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Diaz‐Arocutipa C, Moreno G, Vicent L. Impact of valvular surgery according to frailty risk in patients with infective endocarditis. Clin Cardiol 2024; 47:e24268. [PMID: 38741388 PMCID: PMC11091451 DOI: 10.1002/clc.24268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. METHODS We performed a retrospective study using the 2016-2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. RESULTS A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34-68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. CONCLUSIONS Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
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Affiliation(s)
- Carlos Diaz‐Arocutipa
- Unidad de Revisiones Sistemáticas y Meta‐análisis (URSIGET), Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de OctubreMadridSpain
- Facultad de Enfermería, Fisioterapia y PodologíaUniversidad Complutense de Madrid (UCM)MadridSpain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de OctubreMadridSpain
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Niebauer J, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Sündermann SH. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol 2024; 31:146-181. [PMID: 37804173 DOI: 10.1093/eurjpc/zwad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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3
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Hémar V, Camou F, Roubaud-Baudron C, Ternacle J, Pernot M, Greib C, Dijos M, Wirth G, Chaussade H, Peuchant O, Bonnet F, Issa N. The Mortality of Infective endocarditis with and without Surgery in Elderly (MoISE) Study. Clin Infect Dis 2023; 77:1440-1448. [PMID: 37369092 DOI: 10.1093/cid/ciad384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear. METHODS We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. RESULTS We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality. CONCLUSIONS Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.
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Affiliation(s)
- Victor Hémar
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Fabrice Camou
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Claire Roubaud-Baudron
- Pôle de Gérontologie Clinique, Bordeaux University Hospital Bordeaux, France
- INSERM BRIC UMR 1312, University of Bordeaux, Bordeaux, France
| | - Julien Ternacle
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Mathieu Pernot
- Cardiac Surgery Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Carine Greib
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Marina Dijos
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Gaetane Wirth
- Infectious Diseases Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Hélène Chaussade
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Olivia Peuchant
- Bacteriology Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Fabrice Bonnet
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Nahéma Issa
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
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Sündermann SH, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Niebauer J. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Cardiothorac Surg 2023; 64:ezad181. [PMID: 37804175 DOI: 10.1093/ejcts/ezad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
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Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review. J Pers Med 2023; 13:jpm13020296. [PMID: 36836530 PMCID: PMC9966560 DOI: 10.3390/jpm13020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Infective endocarditis (IE) is a bacterial infection with high morbidity and mortality rates, particularly among the elderly. This systematic review was conducted to determine the clinical characteristics of IE in older adults and the risk factors that could lead to adverse outcomes. The research employed three databases (PubMed, Wiley, and Web of Science), with a primary search for studies that have described cases of IE in patients older than 65 years. From a total of 555 articles, 10 were selected for inclusion in the current study, comprising a total of 2222 patients with a confirmed diagnosis of IE. The primary findings were an increased incidence of staphylococcal and streptococcal infections (33.4% and32.0%, respectively), an increased prevalence of comorbidities, namely, cardiovascular disease, diabetes, and cancer, and a significantly greater mortality risk than the younger group. Regarding mortality risks, the pooled odds ratio for cardiac disorders was OR = 3.81, septic shock OR = 8.22, renal complications OR = 3.75, and advancing age OR = 3.54 were most frequently mentioned. Taking into consideration the fact that the majority of the elderly population suffers from significant complications and is unable to undergo surgery due to an increased risk of complications after the procedure, it is imperative that effective treatment methods should be investigated.
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Kong WKF, Salsano A, Giacobbe DR, Popescu BA, Laroche C, Duval X, Schueler R, Moreo A, Colonna P, Piper C, Calvo-Iglesias F, Badano LP, Srdanovic I, Boutoille D, Huttin O, Stöhr E, Timóteo AT, Vaskelyte JJ, Sadeghpour A, Tornos P, Abid L, Poh KK, Habib G, Lancellotti P. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry. Eur Heart J 2022; 43:2770-2780. [PMID: 35695691 PMCID: PMC9459867 DOI: 10.1093/eurheartj/ehac307] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/21/2022] [Accepted: 05/25/2022] [Indexed: 12/13/2022] Open
Abstract
AIM Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.
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Affiliation(s)
- William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino—IRCCS, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, Genoa, Italy
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy ‘Carol Davila’ Euroecolab, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’, Bucharest, Romania
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | - Xavier Duval
- INSERM Clinical Investigation Center 1425, Université Paris Diderot, Sorbonne Paris-Cité, IAME 1138, Paris, France
- AEPEI Service de Maladies Infectieuses et Tropicales, APHP, Hôpital Bichat, Paris, France
| | | | - Antonella Moreo
- Dipartimento CardioToracoVascolare ‘De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Luigi P Badano
- University of Milano-Bicocca, Milano, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences; Istituto Auxologico Italiano, IRCCS—San Luca Hospital, Milano, Italy
| | - Ilija Srdanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, Nantes, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Nancy, France
- CIC-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, CIC-IT, U1433, CHRU de Nancy, France
- INSERM U1254, IADI, Université de Lorraine, Nancy, France
| | | | - Ana Teresa Timóteo
- Secretária-Geral Sociedade Portuguesa Cardiologia, Lisbon, Portugal
- Assistente Hospitalar Graduada Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisbon Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Anita Sadeghpour
- Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
- Duke Cardiovascular MR Center, Durham, NC, USA
| | - Pilar Tornos
- Cardiology Service, Hospital Quiron, Barcelona, Spain
| | | | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
- University Hospital of Liege (CHU), Liege, Belgium
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Zampino R, Iossa D, Ursi MP, Bertolino L, Karruli A, Molaro R, Esposito G, Vitrone M, D’Amico F, Albisinni R, Durante-Mangoni E. Clinical Significance and Prognostic Value of Hemostasis Parameters in 337 Patients with Acute Infective Endocarditis. J Clin Med 2021; 10:jcm10225386. [PMID: 34830670 PMCID: PMC8624946 DOI: 10.3390/jcm10225386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: The aim of this study was to assess the clinical significance and prognostic role of the main hemostasis parameters in infective endocarditis (IE): prothrombin time as international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, platelet count, homocysteine. (2) Methods: We studied 337 patients with IE. Clinical, hemato-chemical and echocardiography parameters were analyzed. Coagulation parameters were measured on admission. (3) Results: D-dimers levels (p = 0.012) and a prolonged PT-INR (p = 0.013) were associated with higher in-hospital mortality, while prolonged aPTT (p = 0.021) was associated with increased 1-year mortality. Staphylococcus aureus (S. aureus) infection (p = 0.003), prosthetic valve endocarditis (PVE) (p = 0.001), surgical indication (p = 0.002) and higher D-dimer levels (p = 0.005) were independent predictors of in-hospital mortality. PVE (p = 0.001), a higher Charlson Comorbidity Index (p = 0.049), surgical indication (p = 0.001) and prolonged aPTT (p = 0.012) were independent predictors of 1-year mortality. Higher levels of D-dimers (p < 0.001) and a shorter aPTT (p < 0.001) were associated with embolic complications of IE. S. aureus etiology was bound to higher D-dimers levels (p < 0.001) and a shorter aPTT (p = 0.006). (4) Conclusions: Elevated D-dimers are associated with a higher risk for in-hospital mortality in IE patients. High D-dimers and a short aPTT are associated with a higher risk for embolic events in IE. A longer aPTT is associated with 1-year mortality.
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Affiliation(s)
- Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
| | - Domenico Iossa
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Maria Paola Ursi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Lorenzo Bertolino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Arta Karruli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Rosa Molaro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Gennaro Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Martina Vitrone
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Fabiana D’Amico
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Rosina Albisinni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
- Correspondence: ; Tel.: +39-(0)817062475; Fax: +39-(0)817702645
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Bustamante-Munguira J, Figuerola-Tejerina A, Aguilar-Blanco EM, Sanchez-Torralvo C, Herrera-Gómez F. Aortic endocarditis as a possible long-term prognostic factor in surgical aortic valve replacement. Eur J Clin Invest 2021; 51:e13495. [PMID: 33482010 DOI: 10.1111/eci.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
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Prasitlumkum N, Vutthikraivit W, Thangjui S, Leesutipornchai T, Kewcharoen J, Riangwiwat T, Dworkin J. Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:790-801. [DOI: 10.2459/jcm.0000000000001001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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Hidalgo-Tenorio C, Gálvez J, Martínez-Marcos FJ, Plata-Ciezar A, De La Torre-Lima J, López-Cortés LE, Noureddine M, Reguera JM, Vinuesa D, García MV, Ojeda G, Luque R, Lomas JM, Lepe JA, de Alarcón A. Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis. BMC Infect Dis 2020; 20:160. [PMID: 32085732 PMCID: PMC7035751 DOI: 10.1186/s12879-020-4895-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 μg/mL to MRSA. Methods Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41–7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14–7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64–9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985–1999) (OR 8.391; 95% CI (2.82–24.9); 2000–2009 (OR 6.4; 95% CI 2.92–14.06); active neoplasm (OR 6.63; 95% CI 1.7–25.5) and sepsis (OR 2.28; 95% CI 1.053–4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). Conclusion MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas n° 2, 18014, Granada, Spain.
| | - Juan Gálvez
- Infectious Disease Service, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Antonio Plata-Ciezar
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | - José M Reguera
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - David Vinuesa
- Infectious Disease Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - Maria Victoria García
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Guillermo Ojeda
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rafael Luque
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Manuel Lomas
- Infectious Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Antonio Lepe
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arístides de Alarcón
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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KIMURA T, SUGITANI T, NISHIMURA T, ITO M. Validation and Recalibration of Charlson and Elixhauser Comorbidity Indices Based on Data From a Japanese Insurance Claims Database. ACTA ACUST UNITED AC 2019. [DOI: 10.3820/jjpe.24.e2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tomomi KIMURA
- Advanced Informatics and Analytics, Astellas Pharma Inc., Tokyo, Japan
| | | | - Takuya NISHIMURA
- Advanced Informatics and Analytics, Astellas Pharma Inc., Tokyo, Japan
| | - Masanori ITO
- Advanced Informatics and Analytics, Astellas Pharma Inc., Tokyo, Japan
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Abstract
Infective endocarditis (IE) is an uncommon, life-threatening systemic disorder with significant morbidity and persistently high mortality. The age of the peak incidence of IE has shifted from 45 years in the 1950s to 70 years at the present time, and elderly people have a five-fold higher risk of IE than the general adult population. Elderly IE patients demonstrate a higher prevalence of coagulase-negative staphylococci, enterococci and Streptococcus bovis, and lower rates of infection by viridans group streptococci. Methicillin resistance is more prevalent in elderly patients as a consequence of increased nosocomial acquisition. The elderly are a vulnerable group in whom diagnosis is often difficult on account of non-specific presenting features and where higher prevalence of comorbidities contributes to adverse outcomes. Treatment of older patients with IE presents specific challenges associated with prolonged antibiotic therapy, and access to surgery may be denied on account of advanced age and attendant comorbidities. This practical review covers all aspects of elderly IE, including clinical and microbiological diagnosis and appropriate diagnostic procedures, initial antibiotic selection, antibiotic prophylaxis, considerations about antibiotic therapy and surgery.
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13
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El Hadj Sidi C, Mgarrech I, Tarmiz A, Jerbi S. External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population. J Card Surg 2019; 34:266-273. [PMID: 30873659 DOI: 10.1111/jocs.14015] [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: 01/29/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population to validate its use in our country. METHODS This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the receiver operating characteristic (ROC) curve and analyzing its calibration using the Hosmer-Lemeshow statistics. RESULTS The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve more than 0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining P values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). CONCLUSION The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.
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Affiliation(s)
- Chighaly El Hadj Sidi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Imen Mgarrech
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Amine Tarmiz
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Sofiane Jerbi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
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