praveen Upadhyay
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - T P Elamurugan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Apurba S Sastry
- Microbiology: Hospital Infection Control, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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de Santis A, Siciliano RF, Sampaio RO, Akamine M, Veronese ET, de Almeida Magalhaes FM, Araújo MRE, Rossi F, Magri MMC, Nastri AC, Accorsi TAD, Rosa VEE, Titinger DP, Spina GS, Tarasoutchi F. Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report. BMC Infect Dis 2020; 20:907. [PMID: 33256617 PMCID: PMC7708205 DOI: 10.1186/s12879-020-05652-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional “endocarditis team” is essential to achieve favorable clinical outcomes in such defiant scenarios.
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Affiliation(s)
- Antonio de Santis
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil. .,Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Rinaldo Focaccia Siciliano
- Infection Control Team, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Masahiko Akamine
- General Surgery Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Elinthon T Veronese
- Cardiac Surgery Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Maria Rita Elmor Araújo
- Clinical Microbiology Laboratory, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Flavia Rossi
- Clinical Microbiology Laboratory, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcelo M C Magri
- Department of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ana Catharina Nastri
- Department of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tarso A D Accorsi
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Vitor E E Rosa
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - David Provenzale Titinger
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Guilherme S Spina
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Flavio Tarasoutchi
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
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The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology. Clin Res Cardiol 2020; 110:332-342. [PMID: 32488586 PMCID: PMC7906935 DOI: 10.1007/s00392-020-01678-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
Aims Upon suspicion of infective endocarditis, the causative microorganism must be identified to optimize treatment. Blood cultures and culturing of removed valves are the mainstay of this diagnosis and should be complemented by growth-independent methods. We assessed the diagnostic benefit of examining removed endocarditis valves by broad-range bacterial PCR to detect causative bacteria in cases where culturing was not available, negative, or inconclusive because a skin commensal was detected, in patients from our clinical routine practice. Methods and results Patients from Heidelberg University Hospital with suspicion of endocarditis, followed by valve replacement and analysis by 16S rDNA PCR, between 2015 and 2018, were evaluated. 146 patients with definite infective endocarditis, confirmed by the valve macroscopics and/or histology, were included. Valve PCRs were compared to corresponding blood and valve culture results. Overall, valve PCR yielded an additional diagnostic benefit in 34 of 146 cases (23%) and was found to be more sensitive than valve culture. In 19 of 38 patients with both negative blood and valve cultures, valve PCR was the only method rendering a pathogen. In 23 patients with positive blood cultures detecting skin commensals, 4 patients showed discordant valve PCR results, detecting a more plausible pathogen, and in 11 of 23 cases, valve PCR confirmed commensals in blood culture as true pathogens. Only the remaining 8 patients had negative valve PCRs. Conclusion Valve PCR was found to be a valuable diagnostic tool in surgical endocarditis cases with negative blood cultures or positive blood cultures of unknown significance. Trial registration S-440/2017 on 28.08.2017 retrospectively registered. Graphic abstract Subdividing of all infective endocarditis patients in this study, showing that valve PCR yields valuable information for patients with skin commensals in blood cultures, which were either confirmed by the same detection in valve PCR or refuted by the detection of a different and typical pathogen in valve PCR. Additionally, benefit was determined in patients with negative or not available blood cultures and only positive detection in valve PCR. +: Positive; −: negative; n/a: not available results ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01678-x) contains supplementary material, which is available to authorized users.
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Erdem H, Puca E, Ruch Y, Santos L, Ghanem-Zoubi N, Argemi X, Hansmann Y, Guner R, Tonziello G, Mazzucotelli JP, Como N, Kose S, Batirel A, Inan A, Tulek N, Pekok AU, Khan EA, Iyisoy A, Meric-Koc M, Kaya-Kalem A, Martins PP, Hasanoglu I, Silva-Pinto A, Oztoprak N, Duro R, Almajid F, Dogan M, Dauby N, Gunst JD, Tekin R, Konopnicki D, Petrosillo N, Bozkurt I, Wadi J, Popescu C, Balkan II, Ozer-Balin S, Zupanc TL, Cascio A, Dumitru IM, Erdem A, Ersoz G, Tasbakan M, Ajamieh OA, Sirmatel F, Florescu S, Gulsun S, Ozkaya HD, Sari S, Tosun S, Avci M, Cag Y, Celebi G, Sagmak-Tartar A, Karakus S, Sener A, Dedej A, Oncu S, Del Vecchio RF, Ozturk-Engin D, Agalar C. Portraying infective endocarditis: results of multinational ID-IRI study. Eur J Clin Microbiol Infect Dis 2019; 38:1753-1763. [PMID: 31187307 DOI: 10.1007/s10096-019-03607-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/29/2019] [Indexed: 01/18/2023]
Abstract
Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).
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Affiliation(s)
| | - Edmond Puca
- Department of Infectious Diseases, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar São João and Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Xavier Argemi
- Department of Infectious Diseases, Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases, Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Rahmet Guner
- Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara, Turkey
| | - Gilda Tonziello
- Clinical & Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS,, Via Portuense, 292, 00149, Rome, Italy
| | - Jean-Philippe Mazzucotelli
- Department of Cardiovascular Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Najada Como
- Service of Infectious Disease, UHC, Tirana, Albania
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Asuman Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Necla Tulek
- Department of Microbiology, Atilim University, School of Medicine, Ankara, Turkey
| | - Abdullah Umut Pekok
- Department of Infectious Diseases and Clinical Microbiology, Pendik Medical Park Hospital, Istanbul, Turkey
| | - Ejaz Ahmed Khan
- Shifa International Hospital and Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atilla Iyisoy
- Department of Cardiology, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Meliha Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey
| | - Ayse Kaya-Kalem
- Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara, Turkey
| | - Pedro Palma Martins
- Infectious Diseases Department, Centro Hospitalar São João and Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Imran Hasanoglu
- Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara, Turkey
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João and Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Raquel Duro
- Infectious Diseases Department, Centro Hospitalar São João and Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fahad Almajid
- Department of Medicine, Infectious Diseases Division, King Saud University Hospital, Riyadh, Saudi Arabia
| | - Mustafa Dogan
- Department of Infectious Diseases and Clinical Microbiology, Corlu State Hospital, Tekirdag, Antalya, Turkey
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université libre de Bruxelles (ULB), 322 rue Haute, 1000, Brussels, Belgium
| | | | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Deborah Konopnicki
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université libre de Bruxelles (ULB), 322 rue Haute, 1000, Brussels, Belgium
| | - Nicola Petrosillo
- Clinical & Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS,, Via Portuense, 292, 00149, Rome, Italy
| | - Ilkay Bozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Jamal Wadi
- Department of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Disease, Bucharest, Romania
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Safak Ozer-Balin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | | | - Antonio Cascio
- Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Aysegul Erdem
- Department of Pathology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Gulden Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Oday Abu Ajamieh
- Department of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatma Sirmatel
- Department of Infectious Disease and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Simin Florescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Disease, Bucharest, Romania
| | - Serda Gulsun
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Hacer Deniz Ozkaya
- Department of Infectious Diseases and Clinical Microbiology, Cigli Regional Education Hospital, Izmir, Turkey
| | - Sema Sari
- Department of Intensive Care Unit, Turkey Advanced Specialty Education and Research Hospital, Ankara, Turkey
| | - Selma Tosun
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Meltem Avci
- Department of Infectious Disease and Clinical Microbiology, Usak University School of Medicine, Usak, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Guven Celebi
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ayse Sagmak-Tartar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Sumeyra Karakus
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Alper Sener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Arjeta Dedej
- Department of Nephrology, American Hospital, Tirana, Albania
| | - Serkan Oncu
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Rosa Fontana Del Vecchio
- Department of Clinical and Molecular Biomedicine, Section of Infectious Diseases, University of Catania, Catania, Italy
| | - Derya Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Canan Agalar
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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