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Fu F, Song J, Li X, Ji P, Hou J. Parvimonas micra-induced prosthetic valve endocarditis: a challenging case report and literature review. Diagn Microbiol Infect Dis 2024; 110:116285. [PMID: 39018935 DOI: 10.1016/j.diagmicrobio.2024.116285] [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: 10/31/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 07/19/2024]
Abstract
Parvimonas micra, a gram-positive anaerobic bacterium, has garnered increased attention due to its role in infective endocarditis. We present a challenging prosthetic valve endocarditis caused by Parvimonas micra in a patient with a complex cardiac history involving multiple surgeries. The case highlights the difficulties in diagnosis and treatment, emphasizing the importance of advanced diagnostic techniques, including metagenomics next-generation sequencing (mNGS). Additionally, it underscores the need for heightened vigilance regarding oral symptoms and the potential risk of bacteremia in post-valvular surgery patients. This report contributes to a better understanding of Parvimonas micra-associated endocarditis and its unique characteristics.
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Affiliation(s)
- Fangjie Fu
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, PR China; Intensive Care Unit, West China Tianfu Hospital, Sichuan University, Chengdu, PR China
| | - Juelin Song
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Department of Cardiovascular Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xuejie Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Peng Ji
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, PR China; Intensive Care Unit, West China Tianfu Hospital, Sichuan University, Chengdu, PR China.
| | - Jianglong Hou
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Department of Cardiovascular Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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2
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Beltsios E, Zubarevich A, Ruemke S, Rubalskii E, Osswald A, Arjomandi Rad A, Heidenau F, Buer J, Hanke J, Schmitto J, Popov AF, Kuehn C, Schmack B, Ruhparwar A, Weymann A. Antibacterial copper-filled TiO 2 coating of cardiovascular implants to prevent infective endocarditis-A pilot study. Artif Organs 2024; 48:356-364. [PMID: 38010063 DOI: 10.1111/aor.14688] [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: 09/13/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Infective endocarditis (IE) poses a significant health risk, especially in patients with prosthetic heart valves. Despite advances in treatment, mortality rates remain high. This study aims to investigate the antibacterial properties of a copper titanium dioxide (4× Cu-TiO2) coating on cardiovascular implants against Staphylococcus aureus, a common causative agent of IE. METHODS Titanium oxide carriers functionalized with copper ions were employed as an antibacterial coating for heart and vascular prostheses. The coating's antibacterial efficacy was assessed using S. aureus ATCC 29213. Microscopic evaluations were conducted on both biological and artificial materials. Antibacterial activity was qualitatively assessed via a modified disc diffusion method and quantitatively measured through colony counts in NaCl suspensions. RESULTS The coating process was successfully applied to all tested cardiovascular prosthetic materials. Qualitative assessments of antibacterial effectiveness revealed an absence of bacterial growth in the area directly beneath the coated valve. Quantitative evaluations showed a significant reduction in bacterial colonization on coated mechanical valves, with 2.95 × 104 CFU per valve, compared to 1.91 × 105 CFU in control valves. CONCLUSIONS The 4× Cu-TiO2 coating demonstrated promising antibacterial properties against S. aureus, suggesting its potential as an effective strategy for reducing the risk of bacterial colonization of cardiovascular implants. Further studies are needed to assess the longevity of the coating and its efficacy against other pathogens.
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Affiliation(s)
- Eleftherios Beltsios
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Stefan Ruemke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Evgenii Rubalskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | | | | | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jasmin Hanke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Schmitto
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bastian Schmack
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Ashraf H, Nadeem ZA, Ashfaq H, Ahmed S, Ashraf A, Nashwan AJ. Mortality patterns in older adults with infective endocarditis in the US: A retrospective analysis. Curr Probl Cardiol 2024; 49:102455. [PMID: 38342352 DOI: 10.1016/j.cpcardiol.2024.102455] [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: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Infective Endocarditis (IE) has become a significant cause of morbidity and mortality over the last two decades. Despite management advancements, mortality trends in the USA's geriatric population are unexplored. The aim of this study was to assess the trends and regional differences in IE related mortality among geriatric patients in the USA. METHODS We analyzed death certificates sourced from the CDC WONDER database spanning 1999 to 2020. The research targeted individuals aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC), along with 95% CI, were calculated through joinpoint regression analysis. RESULTS From 1999 to 2020, infective endocarditis caused 222,573 deaths, showing a declining trend (APC: -0.8361). Males had higher AAMR (26.8) than females (22.2). NH White had the highest AAMR (25.8), followed by NH American Indians or Alaska Natives (19.6). Geographically, the Midwest had the highest AAMR (27.4), followed by the Northeast (25.8). Rural areas consistently had higher AAMRs (26.6) than urban areas (23.6), while 80.16% of deaths occurring in urban settings. North Dakota, Nebraska, and Montana had the highest state AAMRs, approximately double than the states with the lowest mortality rates: Mississippi, Hawaii, California, and Massachusetts. Those aged 85 and above accounted for 42.9% of deaths. CONCLUSION IE mortality exhibited a clear pattern: rising till 2004, declining from 2004 to 2018, and increasing again till 2020. Key risk factors were male gender, Midwest residence, NH White ethnicity, and age ≥85.Targeted interventions are essential to reduce IE mortality, especially among vulnerable older populations.
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Affiliation(s)
- Hamza Ashraf
- Department of Cardiology, Allama Iqbal Medical College, Pakistan
| | - Zain Ali Nadeem
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Sophia Ahmed
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Ali Ashraf
- Department of Medicine, Punjab Medical College, Pakistan
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Zulet P, Vilacosta I, Pozo E, García-Arribas D, Pérez-García CN, Carnero M, Pérez-Camargo D, Montero L, Saiz-Pardo M, Mahía P, Jerónimo A, Islas F, Gómez D, San Román JA, de Agustín JA, Olmos C. Valvulitis: a new echocardiographic criterion for the diagnosis of bioprosthetic aortic valve infective endocarditis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00097-5. [PMID: 38521440 DOI: 10.1016/j.rec.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Diffuse homogeneous hypoechoic leaflet thickening, with a wavy leaflet motion documented by transesophageal echocardiography (TEE), has been described in some cases of prosthetic valve endocarditis (PVE) involving aortic bioprosthesis (AoBio-PVE). This echocardiographic finding has been termed valvulitis. We aimed to estimate the prevalence of valvulitis, precisely describe its echocardiographic characteristics, and determine their clinical significance in patients with AoBio-PVE. METHODS From 2011 to 2022, 388 consecutive patients with infective endocarditis (IE) admitted to a tertiary care hospital were prospectively included in a multipurpose database. For this study, all patients with AoBio-PVE (n=86) were selected, and their TEE images were thoroughly evaluated by 3 independent cardiologists to identify all cases of valvulitis. RESULTS The prevalence of isolated valvulitis was 12.8%, and 20.9% of patients had valvulitis accompanied by other classic echocardiographic findings of IE. A total of 9 out of 11 patients with isolated valvulitis had significant valve stenosis, whereas significant aortic valve regurgitation was documented in only 1 patient. Compared with the other patients with AoBio-PVE, cardiac surgery was less frequently performed in patients with isolated valvulitis (27.3% vs 62.7%, P=.017). In 4 out of 5 patients with valve stenosis who did not undergo surgery but underwent follow-up TEE, valve gradients significantly improved with appropriate antibiotic therapy. CONCLUSIONS Valvulitis can be the only echocardiographic finding in infected AoBio and needs to be identified by imaging specialists for early diagnosis. However, this entity is a diagnostic challenge and additional imaging techniques might be required to confirm the diagnosis. Larger series are needed.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Pozo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel García-Arribas
- Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Manuel Carnero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel Pérez-Camargo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Montero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Melchor Saiz-Pardo
- Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
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Barua A, Nanjaiah P, Warwick R, Jeeji R, Balacumaraswami L. A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis. J Surg Case Rep 2024; 2024:rjae089. [PMID: 38404448 PMCID: PMC10894697 DOI: 10.1093/jscr/rjae089] [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: 11/17/2023] [Revised: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement. We modified a composite mechanical Valsalva conduit to create a separate sinus of Valsalva left in continuity with the mechanical valve. This approach allowed us to exclude the infected right sinus of Valsalva and the corresponding aortic annulus.
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Affiliation(s)
- Anupama Barua
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Prakash Nanjaiah
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Richard Warwick
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Ravish Jeeji
- Department of Cardiothoracic Anaesthesia, University Hospitals North Midlands NHS Trust, Staffordshire, United Kingdom
| | - Lognathen Balacumaraswami
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
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6
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van Kruijsbergen BWA, Spiegelenberg JP, van Lieshout M, Heuvelmans M. Non-typhoidal Salmonella enteritidis prosthetic valve endocarditis. BMJ Case Rep 2023; 16:e256540. [PMID: 38011951 PMCID: PMC10685981 DOI: 10.1136/bcr-2023-256540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
In this case, we present a rare cause of prosthetic valve endocarditis. A man in his 80s presented to the emergency department with fever and diarrhoea. The patient underwent a transcatheter aortic valve replacement 17 years earlier. A negative PCR result in faeces for Salmonella and positive blood cultures with Salmonella gave rise to the suspicion of an intravascular Salmonella infection, which was confirmed with a positron emission tomography. Due to the low prevalence of Salmonella endocarditis, there is no consensus on the most effective treatment. Guidelines recommend early surgery and long-term antimicrobial treatment in endocarditis with Gram-negative bacteria. In this case, surgery was not deemed feasible given the patient his advanced age and multiple comorbidities. Despite treatment with intravenous antibiotics, the patient succumbed to progression of endocarditis 37 days after admission.
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Affiliation(s)
| | | | - Maarten van Lieshout
- Department of Intensive Care Medicine, Ziekenhuis Rivierenland, Tiel, The Netherlands
| | - Maarten Heuvelmans
- Department of Medical Microbiology, Ziekenhuis Rivierenland, Tiel, The Netherlands
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7
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Bak A, Kim TS, Park H, Park JH. Prosthetic valve endocarditis caused by Campylobacter fetus: a case report and literature review. J Int Med Res 2023; 51:3000605231213264. [PMID: 37987669 PMCID: PMC10664450 DOI: 10.1177/03000605231213264] [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: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
Campylobacter fetus is a Gram-negative bacillus typically associated with bacteremia in immunocompromised patients. Prosthetic valve endocarditis (PVE) is a serious complication of prosthetic valve surgery, with a high mortality rate if not treated promptly. We present a rare case of PVE caused by C. fetus. A man in his mid-60s presented to the Emergency Department with a fever and showed elevated C-reactive protein concentrations. He had prosthetic mitral and aortic valve replacement surgery 15 years previously. Gram-negative rods were detected in a blood culture. These rods were identified as C. fetus using matrix-assisted laser desorption ionization time-of-flight mass spectrometry and confirmed by 16S rRNA sequencing. The patient was treated with gentamicin and imipenem, and underwent valve replacement surgery. C. fetus was isolated in a left atrial appendage swab obtained during the surgery. Follow-up blood cultures were negative after treatment. However, after a cardiac arrest event, the patient's general condition deteriorated, and he died. To the best of our knowledge, this is the first case of PVE caused by C. fetus in Korea and the second fatality to date. This case highlights the importance of considering C. fetus as a potential cause of PVE, even in patients without known risk factors.
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Affiliation(s)
- Ayeong Bak
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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8
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Li Z, Li DW. Ultra-multiplex PCR technique to guide treatment of Aspergillus-infected aortic valve prostheses. Open Life Sci 2023; 18:20220629. [PMID: 37426621 PMCID: PMC10329271 DOI: 10.1515/biol-2022-0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Prosthetic valve endocarditis is a serious complication after heart valve replacement, accounting for about 20-30% of infective endocarditis (IE). Aspergillosis infection accounts for 25-30% of fungal endocarditis, and the mortality rate is 42-68%. Aspergillus IE often has negative blood cultures and lacks fever, which makes diagnosis difficult and delays antifungal therapy. Our study reported a case of IE in a patient with Aspergillus infection after aortic valve replacement. Ultra-multiplex polymerase chain reaction was used to identify Aspergillus infection and guide treatment. The purpose of this study was to enhance the understanding of the management of patients with endocarditis infected by fungi after valve replacement regarding the early detection, timely intervention, and treatment of the fungal infection to reduce the risk of death and improve the long-term survival of patients.
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Affiliation(s)
- Zhe Li
- Department of Intensive Care Unit, Sixth Medical Center of Chinese People’s Liberation Army General Hospital, No. 6, FuCheng Road, Haidian District, Beijing100037, China
| | - Da-Wei Li
- Department of Intensive Care Unit, Sixth Medical Center of Chinese People’s Liberation Army General Hospital, No. 6, FuCheng Road, Haidian District, Beijing100037, China
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Zhao X, Cai D, Hu J, Nie J, Chen D, Qin G, Zhang E. A high-hydrophilic Cu 2O-TiO 2/Ti 2O 3/TiO coating on Ti-5Cu alloy: Perfect antibacterial property and rapid endothelialization potential. BIOMATERIALS ADVANCES 2022; 140:213044. [PMID: 35932660 DOI: 10.1016/j.bioadv.2022.213044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/03/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023]
Abstract
In order to make novel antibacterial Ti-Cu alloy more suitable for cardiovascular implant application, a Cu-containing oxide coating was manufactured on Ti-Cu alloy by plasma-enhanced oxidation deposition in plasma enhanced chemical vapor deposition (PECVD) equipment to further improve the antibacterial ability and the surface bioactivity. The results of X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and water contact angle indicated that a sustainably high-hydrophilic Cu2O-TiO2/Ti2O3/TiO coating with nano-morphology on Ti-5Cu was successfully constructed. The corrosion performance results showed that the coating enhanced the corrosion resistance while releasing more Cu2+, compared with Ti-5Cu. Antibacterial tests confirmed the perfect antibacterial property of the coating (R ≥ 99.9 %), superior to Ti-Cu alloy (R > 90 %). More delightfully, it was observed by phalloidin-FITC and DAPI staining that the coating improved the early adhesion of HUVEC cells mainly due to strong hydrophilicity and nano-morphology. It was demonstrated that the extract of the coated sample significantly promoted proliferation (RGR = 112 %-138 % after cultivation for 1 to 3 days) and migration of HUVEC cells due to the appropriate Cu2+ release concentration. Hemolysis assay and platelet adhesion results showed that the coating had excellent blood compatibility. All results suggested that the coating on Ti-Cu alloy might be a promising surface with the perfect antibacterial ability, blood compatibility and evident promoting endothelialization ability for the cardiovascular application.
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Affiliation(s)
- Xiaotong Zhao
- Key Lab. for Anisotropy and Texture of Materials, Education Ministry of China, School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China
| | - Diangeng Cai
- Key Lab. for Anisotropy and Texture of Materials, Education Ministry of China, School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China
| | - Jiali Hu
- Key Lab. for Anisotropy and Texture of Materials, Education Ministry of China, School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China
| | - Jingjun Nie
- Laboratory of Bone tissue engineering, Beijing Laboratory of biomedical materials, Beijing Research Institute of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Dafu Chen
- Laboratory of Bone tissue engineering, Beijing Laboratory of biomedical materials, Beijing Research Institute of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China.
| | - Gaowu Qin
- Key Lab. for Anisotropy and Texture of Materials, Education Ministry of China, School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China; Research Center for Metallic Wires, Northeastern University, Shenyang 110819, China
| | - Erlin Zhang
- Key Lab. for Anisotropy and Texture of Materials, Education Ministry of China, School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China; Research Center for Metallic Wires, Northeastern University, Shenyang 110819, China.
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van der Vaart TW, Stuifzand M, Boekholdt SM, Cramer MJ, Bonten MJM, Prins JM, van der Meer JTM. The prevalence of persistent bacteraemia in patients with a non-staphylococcal infective endocarditis, a retrospective cohort study. Int J Cardiol 2022; 367:49-54. [PMID: 36002040 DOI: 10.1016/j.ijcard.2022.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/12/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current guidelines on the management of infective endocarditis (IE) recommend follow-up blood cultures (FUBCs) to identify persistent bacteraemia, as this has prognostic value and guides treatment decisions. While persistent bacteraemia frequently occurs in Staphylococcus aureus bacteraemia and IE, its prevalence and impact in non-staphylococcal IE is largely unknown. We determined prevalence and prognostic value of persistent bacteraemia in non-staphylococcal IE. METHODS We conducted a retrospective analysis of all patients diagnosed with definite non-staphylococcal endocarditis according to the modified Duke Criteria in two university hospital endocarditis registries We determined the prevalence and prognostic value of persistent bacteraemia. RESULTS Of the included 159 patients 70 (44%) had prosthetic valve endocarditis (PVE). A median number of two [IQR 1-3] FUBCs were taken during the first week, with 134/159 (84%) having at least one FUBC in the first four days. Seven patients (4,4%) had persistent bacteraemia 48 h after start of antibiotic treatment: 5/70 patients (7.1%) with PVE and 2/89 (2.2%) with native valve endocarditis. Among 97 patients with streptococcal IE, nine patients with HACEK IE and six patients with Cutibacterium IE, no persistent bacteraemia was observed. Enterococcus faecalis was the causative microorganism in five patients with persistent bacteraemia, the other two had non-HACEK Gram-negative endocarditis. CONCLUSION Persistent bacteraemia in non-staphylococcal endocarditis was rare. It was more frequently observed in PVE and was restricted to more resilient microorganisms such as enterococci and non-HACEK Gram-negative bacteria. Routine collection of FUBCs in patients with streptococcal endocarditis has a low yield and may require re-evaluation.
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Affiliation(s)
- Thomas W van der Vaart
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht University, Utrecht, the Netherlands.
| | - Marjon Stuifzand
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht University, Utrecht, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jan T M van der Meer
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Raja Shariff RE, Ibrahim KS, Kasim S. Rapid Progression of Bioprosthetic Aortic Valve Endocarditis: From Paraprosthetic Abscesses into Tricuspid Valve Infiltration. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case of prosthetic valve endocarditis (PVE) in a 49-year-old gentleman with a history of bioprosthetic valve replacement following infective endocarditis of the aortic valve. He was pyrexial on arrival and electrocardiogram showed complete heart block. Transthoracic echocardiography and transoesophageal echocardiography revealed evidence of multiple echogenic, hypodensities within the paraprosthetic regions of the aortic bioprosthetic valve, suggestive of paravalvular abscesses, and infiltration into the right ventricle via the septal leaflet of the tricuspid valve. Early PVE is often nosocomial and ultimate management include radical debridement and major reconstruction with an expectedly high risk for mortality and post-operative complications.
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Affiliation(s)
| | | | - Sazzli Kasim
- Universiti Teknologi MARA (UITM) Sungai Buloh, Sungai Buloh, Malaysia
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13
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Takemiya K, Røise JJ, He M, Taing C, Rodriguez AG, Murthy N, Goodman MM, Taylor WR. Maltohexaose-indocyanine green (MH-ICG) for near infrared imaging of endocarditis. PLoS One 2021; 16:e0247673. [PMID: 33647027 PMCID: PMC7920357 DOI: 10.1371/journal.pone.0247673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
Infectious endocarditis is a life-threatening disease, and diagnostics are urgently needed to accurately diagnose this disease especially in the case of prosthetic valve endocarditis. We show here that maltohexaose conjugated to indocyanine green (MH-ICG) can detect Staphylococcus aureus (S. aureus) infection in a rat model of infective endocarditis. The affinity of MH-ICG to S. aureus was determined and had a Km and Vmax of 5.4 μM and 3.0 X 10−6 μmol/minutes/108 CFU, respectively. MH-ICG had no detectable toxicity to mammalian cells at concentrations as high as 100 μM. The in vivo efficiency of MH-ICG in rats was evaluated using a right heart endocarditis model, and the accumulation of MH-ICG in the bacterial vegetations was 2.5 ± 0.2 times higher than that in the control left ventricular wall. The biological half-life of MH-ICG in healthy rats was 14.0 ± 1.3 minutes, and approximately 50% of injected MH-ICG was excreted into the feces after 24 hours. These data demonstrate that MH-ICG was internalized by bacteria with high specificity and that MH-ICG specifically accumulated in bacterial vegetations in a rat model of endocarditis. These results demonstrate the potential efficacy of this agent in the detection of infective endocarditis.
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Affiliation(s)
- Kiyoko Takemiya
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United states of America
- * E-mail: (KT); (NM); (MMG); (WRT)
| | - Joachim J. Røise
- Department of Bioengineering, University of California at Berkeley, Berkeley, California, United States of America
- Department of Chemistry, University of California at Berkeley, Berkeley, California, United States of America
| | - Maomao He
- Department of Bioengineering, University of California at Berkeley, Berkeley, California, United States of America
| | - Chung Taing
- Department of Chemistry, University of California at Berkeley, Berkeley, California, United States of America
| | - Alexander G. Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United states of America
| | - Niren Murthy
- Department of Bioengineering, University of California at Berkeley, Berkeley, California, United States of America
- * E-mail: (KT); (NM); (MMG); (WRT)
| | - Mark M. Goodman
- Department of Radiology and Imaging Sciences, Emory Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United states of America
- * E-mail: (KT); (NM); (MMG); (WRT)
| | - W. Robert Taylor
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United states of America
- Cardiology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, United states of America
- Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, Georgia, United states of America
- * E-mail: (KT); (NM); (MMG); (WRT)
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14
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Guo P, He Y, Fan R, Wu Z, Chen Y, Huang Y, Liao K, Chen P. A case series of medically managed Candida parapsilosis complex prosthetic valve endocarditis. Ann Clin Microbiol Antimicrob 2021; 20:1. [PMID: 33402178 PMCID: PMC7786486 DOI: 10.1186/s12941-020-00409-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, Candida parapsilosis is recognized as a species complex and is composed of Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. Candida parapsilosis complex prosthetic valve endocarditis (PVE) is rare and the survival rate is still low despite of optimal therapeutic strategies. In our report, it is novel to report cases as Candida parapsilosis complex PVE at species and identify Candida parapsilosis using MALDI-TOF MS. Case presentation A series of 4 cases of Candida parapsilosis complex PVE from our institution was reported. Three were infected by Candida parapsilosis sensu stricto and one was infected by Candida metapsilosis. The condition of two cases got better and the other died. Conclusions More attention should be paid to Candida parapsilosis complex PVE and early diagnosis and prompt antibiotic therapy may play a role in the treatment for Candida parapsilosis complex PVE. It is recommended to identify Candida parapsilosis complex at species level and MALDI-TOF MS as an easy, fast and efficient identification method is worth promoting in clinical microbiology
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Affiliation(s)
- Penghao Guo
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuting He
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Rui Fan
- Department of Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhongwen Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yili Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuli Huang
- Clinical Medicine Research Center, Shunde Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
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15
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Galizia Brito V, Bibiloni Cladera A, Exposito Pineda MDC, Grande Morales C. Pre-implant screening guided by cardiac silhouette fluoroscopy: a way to increase eligibility for the subcutaneous implantable cardioverter-defibrillator: a case report. Eur Heart J Case Rep 2021; 5:ytaa495. [PMID: 33554026 PMCID: PMC7850627 DOI: 10.1093/ehjcr/ytaa495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/09/2020] [Accepted: 10/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Suitability for the subcutaneous implantable cardioverter-defibrillator (S-ICD) depends on a pre-implant electrocardiogram (ECG) screening to ensure appropriate sensing of electrical cardiac signals. Screening is performed positioning electrodes guided by chest surface anatomical landmarks. CASE SUMMARY We report a case of a patient with an initially negative conventional automatic screening for S-ICD, who underwent a modified screening guided by cardiac silhouette position, as seen under fluoroscopy, resulting in eligibility for the S-ICD. DISCUSSION The S-ICD reduces endovascular infection risk, providing therefore a potentially safer alternative in patients with prosthetic valves. It might be reasonable to perform a pre-implant ECG screening guided by fitting the cardiac silhouette in the shock vector, as this modified screening position could increase eligibility in patients who may benefit from S-ICD therapy such as the one presented.
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Affiliation(s)
- Victoria Galizia Brito
- Department of Cardiology (Cardiac Arrhythmia and Electrophysiology Unit), Hospital Universitario Son Espases, Carretera de Valldemossa 79, Palma de Mallorca,Spain
| | - Aina Bibiloni Cladera
- Department of Cardiology (Cardiac Arrhythmia and Electrophysiology Unit), Hospital Universitario Son Espases, Carretera de Valldemossa 79, Palma de Mallorca,Spain
| | - Maria del Carmen Exposito Pineda
- Department of Cardiology (Cardiac Arrhythmia and Electrophysiology Unit), Hospital Universitario Son Espases, Carretera de Valldemossa 79, Palma de Mallorca,Spain
| | - Carlos Grande Morales
- Department of Cardiology (Cardiac Arrhythmia and Electrophysiology Unit), Hospital Universitario Son Espases, Carretera de Valldemossa 79, Palma de Mallorca,Spain
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Aragoneses JM, Aragoneses J, Brugal VA, Algar J, Suarez A. Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic. Front Public Health 2020; 8:585332. [PMID: 33330328 PMCID: PMC7732663 DOI: 10.3389/fpubh.2020.585332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease caused by bacterial adherence to the lining of the heart and heart valve, and it can be caused by bacterial contamination of the bloodstream during invasive dental procedures. The American Heart Association (AHA) recommended guidelines for antibiotic prophylaxis in 2008 before invasive dental procedures; however, in the Dominican Republic, no official guidelines or regulations on this topic have been yet established. This study aimed to evaluate the current knowledge about bacterial endocarditis prevention among dentists in Santo Domingo. The study participants were dentists who attended a conference organized by Universidad Federico Henríquez y Carvajal (n = 95), of which 74 responded to the questionnaire survey. Seventy-eight percentage of the participants responded that an indication of antibiotics is recommended in cases of prophylaxis for IE. The prescription of antibiotics was applied to patients with prosthetic valves (78.4%), presented a history of previous IE (77%) among others. Among all the interventions in which the respondents would prescribe antibiotics, tooth extraction (70.7%) was the most frequent. Amoxicillin was the preferred drug choice (63.5%) and clindamycin was the antibiotic of choice in allergic patients (55.4%). Even though the choice of antibiotics were according to AHA guidelines (2008), majority of the dentists (58.82 and 55.4%) were not aware of the correct dosage and timing of administration of azithromycin and clindamycin in drugs in patients allergic to penicillin.
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Affiliation(s)
- Juan Manuel Aragoneses
- Department of Dental Research, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Javier Aragoneses
- Department of Dentistry, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Vanessa Arlette Brugal
- Department of Pediatric Dentistry and Orthopedics, School of Dentistry, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Suarez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
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The role of endocarditis in sudden cardiac death: highlighting the value of the autopsy, pathological features and cardiac complications. Cardiovasc Pathol 2020; 50:107292. [PMID: 32950709 DOI: 10.1016/j.carpath.2020.107292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Endocarditis is increasing in incidence due to growing numbers of cardiac interventions, valve replacements and immunosuppressants. It can be difficult to diagnose clinically, has high mortality and can present as sudden cardiac death (SCD) with few/subtle preceding symptoms. True incidence of SCD related to endocarditis is unknown. METHODS Retrospective analysis of UK national database of 6000 cases of SCD, 1994-2020, for "endocarditis" as cause of death. RESULTS Of 30 cases (0.50%), 19(63%) were male and mean age was 36.2 ± 20.1 years. Postmortem examination showed the aortic valve was solely affected in 13 (43%), mitral in 9 (30%), tricuspid in 2(6.7%) and pulmonary in 1 (3.3%). Three cases (10%) had more than one valve affected and 2 (6.7%) were nonvalvular affecting the ascending aorta. Vegetations ranged from small easily missed irregularities to large fungating masses. Ten (33%) patients developed aortic abscesses, 2 of which had aneurysms, 13 (43%) had coronary artery septic emboli with micro-abscesses and myocardial microinfarction, and 2 (6.7%) were healed endocarditis with perforation and regurgitation with ventricular remodeling. Thirteen (43%) had an identifiable underlying valve abnormality or replacement, most common being a bicuspid aortic valve (7; 54%). CONCLUSIONS This study highlights that although rare, endocarditis is an important cause of SCD in those with normal valves, valvular disease and valve replacement surgery. Absence of a premortem diagnosis in 70% of our cohort highlights the need for detailed analysis of the heart and cardiac valves at autopsy. Gross appearance of vegetations varies widely and can be missed. Awareness of associated cardiac complications is required for elucidation of the cause of death and will provide valuable lessons for clinicians.
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18
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Javaid A, Sehgal S, Dazley J. Three-valve endocarditis in a patient with bioprosthetic aortic valve replacement and intravenous drug use: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-4. [PMID: 32123799 PMCID: PMC7042142 DOI: 10.1093/ehjcr/ytz185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/04/2019] [Accepted: 09/25/2019] [Indexed: 11/21/2022]
Abstract
Background Here, we outline the case of a US Veteran’s Health Administration (VA) patient with a history of recent bioprosthetic aortic valve replacement (AVR) and recent intravenous drug use (IVDU) who was found to have three-valve infective endocarditis (IE) resulting in septic shock. We highlight this case because it represents an uncommon case of three-valve IE in the setting of recent bioprosthetic valve replacement and IVDU, and it raises the need for continued awareness of mental health and drug rehabilitation in the US military veteran population. Case summary A 62-year-old gentleman with recent bioprosthetic AVR presented with dyspnoea and lower extremity oedema and was found to have a heart failure exacerbation. He developed sepsis and was found to have three-valve endocarditis, as well as aortic root abscess and pacemaker lead infection. He was treated with broad-spectrum antibiotics and evaluated for surgical intervention. After discussion with the surgical team, the patient decided not to pursue surgery due to prohibitively high perioperative mortality risk. The patient was transferred to hospice and expired within 2 weeks. Discussion Three-valve IE is sparingly documented in published literature and can be difficult to treat. Providers must be cognizant of prosthetic valve endocarditis as an uncommon but known complication of valve replacement surgery. Intravenous drug use is a common risk factor for endocarditis and is prevalent in the US military veteran population. Prosthetic valve endocarditis should be treated with broad-spectrum antibiotics, and in general, if it leads to new significant valvular abnormalities, the valve should be replaced.
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Affiliation(s)
- Awad Javaid
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 West Charleston Blvd, Suite 230, Las Vegas, NV 89102, USA
| | - Sumit Sehgal
- Department of Cardiology, University of Nevada Las Vegas School of Medicine, 1701 West Charleston Blvd, Suite 230, Las Vegas, NV 89102, USA
| | - Jason Dazley
- Department of Infectious Disease, VA Southern Nevada Healthcare System, 6900 North Pecos Road, Las Vegas, NV 89086, USA
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19
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Moussa Y, Moussa M, Chakra MA. Enterococcal prosthetic valve endocarditis secondary to transurethral prostatic resection. IDCases 2020; 19:e00708. [PMID: 32055442 PMCID: PMC7005459 DOI: 10.1016/j.idcr.2020.e00708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
Prosthetic valve endocarditis (PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. Staphylococci (both Staphylococcus aureus and coagulase-negative Staphylococcui) are the most common cause of PVE. Diagnosis may often be difficult because of its complications and extracardiac manifestations. Positive blood and valve cultures are one of the most important diagnostic criteria for IE. Transesophageal echography should be performed without delay in all patients suspected to have PVE. As for treatment, according to the guidelines sensitive antimicrobials should be administered for 6 weeks. Surgery is recommended in case of PVE complicated by heart failure, severe prosthetic dysfunction, abscess or persistent fever. We present a case of PVE after transurethral resection of the prostate in a 63-year-old male patient with a history of mitral valve replacement. The patient was treated by appropriate antimicrobials for 6 weeks and recovered completely.
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Affiliation(s)
- Yasmin Moussa
- Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Barbarastraße 15, 45964 Gladbeck, Germany
| | - Mohamed Moussa
- Head of Urology Department, Zahra Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamed Abou Chakra
- Faculty of Medicine, Department of Urology, Lebanese University, Beirut, Lebanon
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20
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Luehr M, Bauernschmitt N, Peterss S, Li Y, Heyn O, Dashkevich A, Oberbach A, Bagaev E, Pichlmaier MA, Juchem G, Hagl C. Incidence and Surgical Outcomes of Patients With Native and Prosthetic Aortic Valve Endocarditis. Ann Thorac Surg 2019; 110:93-101. [PMID: 31794735 DOI: 10.1016/j.athoracsur.2019.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the incidence and surgical outcomes of patients with native infective endocarditis (IE) and prosthetic aortic valve endocarditis (PVE) over the past decade at a single institution. METHODS Between January 2005 and December 2015, 289 patients (mean age, 63.3 ± 14.2 years) suffering from native IE (n = 186) and PVE (n = 103) of the aortic valve underwent surgical procedures. Perioperative data were acquired retrospectively for statistical analysis. RESULTS During the study period the mean incidence of endocarditis increased from 22.0 ± 4.2 (2005-2009) to 29.8 ± 10.1 (2010-2015) cases per year. In-hospital mortality was significantly increased in PVE (22.3%) versus IE (9.1%) patients (P < .001). In elective cases in-hospital mortality between the 2 groups was comparable (2.2% vs 4.6%; P = .288). Multivariate analysis identified urgent surgery (odds ratio [OR], 6.461; 95% CI, 1.941-21.509; P = .002), mitral regurgitation II (OR, 4.230; 95% CI, 1.249-14.331; P = .021), previous homograft operation (OR, 66.096; 95% CI, 2.369-1844.272; P = .0.14), and left ventricular ejection fraction < 40% (OR, 8.267; 95% CI, 1.931-35.388; P = .004) as independent risk factors for in-hospital mortality, whereas pathogen identification by preoperative blood cultures (OR, .228; 95% CI, 0.063-0.817; P = .023) was found to be independently protective. CONCLUSIONS Surgery for native IE and PVE of the aortic valve may be performed with satisfactorily results at experienced cardiac surgical centers. In comparison PVE patients suffer from a more than twice as high in-hospital mortality, more postoperative complications, and inferior long-term survival. However preoperative identification of causative pathogens in IE and PVE allows for improved in-hospital survival.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Nina Bauernschmitt
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, New Jersey
| | - Oliver Heyn
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Oberbach
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Gerd Juchem
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
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Liu Q, Jin J, Shao L, Weng S, Zhou J, Li F, Zhang W, Weng X, Gao Y. Late prosthetic valve endocarditis with Mycobacterium tuberculosis after the Bentall procedure. Ann Clin Microbiol Antimicrob 2019; 18:15. [PMID: 30922382 PMCID: PMC6437957 DOI: 10.1186/s12941-019-0314-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prosthetic valve endocarditis (PVE) is a rare but severe complication of valve replacement surgery, with an incidence rate of 0.3–1.2% per patient-year. At present, staphylococci are the predominant causative microorganism of PVE. Herein, we report a confirmed case of late PVE in a mechanical aortic valve caused by Mycobacterium tuberculosis. Case presentation A 32-year-old immunocompetent man with recurrent fever and 5-kg weight loss had a history of having undergone the Bentall procedure due to congenital heart disease. Nine years after the operation, he developed a paravalvular abscess in the mechanical aortic valve, presented with evidence of pulmonary tuberculosis on CT scan and was diagnosed with tuberculous endocarditis. This case report highlights a rare and non-negligible example of tuberculous endocarditis involving a mechanical valve. Conclusions Tuberculous PVE should be considered in patients with a history of valve replacement, recurrent fever, unexplained weight loss, pulmonary tuberculosis and meaningful valvular findings on echocardiogram.
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Affiliation(s)
- Qianqian Liu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jialin Jin
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Shanshan Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Ju Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Feng Li
- Department of Cardiac Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.,Key Laboratory of Medical Molecular Virology, Ministry of Education and Health, Shanghai Medical College and Institutes of Biomedical Science, Fudan University, Shanghai, 200032, China
| | - Xinhua Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yan Gao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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Ivanovic B, Trifunovic D, Matic S, Petrovic J, Sacic D, Tadic M. Prosthetic valve endocarditis - A trouble or a challenge? J Cardiol 2018; 73:126-133. [PMID: 30389305 DOI: 10.1016/j.jjcc.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
Prosthetic valve endocarditis (PVE) represents a rare and serious complication of valve replacement associated with high morbidity and mortality, which significantly differs from native valve endocarditis (NVE). There are two major problems: establishing diagnosis and treatment of PVE. Diagnosis in PVE is challenging and often requires several imaging methods besides standard microbiological analyzes. Transesophageal echocardiographic examination remains the widely used imaging technique in PVE diagnosis, but additional techniques such as computed tomography (CT) and 18F-fluodeoxyglucose positron emission tomography/CT are often necessary. Persistent fever, embolic complications, valve dehiscence, intracardial abscess, heart failure, as well as staphylococcal and fungal PVE require surgical treatment to avoid lethal outcome. The introduction of transcatheter valve implantations and devices significantly complicated the approach - diagnostic and therapeutic to PVE patients. Despite constantly increasing knowledge regarding pathogenesis and treatment of PVE, the optimal therapy remains a matter of debate. Additional studies are necessary to define therapeutic strategies for this potentially fatal complication.
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Affiliation(s)
| | | | - Snezana Matic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Jelena Petrovic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Dalila Sacic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.
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Takemiya K, Ning X, Seo W, Wang X, Mohammad R, Joseph G, Titterington JS, Kraft CS, Nye JA, Murthy N, Goodman MM, Taylor WR. Novel PET and Near Infrared Imaging Probes for the Specific Detection of Bacterial Infections Associated With Cardiac Devices. JACC Cardiovasc Imaging 2018; 12:875-886. [PMID: 29680350 DOI: 10.1016/j.jcmg.2018.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/04/2018] [Accepted: 02/08/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this study was to develop imaging agents to detect early stage infections in implantable cardiac devices. BACKGROUND Bacteria ingest maltodextrins through the specific maltodextrin transporter. We developed probes conjugated with either a fluorescent dye (maltohexaose fluorescent dye probe [MDP]) or a F-18 (F18 fluoromaltohexaose) and determined their usefulness in a model of infections associated with implanted cardiac devices. METHODS Stainless steel mock-ups of medical devices were implanted subcutaneously in rats. On post-operative day 4, animals were injected with either Staphylococcus aureus around the mock-ups to induce a relatively mild infection or oil of turpentine to induce noninfectious inflammation. Animals with a sterile implant were used as control subjects. On post-operative day 6, either the MDP or F18 fluoromaltohexaose was injected intravenously, and the animals were scanned with the appropriate imaging device. Additional positron emission tomography imaging studies were performed with F18-fluorodeoxyglucose as a comparison of the specificity of our probes (n = 5 to 9 per group). RESULTS The accumulation of the MDP in the infected rats was significantly increased at 1 h after injection when compared with the control and noninfectious inflammation groups (intensity ratio 1.54 ± 0.07 vs. 1.26 ± 0.04 and 1.20 ± 0.05, respectively; p < 0.05) and persisted for more than 24 h. In positron emission tomography imaging, both F18 fluoromaltohexaose and F18 fluorodeoxyglucose significantly accumulated in the infected area 30 min after the injection (maximum standard uptake value ratio 4.43 ± 0.30 and 4.87 ± 0.28, respectively). In control rats, there was no accumulation of imaging probes near the device. In the noninfectious inflammation rats, no significant accumulation was observed with F18 fluoromaltohexaose, but F18 fluorodeoxyglucose accumulated in the mock-up area (maximum standard uptake value 2.53 ± 0.39 vs. 4.74 ± 0.46, respectively; p < 0.05). CONCLUSIONS Our results indicate that maltohexaose-based imaging probes are potentially useful for the specific and sensitive diagnosis of infections associated with implantable cardiac devices.
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Affiliation(s)
- Kiyoko Takemiya
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia
| | - Xinghai Ning
- University of California at Berkeley, Department of Bioengineering, Berkeley, California
| | - Wonewoo Seo
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Emory Center for Systems Imaging, Atlanta, Georgia
| | - Xiaojian Wang
- University of California at Berkeley, Department of Bioengineering, Berkeley, California
| | - Rafi Mohammad
- University of California at Berkeley, Department of Bioengineering, Berkeley, California
| | - Giji Joseph
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia
| | - Jane S Titterington
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia
| | - Colleen S Kraft
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia
| | - Jonathan A Nye
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Emory Center for Systems Imaging, Atlanta, Georgia
| | - Niren Murthy
- University of California at Berkeley, Department of Bioengineering, Berkeley, California.
| | - Mark M Goodman
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Emory Center for Systems Imaging, Atlanta, Georgia.
| | - W Robert Taylor
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Cardiology Division, Atlanta, Georgia; Emory University School of Medicine and Georgia Institute of Technology, Department of Biomedical Engineering, Atlanta, Georgia.
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Advanced acuity in microbial biofilm genesis, development, associated clinical infections and control. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.antinf.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abdallah L, Habib G, Remadi JP, Salaun E, Casalta JP, Tribouilloy C. Comparison of prognoses of Staphylococcus aureus left-sided prosthetic endocarditis and prosthetic endocarditis caused by other pathogens. Arch Cardiovasc Dis 2016; 109:542-549. [PMID: 27342809 DOI: 10.1016/j.acvd.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Staphylococcus aureus prosthetic valve endocarditis (SAPIE) is a serious disease. AIMS Our objective was to study the clinical, echocardiographic and prognostic characteristics of left-sided SAPIE, and to compare these characteristics with those of left-sided non-S. aureus prosthetic infective endocarditis (NSAPIE) (i.e. left-sided prosthetic infective endocarditis caused by another germ). METHODS This was a retrospective analysis of 35 cases of SAPIE among 247 cases of left-sided prosthetic valve endocarditis hospitalized at two university hospitals (Amiens and Marseille, France). RESULTS SAPIE accounted for 14.1% of the cases of left-sided prosthetic valve endocarditis. SAPIE complications included heart failure (in 42.8% of cases), acute renal failure (in 51.4%), sepsis (in 51.4%), neurological events (in 31.4%), systemic embolic event (in 34.2%) and abscess (in 60.0%). In-hospital mortality occurred in 48.5% of SAPIE cases compared with 16% of NSAPIE cases. A comparison of the SAPIE and NSAPIE groups showed a significant difference in terms of 4-year survival (31.8±7.3% vs 60.1±4.1%; P=0.001). Severe sepsis was the only prognostic factor associated with in-hospital mortality (odds ratio 5.7; P=0.03) and long-term mortality (odds ratio 3.7; P=0.01) in cases of SAPIE. Sepsis-induced multiple organ dysfunction syndrome was the main cause of in-hospital mortality (70.5%). CONCLUSIONS SAPIE is a very serious disease, with elevated in-hospital mortality resulting from sepsis-induced multiple organ dysfunction syndrome. Emergency surgery is recommended in these cases, when possible, before the occurrence of complications, especially severe sepsis.
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Affiliation(s)
- Layal Abdallah
- Département de cardiologie, CHU d'Amiens-Picardie, 80054 Amiens, France
| | - Gilbert Habib
- Département de cardiologie, hôpital de la Timone, Aix-Marseille université, CHU de Marseille, 13385 Marseille, France
| | - Jean-Paul Remadi
- Département de cardiologie, CHU d'Amiens-Picardie, 80054 Amiens, France
| | - Erwan Salaun
- Département de cardiologie, hôpital de la Timone, Aix-Marseille université, CHU de Marseille, 13385 Marseille, France
| | - Jean-Paul Casalta
- Département de cardiologie, hôpital de la Timone, Aix-Marseille université, CHU de Marseille, 13385 Marseille, France
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Miranda WR, Connolly HM, Bonnichsen CR, DeSimone DC, Dearani JA, Maleszewski JJ, Greason KL, Wilson WR, Baddour LM. Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults. Eur Heart J Cardiovasc Imaging 2016; 17:936-43. [DOI: 10.1093/ehjci/jew086] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/31/2016] [Indexed: 01/27/2023] Open
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Martí-Carvajal AJ, Dayer M, Conterno LO, Gonzalez Garay AG, Martí-Amarista CE, Simancas-Racines D. A comparison of different antibiotic regimens for the treatment of infective endocarditis. Cochrane Database Syst Rev 2016; 4:CD009880. [PMID: 27092951 DOI: 10.1002/14651858.cd009880.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but their use is not standardised, due to the differences in presentation, populations affected and the wide variety of micro-organisms that can be responsible. OBJECTIVES To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE Classic and EMBASE, LILACS, CINAHL and the Conference Proceedings Citation Index on 30 April 2015. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials assessing the effects of antibiotic regimens for treating possible infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. DATA COLLECTION AND ANALYSIS Three review authors independently performed study selection, 'Risk of bias' assessment and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of studies. We described the included studies narratively. MAIN RESULTS Four small randomised controlled trials involving 728 allocated/224 analysed participants met our inclusion criteria. These trials had a high risk of bias. Drug companies sponsored two of the trials. We were unable to pool the data due to the heterogeneity in outcome definitions and the different antibiotics used.The included trials compared the following antibiotic schedules. The first trial compared quinolone (levofloxacin) plus standard treatment (anti-staphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin) and rifampicin) versus standard treatment alone reporting uncertain effects on all-cause mortality (8/31 (26%) with levofloxacin plus standard treatment versus 9/39 (23%) with standard treatment alone; RR 1.12, 95% CI 0.49 to 2.56, very low quality evidence). The second trial compared daptomycin versus low-dose gentamicin plus an anti-staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or vancomycin. This showed uncertain effects in terms of cure rates (9/28 (32.1%) with daptomycin versus 9/25 (36%) with low-dose gentamicin plus anti-staphylococcal penicillin or vancomycin, RR 0.89 95% CI 0.42 to 1.89; very low quality evidence). The third trial compared cloxacillin plus gentamicin with a glycopeptide (vancomycin or teicoplanin) plus gentamicin. In participants receiving gentamycin plus glycopeptide only 13/23 (56%) were cured versus 11/11 (100%) receiving cloxacillin plus gentamicin (RR 0.59, 95% CI 0.40 to 0.85; very low quality evidence). The fourth trial compared ceftriaxone plus gentamicin versus ceftriaxone alone and found no conclusive differences in terms of cure (15/34 (44%) with ceftriaxone plus gentamicin versus 21/33 (64%) with ceftriaxone alone, RR 0.69, 95% CI 0.44 to 1.10; very low quality evidence).The trials reported adverse events, need for cardiac surgical interventions, uncontrolled infection and relapse of endocarditis and found no conclusive differences between comparison groups (very low quality evidence). No trials assessed septic emboli or quality of life. AUTHORS' CONCLUSIONS Limited and very low quality evidence suggested that there were no conclusive differences between antibiotic regimens in terms of cure rates or other relevant clinical outcomes. However, because of the very low quality evidence, this needs confirmation. The conclusion of this Cochrane review was based on randomised controlled trials with high risk of bias. Accordingly, current evidence does not support or reject any regimen of antibiotic therapy for treatment of infective endocarditis.
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Steffen V, Marsch G, Burgwitz K, Kuehn C, Teebken OE. Resistance to infection of long-term cryopreserved human aortic valve allografts. J Thorac Cardiovasc Surg 2015; 151:1251-9. [PMID: 26725710 DOI: 10.1016/j.jtcvs.2015.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/18/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the in vitro antimicrobial activity of 3 antibiotic regimens (group A, gentamicin-piperacillin-vancomycin-metronidazole-amphotericin B; group B, gentamicin-piperacillin-flucloxacillin-metronidazole-amphotericin B; and group C, meropenem-vancomycin-tobramycin-colistin-amphotericin B) used in the processing of cryopreserved human ascending aortic tissue and aortic valves against Staphylococcus epidermidis and Staphylococcus aureus. The results were additionally compared with the infection resistance of cryopreserved ascending aortic tissue against Escherichia coli and Pseudomonas aeruginosa. MATERIALS Each of 10 cryopreserved human allografts (CHAs) was divided into 25 pieces (separating aortic wall and valve). Eighteen segments were microbiologically tested, and 7 pieces underwent scanning electron microscopy. A bacterial solution (4 mL; optical density, 0.20 ± 0.02) was used for contamination. After incubation, the optical density of the solution was measured. CHAs underwent sonication to release viable adherent bacteria. The number of attached bacteria was quantified by the colony forming units per square centimeter of CHA surface. RESULTS Antibiotic regimen groups B and C were more efficient than group A in eradicating gram-positive organisms adherent to the aortic wall (P < .001). Group C showed enhanced resistance against E coli compared with group A or B (P < .001), whereas group B appeared to be more effective against P aeruginosa (P < .001). With reference to each antibiotic regimen, ascending aortic tissue showed significantly less bacterial contamination with staphylococcal bacteria than valve grafts (P ≤ .01). CONCLUSIONS CHAs possess antibacterial activity despite long-term storage over 5 years. Antibiotic combinations applied during CHA processing have a significant influence on their infection resistance. Ascending aortic tissue shows a significantly enhanced bacterial resistance against staphylococcal bacteria compared with aortic valves.
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Affiliation(s)
- Viola Steffen
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany
| | - Georg Marsch
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karin Burgwitz
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany
| | - Omke E Teebken
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Total Artificial Heart as Bridge to Transplantation for Severe Culture-Negative Prosthetic Valve Endocarditis Due to Gemella haemolysans. ASAIO J 2015; 60:479-81. [PMID: 24727539 DOI: 10.1097/mat.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of a patient with prosthetic valve endocarditis (PVE) requiring implantation of a total artificial heart (TAH) as a bridge to heart transplantation. Gemella haemolysans, an unusual cause of PVE, was identified as the organism responsible only by 16s rRNA polymerase chain reaction analysis of surgical tissue samples. We also describe one of the first uses of combined TAH and veno-venous extracorporeal membrane oxygenation therapy in the setting of severe respiratory and cardiac failure. Implantation of a TAH may be considered in situations where more traditional reconstructive methods are not feasible.
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Wu H, Moser C, Wang HZ, Høiby N, Song ZJ. Strategies for combating bacterial biofilm infections. Int J Oral Sci 2015; 7:1-7. [PMID: 25504208 PMCID: PMC4817533 DOI: 10.1038/ijos.2014.65] [Citation(s) in RCA: 542] [Impact Index Per Article: 60.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 12/30/2022] Open
Abstract
Formation of biofilm is a survival strategy for bacteria and fungi to adapt to their living environment, especially in the hostile environment. Under the protection of biofilm, microbial cells in biofilm become tolerant and resistant to antibiotics and the immune responses, which increases the difficulties for the clinical treatment of biofilm infections. Clinical and laboratory investigations demonstrated a perspicuous correlation between biofilm infection and medical foreign bodies or indwelling devices. Clinical observations and experimental studies indicated clearly that antibiotic treatment alone is in most cases insufficient to eradicate biofilm infections. Therefore, to effectively treat biofilm infections with currently available antibiotics and evaluate the outcomes become important and urgent for clinicians. The review summarizes the latest progress in treatment of clinical biofilm infections and scientific investigations, discusses the diagnosis and treatment of different biofilm infections and introduces the promising laboratory progress, which may contribute to prevention or cure of biofilm infections. We conclude that, an efficient treatment of biofilm infections needs a well-established multidisciplinary collaboration, which includes removal of the infected foreign bodies, selection of biofilm-active, sensitive and well-penetrating antibiotics, systemic or topical antibiotic administration in high dosage and combinations, and administration of anti-quorum sensing or biofilm dispersal agents.
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Affiliation(s)
- Hong Wu
- 1] Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark [2] Department of International Health, Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Heng-Zhuang Wang
- Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Niels Høiby
- 1] Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark [2] Department of International Health, Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Zhi-Jun Song
- 1] Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark [2] Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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Carbapenem-Resistant Klebsiella pneumoniae Prosthetic Valve Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e318287c881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A case of indolent endocarditis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:e51-2. [PMID: 23997783 DOI: 10.1155/2012/460301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ko T, Mahara K, Ota M, Kato Y, Tobaru T, Takanashi S, Kikuchi K, Umemura J, Sumiyoshi T, Tomoike H. A case of prosthetic valve endocarditis caused by Streptococcus constellatus as a rare agent of endocarditis. Heart Lung 2013; 42:379-81. [PMID: 23831301 DOI: 10.1016/j.hrtlng.2013.05.006] [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: 05/18/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
We present a case of prosthetic valve endocarditis, which was caused by a rare etiological agent, Streptococcus constellatus. In our case, transesophageal echocardiography showed a large and broad abscess formation throughout the patient's aortic prosthetic valve ring and left atrium. Despite specific intravenous antibiotic therapy, the infection was uncontrollable, and the patient underwent surgical treatment. The pathogen rarely causes endocarditis, but it is known to have a strong potential to form abscess, and therefore its infection may be more serious than other Streptococcus species. Our case seems to be the first report of surgical treatment of PVE caused by S. constellatus. As in our case, transesophageal echocardiography is useful for the detection of vegetation and abscess, and early cardiac surgery may be a more appropriate therapeutic approach for endocarditis caused by S. constellatus.
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Affiliation(s)
- Toshiyuki Ko
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Importancia clínica de la insuficiencia cardiaca congestiva en la endocarditis protésica. Estudio multicéntrico de 257 pacientes. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. ACTA ACUST UNITED AC 2013; 66:384-90. [PMID: 24775821 DOI: 10.1016/j.rec.2012.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 01/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. METHODS A total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients. RESULTS Persistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5). CONCLUSIONS The incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.
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Malvindi PG, Ornaghi D, Tarelli G, Raffa GM. Left ventricular pseudoaneurysm following aortic valve prosthesis endocarditis. J Cardiovasc Med (Hagerstown) 2012; 13:457-9. [PMID: 22644403 DOI: 10.2459/jcm.0b013e3283511f17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 63-year-old man underwent aortic valve replacement and an early reoperation for recurrent endocarditis. Sixteen months later he presented with persistent fever and a 64-slice computed tomography (CT) scan revealed a subannular left ventricular pseudoaneurysm. He underwent successful left ventricular outflow tract reconstruction and aortic valve prosthesis, partial root and ascending aorta replacement.
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Martí-Carvajal AJ, Conterno LO, Hidalgo R, Kwong JSW, Georgoulas P, Salanti G. Antibiotic therapy for treatment of infective endocarditis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Huang HH, Chuang YC, Lee KC, Sue SH, Chang CY, Wei J. Prosthetic Endocarditis Treated by Repeated Heart Transplantation: Report of a Successful Case. Transplant Proc 2012; 44:1171-3. [DOI: 10.1016/j.transproceed.2012.01.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kozarov E. Bacterial invasion of vascular cell types: vascular infectology and atherogenesis. Future Cardiol 2012; 8:123-38. [PMID: 22185451 DOI: 10.2217/fca.11.75] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To portray the chronic inflammation in atherosclerosis, leukocytic cell types involved in the immune response to invading pathogens are often the focus. However, atherogenesis is a complex pathological deterioration of the arterial walls, where vascular cell types are participants with regards to deterioration and disease. Since other recent reviews have detailed the role of both the innate and adaptive immune response in atherosclerosis, herein we will summarize the latest developments regarding the association of bacteria with vascular cell types: infections as a risk factor for atherosclerosis; bacterial invasion of vascular cell types; the atherogenic sequelae of bacterial presence such as endothelial activation and blood clotting; and the identification of the species that are able to colonize this niche. The evidence of a polybacterial infectious component of the atheromatous lesions opens the doors for exploration of the new field of vascular infectology and for the study of atherosclerosis microbiome.
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Affiliation(s)
- Emil Kozarov
- Section of Oral & Diagnostic Sciences, Columbia University Medical Center, 630 West 168 Street, P&S Box 20, New York, NY 10032, USA.
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Treglia G, Maggi F, Bonomo L, Giordano A. Usefulness of fluorine-18 fluorodeoxyglucose PET/computed tomography in diagnosis of aortitis and treatment response evaluation in a patient with aortic prosthesis. J Cardiovasc Med (Hagerstown) 2012; 12:814-6. [PMID: 21934523 DOI: 10.2459/jcm.0b013e32834ba0fd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of an 82-year-old man with aortic prosthesis inflammation in whom fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography has been useful in the detection of the cause of fever of unknown origin. We also describe the correlation between decrease of FDG uptake in the vascular prosthesis after treatment and clinical improvement with normalization of the serological levels of inflammatory markers.
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Affiliation(s)
- Giorgio Treglia
- Department of Bioimaging and Radiological Sciences, Institute of Nuclear Medicine, Italy.
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Santos OD, De Resende MCC, De Mello AL, Frazzon APG, D'Azevedo PA. The use of whole-cell protein profile analysis by SDS-PAGE as an accurate tool to identify species and subspecies of coagulase-negative staphylococci. APMIS 2011; 120:39-46. [PMID: 22151307 DOI: 10.1111/j.1600-0463.2011.02809.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) as a tool to characterize coagulase-negative staphylococci (CoNS). Of 253 clinical isolates and 10 control strains, five species and four subspecies were analyzed. All the isolates were identified using conventional phenotypic tests and SDS-PAGE. Discrepant results between these methods, as well as less common species and subspecies, were confirmed by sodA and 16S rDNA gene sequencing. Intraspecies similarities, calculated by the Dice coefficient, were significantly higher when compared to interspecies similarities. The conventional method failed to identify eight (3.2%) molecularly defined and SDS-PAGE-determined isolates. Therefore, SDS-PAGE was able to discriminate between all unidentified or misidentified isolates using a phenotypic method. In addition, SDS-PAGE identified all atypical isolates using biochemistry and CoNS at the subspecies level.
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Affiliation(s)
- Odelta Dos Santos
- Federal University of Health Science of Porto Alegre, UFCSPA, Brazil.
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O'Brien S, Dayer M, Benzimra J, Hardman S, Townsend M. Streptococcus pneumoniae endocarditis on replacement aortic valve with panopthalmitis and pseudoabscess. BMJ Case Rep 2011; 2011:bcr.06.2011.4304. [PMID: 22678733 DOI: 10.1136/bcr.06.2011.4304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a bioprosthetic aortic valve replacement presented with a short history of malaise, a right panopthalmitis with a Roth spot on funduscopy of the left eye and Streptococcus pneumoniae grown from vitreous and aqueous taps as well as blood cultures. She developed first degree heart block and her ECG was suggestive of an aortic root abscess. This gradually resolved over 6 weeks, during which she was treated with intravenous antibiotics. After careful consideration, it is likely that what was thought to be an aortic root abscess was instead an area of perivalvular inflammation.
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Affiliation(s)
- Stephen O'Brien
- Care of the Elderly, Musgrove Park Hospital, Taunton, Somerset, UK
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Candan O, Gecmen C, Guler A, Karabay CY, Aung SM, Agus HZ, Sonmez K. Aorto-right atrial fistula secondary to infective endocarditis presenting with cardiogenic shock. J Cardiovasc Med (Hagerstown) 2010; 13:65-7. [PMID: 21045716 DOI: 10.2459/jcm.0b013e328340370c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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