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Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet 2024; 404:377-392. [PMID: 39067905 DOI: 10.1016/s0140-6736(24)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
First described more than 350 years ago, infective endocarditis represents a global health concern characterised by infections affecting the native or prosthetic heart valves, the mural endocardium, a septal defect, or an indwelling cardiac device. Over recent decades, shifts in causation and epidemiology have been observed. Echocardiography remains pivotal in the diagnosis of infective endocarditis, with alternative imaging modalities gaining significance. Multidisciplinary management requiring expertise of cardiologists, cardiovascular surgeons, infectious disease specialists, microbiologists, radiologists and neurologists, is imperative. Current recommendations for clinical management often rely on observational studies, given the limited number of well conducted randomised controlled trials studying infective endocarditis due to the rarity of the disease. In this Seminar, we provide a comprehensive overview of optimal clinical practices in infective endocarditis, highlighting key aspects of pathophysiology, pathogens, diagnosis, management, prevention, and multidisciplinary approaches, providing updates on recent research findings and addressing remaining controversies in diagnostic accuracy, prevention strategies, and optimal treatment.
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Affiliation(s)
- Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Aortic Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B K S Sastry
- Department of Cardiology, Renova Century Hospital, Hyderabad, Telangana, India
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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3
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Philip J, Bond MC. Emergency Considerations of Infective Endocarditis. Emerg Med Clin North Am 2022; 40:793-808. [DOI: 10.1016/j.emc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Panagides V, Del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 75:638-646. [PMID: 34894124 DOI: 10.1093/cid/ciab1004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. METHODS This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. RESULTS A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all). CONCLUSION PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada.,Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA.,Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy.,University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany.,St.-Johannes Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy.,Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Durante-Mangoni E, Giuffrè G, Ursi MP, Iossa D, Bertolino L, Senese A, Pafundi PC, D'Amico F, Albisinni R, Zampino R. Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients. Eur J Intern Med 2021; 94:27-33. [PMID: 34474958 DOI: 10.1016/j.ejim.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Very limited data are available on the long-term outcome of infective endocarditis (IE) and its determinants. The aim of this study was to identify the predictors of long-term mortality in patients affected by left sided IE (LSIE). METHODS This was an historical retrospective observational study on prospectively collected data from patients with LSIE hospitalized in our Unit (January 2000-December 2017). Multiple variables relevant to history, physical examination, laboratory tests, echocardiography, comorbidities, complications and outcome were analysed by Cox regression to identify predictors of long-term mortality. RESULTS 414 patients were included, and followed up for a median of 39 months [IQR 11-74]. Median age was 59 years [range 3-89], and most patients were male. Over 50% showed at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors of 1-year mortality. At multivariate analysis, peripheral arterial disease (p= 0.017), hyperglycemia on admission (p=0.013) and a higher BMI (p=0.009) were independent predictors of long-term mortality in 1-year survivors. At multivariable Cox proportional hazard regression, peripheral arterial disease (p=0.002), hyperglycemia (p=0.041) and CKD on hemodialysis (p=0.025) confirmed to be independently associated with an increased risk of long-term mortality in the overall 414 patient cohort. CONCLUSIONS Cardiovascular and metabolic risk signals, specifically peripheral arterial disease and hyperglicemia, affect long-term mortality of LSIE. An active and long-term follow up seems warranted in IE survivors showing these conditions at outset.
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Affiliation(s)
- Emanuele Durante-Mangoni
- Departments of Precision Medicine, Univeristy of Perugia; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy.
| | | | | | - Domenico Iossa
- Departments of Precision Medicine, Univeristy of Perugia
| | | | | | | | | | - Rosina Albisinni
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Rosa Zampino
- Advanced Medical and Surgical Sciences, University of Campania 'L. Vanvitelli'; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
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6
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Mortalidad a corto y largo plazo de pacientes con indicación quirúrgica no intervenidos en el curso de la endocarditis infecciosa izquierda. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Risk factors and outcomes of early acute kidney injury in infective endocarditis: A retrospective cohort study. Int J Infect Dis 2020; 99:421-427. [PMID: 32795604 DOI: 10.1016/j.ijid.2020.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The incidence of acute kidney injury (AKI) in infective endocarditis (IE), its risk factors and consequences on patient and renal survival remain debated. METHODS Patients hospitalized for a first episode of IE (possible or definite according to modified Duke criteria) between 2013 and 2016 were included. The primary endpoint was to determine risk factors for early AKI (E-AKI) during the first week of management of IE. RESULTS A total of 276 patients were included: 220 (79.7%) had definite IE and 56 (20.3%) had possible IE. E-AKI occurred in 150 patients (53%). IE due to Staphylococcus aureus (OR 3.41; 95% CI 1.83-6.39; p<0.01), history of diabetes (OR 2.34; 95% CI 1.25-4.37; p<0.01), peripheral arterial disease (OR 2.59; 95% CI 1.07-6.23; p<0.05), immunological manifestations (OR 3.11; 95% CI 1.31-7.39; p=0.01), and use of norepinephrine (OR 3.44; 95% CI 1.72-7.02; p<0.01) were associated with E-AKI. In subgroup analysis, infectious disease consultation was associated with a lower risk of AKI at day 7 (OR 0.41; 95% CI 0.16-0.88; p=0.04). E-AKI was associated with 1-year mortality (OR 1.65; 95% CI 1.03-2.64; p=0.04) and chronic kidney disease progression (OR 2.23; 95% CI 1.30-3.82; p<0.01). CONCLUSIONS E-AKI is common in IE and often associated with non-modifiable variables. Multidisciplinary management should be mandatory, and awareness of AKI diagnosis and etiological explorations should be raised.
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8
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Troponin elevation is very common in patients with infective endocarditis and is associated with a poor outcome. Int J Cardiol 2020; 307:82-86. [DOI: 10.1016/j.ijcard.2020.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
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Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery. Clin Res Cardiol 2020; 109:1342-1351. [PMID: 32185504 DOI: 10.1007/s00392-020-01628-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Infective endocarditis (IE) may require heart valve surgery. It is well known that heart valve surgery itself and previous IE predispose to IE. However, data are sparse on whether the risk of IE is different among patients undergoing valve surgery due to IE and other causes (i.e. recurrent vs. first-time IE). METHODS Using Danish nationwide registries, patients undergoing left-sided heart valve surgery in the course of an IE hospitalization (1996-2017) were identified and matched with controls undergoing left-sided heart valve surgery due to another cause than IE in a 1:1 ratio. Patients were stratified according to type of surgical valve intervention and affected valve. The comparative risk of recurrent vs. first-time IE was assessed by cumulative incidence curves and multivariable Cox regression analyses. RESULTS The study population comprised 971 patients with a first-time admission for IE requiring heart valve surgery matched with 971 controls undergoing heart valve surgery due to other causes than IE. The risk of recurrent IE was significantly higher than the risk of first-time IE following heart valve surgery (5.5% and 3.0% by 10 years, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.02-2.70). The risk of IE recurrence was not significantly different comparing valve replacement and valve repair (5.5% and 5.3%, respectively, HR 1.60, 95% CI 0.71-3.60). Yet, the risk of IE recurrence was significantly higher among patients with biological versus mechanical prostheses (6.3% and 4.6%, respectively, HR 2.00, 95% CI 1.02-3.70). CONCLUSIONS Following heart valve surgery, the risk of recurrent IE was significantly higher than the risk of first-time IE.
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Østergaard L, Dahl A, Bruun NE, Oestergaard LB, Lauridsen TK, Torp-Pedersen C, Mortensen R, Smerup M, Valeur N, Koeber L, Hassager C, Ihlemann N, Fosbøl EL. Valve regurgitation in patients surviving endocarditis and the subsequent risk of heart failure. Heart 2019; 106:1015-1022. [PMID: 31822570 DOI: 10.1136/heartjnl-2019-315715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/28/2019] [Accepted: 11/03/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Significant valve regurgitation is common in patients surviving native valve infective endocarditis (IE), however the associated risk of heart failure (HF) subsequent to hospital discharge after IE is sparsely described. METHODS We linked data from the East Danish Endocarditis Registry with administrative registries from 2002 to 2016 and included patients treated medically for IE who were discharged alive. Left-sided valve regurgitation was assessed by echocardiography at IE discharge and examined for longitudinal risk of HF. Multivariable adjusted Cox analysis was used to assess the associated risk of HF in patients with regurgitation (moderate or severe) compared with patients without regurgitation. RESULTS We included 192 patients, 87 patients with regurgitation at discharge (30 with aortic regurgitation and 57 with mitral regurgitation) and 105 patients without. The cumulative risk of HF at 5 years of follow-up was 28.7% in patients with regurgitation at IE discharge and 12.4% in patients without regurgitation; the corresponding multivariable adjusted HR was 3.53 (95% CI 1.72 to 7.25). We identified an increased associated risk of HF for patients with aortic regurgitation (HR=2.91, 95% CI 1.14 to 7.43) and mitral regurgitation (HR=3.95, 95% CI 1.80 to 8.67) compared with patients without regurgitation. During follow-up, 21.9% and 5.7% underwent left-sided valve surgery among patients with and without regurgitation. CONCLUSION In patients surviving IE, treated medically, we observed that severe or moderate left-sided native valve regurgitation was associated with a significantly higher risk of HF compared with patients without regurgitation at IE discharge. Close monitoring of these patients is needed to initiate surgery timely.
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Affiliation(s)
| | - Anders Dahl
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark
| | | | | | | | - Rikke Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Koeber
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
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Vallejo Camazón N, Cediel G, Núñez Aragón R, Mateu L, Llibre C, Sopena N, Gual F, Ferrer E, Quesada MD, Berastegui E, Teis A, López Ayerbe J, Juncà G, Vivero A, Muñoz Guijosa C, Pedro-Botet L, Bayés-Genís A. Short- and long-term mortality in patients with left-sided infective endocarditis not undergoing surgery despite indication. ACTA ACUST UNITED AC 2019; 73:734-740. [PMID: 31767290 DOI: 10.1016/j.rec.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES In infective endocarditis (IE), decisions on surgical interventions are challenging and a high percentage of patients with surgical indication do not undergo these procedures. This study aimed to evaluate the short- and long-term prognosis of patients with surgical indication, comparing those who underwent surgery with those who did not. METHODS We included 271 patients with left-sided IE treated at our institution from 2003 to 2018 and with an indication for surgery. There were 83 (31%) surgery-indicated not undergoing surgery patients with left-sided infective endocarditis (SINUS-LSIE). The primary outcome was all-cause death by day 60 and the secondary outcome was all-cause death from day 61 to 3 years of follow-up. Multivariable Cox regression and propensity score matching were used for the analysis. RESULTS At the 60-day follow-up, 40 (21.3%) surgically-treated patients and 53 (63.9%) SINUS-LSIE patients died (P <.001). Risk of 60-day mortality was higher in SINUS-LSIE patients (HR, 3.59; 95%CI, 2.16-5.96; P <.001). Other independent predictors of the primary endpoint were unknown etiology, heart failure, atrioventricular block, and shock. From day 61 to the 3-year follow-up, there were no significant differences in the risk of death between surgically-treated and SINUS-LSIE patients (HR, 1.89; 95%CI, 0.68-5.19; P=.220). Results were consistent after propensity score matching. Independent variables associated with the secondary endpoint were previous IE, diabetes mellitus, and Charlson index. CONCLUSIONS Two-thirds of SINUS-LSIE patients died within 60 days. Among survivors, the long-term mortality depends more on host conditions than on the treatment received during admission.
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Affiliation(s)
- Nuria Vallejo Camazón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raquel Núñez Aragón
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Lourdes Mateu
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cinta Llibre
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Nieves Sopena
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Gual
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena Ferrer
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Dolores Quesada
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabeth Berastegui
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Albert Teis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge López Ayerbe
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Gladys Juncà
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ainhoa Vivero
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Lluisa Pedro-Botet
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
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12
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[Complications and prognosis of infective endocarditis]. Presse Med 2019; 48:532-538. [PMID: 31056233 DOI: 10.1016/j.lpm.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022] Open
Abstract
Clinical manifestations of infective endocarditis may involve almost all body organs. They are usually classified as either cardiac or extra-cardiac complications. The first stage of infection is the development of intra-cardiac vegetation, which may further spread with an increase in size and number of vegetations, destructive valve lesions, and perivalvular extension of the infection. These anatomical lesions are responsible for hemodynamic disorders, mostly valvular regurgitation, and often lead to heart failure, which is the most frequent complication of IE. Embolic events may affect various vascular territories, the most frequent sites being brain, spleen and kidney for left-sided IE, and lung for right-sided IE. Cerebral complications may be of ischemic, hemorrhagic and/or infectious origin, are often the revealing symptoms of IE, and are well-recognized factors of poor prognosis. IE remains a dreadful disease with an in hospital mortality of 20%, a 5 year mortality of 40% and a significant morbidity.
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Abegaz TM, Bhagavathula AS, Gebreyohannes EA, Mekonnen AB, Abebe TB. Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:291. [PMID: 29233094 PMCID: PMC5728061 DOI: 10.1186/s12872-017-0729-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Despite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE. Methods A computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests. Results Twenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively. Conclusion Irrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results. Electronic supplementary material The online version of this article (10.1186/s12872-017-0729-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemayehu B Mekonnen
- Medication Safety Chair, College of Pharmacy, King Saud University, Riadh, Saudi Arabia
| | - Tamrat Befekadu Abebe
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Master's Program in Health Economics, Policy and Managment; Student; Department of Learning, Informatics, Managent and Ethics, Karolinska Institutet, Solna, Sweden
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14
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Tao E, Wan L, Wang W, Luo Y, Zeng J, Wu X. The prognosis of infective endocarditis treated with biological valves versus mechanical valves: A meta-analysis. PLoS One 2017; 12:e0174519. [PMID: 28407024 PMCID: PMC5390962 DOI: 10.1371/journal.pone.0174519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/10/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Surgery remains the primary form of treatment for infective endocarditis (IE). However, it is not clear what type of prosthetic valve provides a better prognosis. We conducted a meta-analysis to compare the prognosis of infective endocarditis treated with biological valves to cases treated with mechanical valves. METHODS Pubmed, Embase and Cochrane databases were searched from January 1960 to November 2016.Randomized controlled trials, retrospective cohorts and prospective studies comparing outcomes between biological valve and mechanical valve management for infective endocarditis were analyzed. The Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the literature and extracted data, and Stata 12.0 software was used for the meta-analysis. RESULTS A total of 11 publications were included; 10,754 cases were selected, involving 6776 cases of biological valves and 3,978 cases of mechanical valves. The all-cause mortality risk of the biological valve group was higher than that of the mechanical valve group (HR = 1.22, 95% CI 1.03 to 1.44, P = 0.023), as was early mortality (RR = 1.21, 95% CI 1.02 to 1.43, P = 0.033). The recurrence of endocarditis (HR = 1.75, 95% CI 1.26 to 2.42, P = 0.001), as well as the risk of reoperation (HR = 1.79, 95% CI 1.15 to 2.80, P = 0.010) were more likely to occur in the biological valve group. The incidence of postoperative embolism was less in the biological valve group than in the mechanical valve group, but this difference was not statistically significant (RR = 0.90, 95% CI 0.76 to 1.07, P = 0.245). For patients with prosthetic valve endocarditis (PVE), there was no significant difference in survival rates between the biological valve group and the mechanical valve group (HR = 0.91, 95% CI 0.68 to 1.21, P = 0.520). CONCLUSION The results of our meta-analysis suggest that mechanical valves can provide a significantly better prognosis in patients with infective endocarditis. There were significant differences in the clinical features of patients receiving a biological valve compared to patients receiving a mechanical valve. A large, multicenter retrospective study included in our meta-analysis suggested that any mortality risk of the biological valve group was significant higher than that of the mechanical valve group. However, the risk was no different after risk was adjusted. So, we thought the reason for this result may be related to the characteristics of the patient rather than valve dysfunction. It is still necessary to future randomized studies to verify this conclusion.
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Affiliation(s)
- Ende Tao
- Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Wan
- Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - WenJun Wang
- Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - YunLong Luo
- Department of Neurosurgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - JinFu Zeng
- Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xia Wu
- Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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16
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Baty V. Performing a Systematic Colonoscopy After Staphylococcal Infective Endocarditis: How Good Is the Evidence? J Am Coll Cardiol 2016; 68:773-4. [PMID: 27515341 DOI: 10.1016/j.jacc.2016.04.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
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17
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Solari S, Mastrobuoni S, De Kerchove L, Navarra E, Astarci P, Noirhomme P, Poncelet A, Jashari R, Rubay J, El Khoury G. Over 20 years experience with aortic homograft in aortic valve replacement during acute infective endocarditis. Eur J Cardiothorac Surg 2016; 50:1158-1164. [PMID: 27229671 DOI: 10.1093/ejcts/ezw175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/23/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Despite the controversy, the aortic homograft is supposedly the best option in acute infective endocarditis (AIE), due to its resistance to reinfection. However, the technical complexity and the risk of structural deterioration over time have limited its utilization. The aim of this study was to evaluate the long-term results of aortic homograft for the treatment of infective endocarditis in our institution with particular attention to predictors of survival and homograft reoperation. METHODS The cohort includes 112 patients who underwent aortic valve replacement with an aortic homograft for AIE between January 1990 and December 2014. RESULTS Fifteen patients (13.4%) died during the first 30 days after the operation. Two patients were lost to follow-up after discharge from the hospital; therefore, 95 patients were available for long-term analysis. The median duration of follow-up was 7.8 years (IQR 4.7-17.6). Five patients (5.3%) suffered a recurrence of infective endocarditis (1 relapse and 4 new episodes). Sixteen patients (16.8%) were reoperated for structural valve degeneration (SVD; n = 14, 87.5%) or for infection recurrence (n = 2, 12.5%). Freedom from homograft reoperation for infective endocarditis or structural homograft degeneration at 10 and 15 years postoperatively was 86.3 ± 5.5 and 47.3 ± 11.0%, respectively. For patients requiring homograft reoperation, the median interval to reintervention was 11.6 years (IQR 8.3-14.5). Long-term survival was 63.6% (95% CI 52.4-72.8%) and 53.8% (95% CI 40.6-65.3%) at 10 and 15 years, respectively. CONCLUSIONS The use of aortic homograft in acute aortic valve endocarditis is associated with a remarkably low risk of relapsing infection and very acceptable long-term survival. The risk of reoperation due to SVD is significant after one decade especially in young patients. The aortic homograft seems to be ideally suited for reconstruction of the aortic valve and cardiac structures damaged by the infective process especially in early surgery.
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Affiliation(s)
- Silvia Solari
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent De Kerchove
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Noirhomme
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alain Poncelet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ramadan Jashari
- European Homograft Bank (EHB), Hôpital Saint-Jean, Brussels, Belgium
| | - Jean Rubay
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium .,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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18
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Abstract
Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. The microbiology of the disease has also changed, and staphylococci, most often associated with health-care contact and invasive procedures, have overtaken streptococci as the most common cause of the disease. Although novel diagnostic and therapeutic strategies have emerged, 1 year mortality has not improved and remains at 30%, which is worse than for many cancers. Logistical barriers and an absence of randomised trials hinder clinical management, and longstanding controversies such as use of antibiotic prophylaxis remain unresolved. In this Seminar, we discuss clinical practice, controversies, and strategies needed to target this potentially devastating disease.
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Affiliation(s)
- Thomas J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, UK
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19
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Martínez-Sellés M, Bouza E, Díez-Villanueva P, Valerio M, Fariñas MC, Muñoz-García AJ, Ruiz-Morales J, Gálvez-Acebal J, Antorrena I, de la Hera Galarza JM, Navas E, Muñoz P. Incidence and clinical impact of infective endocarditis after transcatheter aortic valve implantation. EUROINTERVENTION 2016; 11:1180-7. [DOI: 10.4244/eijy15m02_05] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3143] [Impact Index Per Article: 349.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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21
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Dong Y, Huang J, Li G, Li L, Li W, Li X, Liu X, Liu Z, Lu Y, Ma A, Sun H, Wang H, Wen X, Xu D, Yang J, Zhang J, Zhao H, Zhou J, Zhu L, Committee Members:, Bai L, Cao K, Chen M, Chen M, Dai G, Ding W, Dong W, Fang Q, Fang W, Fu X, Gao W, Gao R, Ge J, Ge Z, Gu F, Guo Y, Han H, Hu D, Huang W, Huang L, Huang C, Huang D, Huo Y, Jin W, Ke Y, Lei H, Li X, Li Y, Li D, Li G, Li X, Li Z, Liang Y, Liao Y, Liu G, Ma A, Ma C, Ma D, Ma Y, Shen L, Sun J, Sun C, Sun Y, Tang Q, Wan Z, Wang H, Wang J, Wang S, Wang D, Wang G, Wang J, Wu Y, Wu P, Wu S, Wu X, Wu Z, Yang J, Yang T, Yang X, Yang Y, Yang Z, Ye P, Yu B, Yuan F, Zhang S, Zhang Y, Zhang R, Zhang Y, Zhang Y, Zhao S, Zhou X. Guidelines for the prevention, diagnosis, and treatment of infective endocarditis in adults: The Task Force for the Prevention, Diagnosis, and Treatment of Infective Endocarditis in Adults of Chinese Society of Cardiology of Chinese Medical Association, and of the Editorial Board of Chinese Journal of Cardiology. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Martínez-Sellés M, Muñoz P, Arnáiz A, Moreno M, Gálvez J, Rodríguez-Roda J, de Alarcón A, García Cabrera E, Fariñas MC, Miró JM, Montejo M, Moreno A, Ruiz-Morales J, Goenaga MA, Bouza E. Valve surgery in active infective endocarditis: A simple score to predict in-hospital prognosis. Int J Cardiol 2014; 175:133-7. [DOI: 10.1016/j.ijcard.2014.04.266] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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23
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Ferreira JP, Gomes F, Rodrigues P, Araújo Abreu M, Maia JM, Bettencourt P, Luz A, Torres S, Araújo Correia J. Left-sided infective endocarditis: Analysis of in-hospital and medium-term outcome and predictors of mortality. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2012.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ferreira JP, Gomes F, Rodrigues P, Araújo Abreu M, Maia JM, Bettencourt P, Luz A, Torres S, Araújo Correia J. Left-sided infective endocarditis: Analysis of in-hospital and medium-term outcome and predictors of mortality. Rev Port Cardiol 2013; 32:777-84. [DOI: 10.1016/j.repc.2012.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/01/2012] [Indexed: 02/07/2023] Open
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25
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Fernández-Hidalgo N, Tornos Mas P. Epidemiología de la endocarditis infecciosa en España en los últimos 20 años. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Epidemiology of infective endocarditis in Spain in the last 20 years. ACTA ACUST UNITED AC 2013; 66:728-33. [PMID: 24773679 DOI: 10.1016/j.rec.2013.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is an uncommon disease, with an estimated incidence of 3.1 to 3.7 episodes per 100 000 inhabitants/year. The incidence is highest in elderly people. The microorganisms most frequently isolated in infective endocarditis are staphylococci and streptococci. In the last few decades, the spectrum of heart diseases predisposing to infective endocarditis has changed, since degenerative heart disease is the most common valve disease, and there are an increasing number of infective endocarditis patients without previously known valve disease. In addition, up to one-third of infective endocarditis patients become infected through contact with the health system. These patients are more frail, which leads to higher in-hospital mortality. As a result of substantial epidemiological changes, few cases of infective endocarditis can be prevented by antibiotic prophylaxis. Despite advances in medical and surgical treatment, in-hospital mortality among infective endocarditis patients is high. Nevertheless, there is room for improvement in reducing the rate of nosocomial bacteremia, the prompt diagnosis of infective endocarditis in at-risk patients, and the early identification of patients with a highest risk of complications, as well as in the creation of multidisciplinary teams for the management of this disease.
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Ternhag A, Cederström A, Törner A, Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS One 2013; 8:e67519. [PMID: 23861768 PMCID: PMC3704638 DOI: 10.1371/journal.pone.0067519] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) remains a serious disease with substantial mortality. In this study we investigated the incidence of IE, as well as its associated short and long term mortality rates. METHODS The IE cases were identified in the Swedish national inpatient register using ICD-10 codes, and then linked to the population register in order to identify deaths in the cohort. Crude mortality rates among IE patients were obtained for different time intervals. These rates were directly standardized using sex- and age-matched mortality in the general population. RESULTS The cohort consisted of 7603 individuals and 7817 episodes of IE during 1997-2007. The 30 days all-cause crude mortality rate was 10.4% and the standardized mortality ratio (SMR) was 33.7 (95% confidence interval [CI]: 31.0-36.6). Excluding the first year of follow-up, the long term mortality (1-5 years) showed an increased SMR of 2.2 (95% CI: 2.0-2.3) compared to the general population. Significantly higher SMR was found for cases of IE younger than 65 years of age with a 1-5 year SMR of 6.3, and intravenous drug-users with a SMR of 19.1. Native valve IE cases, in which surgery was performed had lower crude mortality rates and Mantel-Haenzel odds ratios of less than one compared to those with medical therapy alone during 30-day and 5-years follow-up. CONCLUSIONS The 30-days crude mortality rate for IE was 10.4% and long-term relative mortality risk remains increased even up to 5 years of follow-up, therefore a close monitoring of these patients would be of value.
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Affiliation(s)
- Anders Ternhag
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Agneta Cederström
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Anna Törner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Westling
- Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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28
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Bor DH, Woolhandler S, Nardin R, Brusch J, Himmelstein DU. Infective endocarditis in the U.S., 1998-2009: a nationwide study. PLoS One 2013; 8:e60033. [PMID: 23527296 PMCID: PMC3603929 DOI: 10.1371/journal.pone.0060033] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/22/2013] [Indexed: 01/16/2023] Open
Abstract
Background Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates. Methods and Findings Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness. Conclusions Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections.
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Affiliation(s)
- David H. Bor
- Department of Medicine and Division of Infectious Diseases, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Steffie Woolhandler
- School of Public Health, City University of New York, New York, New York, United States of America; and Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Rachel Nardin
- Department of Medicine and Division of Neurology, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - John Brusch
- Department of Medicine and Division of Infectious Diseases, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - David U. Himmelstein
- School of Public Health, City University of New York, New York, New York, United States of America; and Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, United States of America
- * E-mail:
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Fernández-Hidalgo N, Almirante B, Tornos P, González-Alujas MT, Planes AM, Galiñanes M, Pahissa A. Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital. Clin Microbiol Infect 2012; 18:E522-30. [PMID: 23077981 DOI: 10.1111/1469-0691.12033] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to describe the immediate and long-term prognosis of a contemporary cohort of patients with left-sided infective endocarditis (LSIE). A prospective observational cohort study was conducted in a referral centre. Between January 2000 and December 2011, all consecutive adult patients with LSIE were followed-up until death, relapse, recurrence, need for late surgery, or last control. During the active phase of IE, 174 of 438 patients underwent surgery (40% overall; 43% native valve (NVIE), 30% prosthetic valve (PVIE)) and 125 died (29% overall; 26% NVIE, 39% PVIE). The median follow-up in survivors was 3.2 years (interquartile range (IQR) 1.0-6.0 years). Relapses occurred in seven patients (2.2%; 95% CI, 1.1-4.5) and recurrences in eight (2.6%; 95% CI, 1.3-5.0), with an incidence density of 0.0067 per patient-year (95% CI, 0.0029-0.0133) and high mortality (75% of recurrences). Only four of 130 survivors (3.1%; 95% CI, 1.2-7.6) who were treated surgically during the active phase of the disease, and 14/183 (7.7%; 95% CI, 4.6-12.4) of those not undergoing surgery needed operation during follow-up (p 0.09). In the 313 survivors, actuarial survival was 86% at 1 year (87% NVIE, 83% PVIE), 79% at 2 years (81% NVIE, 72% PVIE) and 68% at 5 years (71% NVIE, 57% PVIE). At 1 year, 115 of 397 patients (29.0%; 95% CI, 24.7-33.6) remained alive, with no surgery requirement, relapse or recurrence. LSIE is associated with considerable in-hospital and long-term mortality, especially PVIE. However, relapses, recurrences and the need for late surgery are uncommon.
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Affiliation(s)
- N Fernández-Hidalgo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Thuny F, Giorgi R, Habachi R, Ansaldi S, Le Dolley Y, Casalta JP, Avierinos JF, Riberi A, Renard S, Collart F, Raoult D, Habib G. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J 2012; 164:94-101. [PMID: 22795288 DOI: 10.1016/j.ahj.2012.04.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 04/12/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Mortality and morbidity associated with infective endocarditis may extend beyond successful treatment. The primary objective was to analyze rates, temporal changes, and predictors of excess mortality in patients surviving the acute phase of endocarditis. The secondary objective was to determine the rate of recurrence and the need for late cardiac surgery. METHODS An observational cohort study was conducted at a university-affiliated tertiary medical center, among 328 patients who survived the active phase of endocarditis. We used age-, sex-, and calendar year-specific mortality hazard rates of the Bouches-du-Rhone French district population to calculate expected survival and excess mortality. The risk of recurrence and late valve surgery was also assessed. RESULT Compared with expected survival, patients surviving a first episode of endocarditis had significantly worse outcomes (P = .001). The relative survival rates at 1, 3, and 5 years were 92% (95% CI, 88%-95%), 86% (95% CI, 77%-92%), and 82% (95% CI, 59%-91%), respectively. This excess mortality was observed during the entire follow-up period but was the highest during the first year after hospital discharge. Most of the recurrences and late cardiac surgeries also occurred during this period. Women exhibited a higher risk of age-adjusted excess mortality (adjusted excess hazard ratio, 2.0; 95% CI, 1.05-3.82; P = .03). Comorbidity index, recurrence of endocarditis, and history of an aortic valve endocarditis in women were independent predictors of excess mortality. CONCLUSIONS These results justify close monitoring of patients after successful treatment of endocarditis, at least during the first year. Special attention should be paid to women with aortic valve damage.
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Affiliation(s)
- Franck Thuny
- Département de Cardiologie, Hôpital La Timone, Aix-Marseille Université, Marseille, France.
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Possible role of F18-FDG-PET/CT in the diagnosis of endocarditis: preliminary evidence from a review of the literature. Int J Cardiovasc Imaging 2011; 28:1417-25. [DOI: 10.1007/s10554-011-9984-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/16/2011] [Indexed: 01/30/2023]
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Rabkin DG, Mokadam NA, Miller DW, Goetz RR, Verrier ED, Aldea GS. Long-term outcome for the surgical treatment of infective endocarditis with a focus on intravenous drug users. Ann Thorac Surg 2011; 93:51-7. [PMID: 22054655 DOI: 10.1016/j.athoracsur.2011.08.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/03/2011] [Accepted: 08/08/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND We reviewed our experience with surgical procedures for infective endocarditis (IE) in order to evaluate modern outcomes and objectively examine our institutional preferences, including the use of bioprostheses in intravenous drug users (IVDUs) regardless of age and prompt surgical intervention in patients with either septic cerebral emboli or active infection. METHODS Review of medical records was conducted from February 1999 to November 2010. The Social Security Death Index was used to determine death from any cause in the postoperative period. Hospital records were used to identify infectious complications, recurrent endocarditis, and reoperation. RESULTS Sixty-four patients were identified as IVDUs and 133 patients as non-IVDUs. Survival at 30 days, 1 year, 5 years, and 10 years for IVDUs and non-IVDUs was 91.2% versus 93.6%, 77.5% versus 83.0%, 46.7% versus 71.1%, and 41.1% versus 52.0%, respectively. Cox regression analysis identified intravenous drug use as an independent risk factor for diminished survival (p=0.03), although not for reoperation (p=0.95) despite 95.3% of IVDUs receiving bioprostheses versus 73.7% of non-IVDUs (p=0.0002, Fisher's exact test). Forty-three patients were identified as having preoperative septic cerebral emboli; none had a perioperative hemorrhagic event. Active infection approached significance as an independent risk factor for the composite end point of recurrent IE and perioperative infection (odds ratio 2.8; 95% confidence interval, 0.777 to 10.9; p=0.12, Fisher's exact test). CONCLUSIONS Bioprostheses are reasonable for IVDUs undergoing valve replacement for IE regardless of age. Prompt surgical intervention in the setting of septic cerebral emboli is justified; in the setting of active infection it is less clear.
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Affiliation(s)
- David G Rabkin
- Division of Cardiac Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington 98195, USA.
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Laupland KB, Svenson LW, Gregson DB, Church DL. Long-term mortality associated with community-onset bloodstream infection. Infection 2011; 39:405-10. [DOI: 10.1007/s15010-011-0149-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
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Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S. Recommendations for the practice of echocardiography in infective endocarditis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 11:202-19. [PMID: 20223755 DOI: 10.1093/ejechocard/jeq004] [Citation(s) in RCA: 339] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short- and long-term prognosis, the prediction of embolic events, and the follow-up of patients under specific antibiotic therapy. Echocardiography is also useful for the diagnosis and management of the complications of IE, helping the physician in decision-making, particularly when a surgical therapy is considered. Finally, intraoperative echocardiography must be performed in IE to help the surgeon in the assessment and management of patients with IE during surgery. The current 'recommendations for the practice of echocardiography in infective endocarditis' aims to provide both an updated summary concerning the value and limitations of echocardiography in IE, and clear and simple recommendations for the optimal use of both transthoracic and transoesophageal echocardiography in IE.
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Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Boulevard Jean Moulin, Marseille, France.
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Nayak A, Mundy J, Wood A, Griffin R, Pinto N, Peters P, Shah P. Surgical management and mid-term outcomes of 108 patients with infective endocarditis. Heart Lung Circ 2011; 20:532-7. [PMID: 21550303 DOI: 10.1016/j.hlc.2011.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 02/27/2011] [Accepted: 03/18/2011] [Indexed: 12/27/2022]
Abstract
This study evaluates the early and mid-term outcomes, predictors of mortality and morbidity and quality of life of patients operated for infective endocarditis. Data on 108 patients undergoing 113 surgical procedures during October 1998 to January 2010 was prospectively collected. NYHA Class was >III in 49 (43.4%) cases. Thirty-seven (33%) patients had isolated mitral valve procedures, 58 (51%) had aortic valve, two had tricuspid valve and 16 had multivalvular procedures. Active endocarditis was noted in 86 (76%) procedures, native valve endocarditis in 105 (93%) and prosthetic valve endocarditis in eight procedures. Logistic EuroSCORE at presentation was >14 in 18 (17%) patients. Staphylococcus aureus was the most common organism isolated. Follow-up was carried out in 76/85 (88.37%) of surviving patients, and the mean follow-up time was 37.2 months. Functional class and quality of life (using EQ-5D Health Questionnaire) were assessed by telephone interviews. NYHA Class on follow-up was I-II in 62/76 (83%). Multivariate predictor of 30-day mortality was peripheral vascular disease (p = 0.025) whilst multivariate predictors of long-term survival were male sex (p = 0.01), peripheral vascular disease (p = 0.02) and bypass time (p = 0.006). The overall survival was 87% at one year and 80% at five years. Thirty-three percent (25/76) patients reported a score reflecting full health. Optimal antibiotic therapy and timely surgical intervention were associated with improved functional class, quality of life and mid-term survival.
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Affiliation(s)
- Arun Nayak
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4102, Australia
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Thajam D, Atkinson DE, Sibley CP, Lavender T. Is Neonatal Abstinence Syndrome Related to the Amount of Opiate Used? J Obstet Gynecol Neonatal Nurs 2010; 39:503-9. [DOI: 10.1111/j.1552-6909.2010.01174.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Risk factors of mid-term mortality of patients with infective endocarditis. Eur J Clin Microbiol Infect Dis 2010; 29:1355-60. [PMID: 20640585 DOI: 10.1007/s10096-010-1006-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 06/20/2010] [Indexed: 12/13/2022]
Abstract
In-hospital and long-term mortality of infective endocarditis (IE) are well noted, but the studies for mid-term (90-day) mortality of IE is still limited. We determine the mid-term mortality rate of IE and its significant predictors. Seventy patients with IE were hospitalised at St. Luke's International Hospital between January 1996 and March 2009, of whom 62 consecutive patients could be followed up for 90 days after diagnosis. We then calculated Kaplan-Meier (KM) estimates and performed time-to-event analysis. The mean (standard deviation, SD) age was 66.6 (15.3) years. Thirty-five patients (56%) were male. Blood cultures were positive in 87%. Causative microorganisms were: viridans group streptococci (23%), β-streptococci (16%), Staphylococcus aureus (15%), including methicillin-resistant S. aureus (MRSA) (5%). Thirty-three cases (53%) had at least one complication such as heart failure (34%), central nervous system (CNS) complication (29%) or emboli peripheral to CNS (6%). KM estimates (95% CI) of the 90-day mortality was 14.5% (7.8-25%). In multiple regression analysis using the Cox proportional hazards model, hazard ratios of at least one complication for the 90-day mortality was 8.2 (1.4-155). Mid-term mortality of IE continues to be high and the presence of at least one complication may be considered as an independent risk factor of mid-term mortality.
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Buchholtz K, Larsen CT, Hassager C, Bruun NE. Infective endocarditis: Long-term reversibility of kidney function impairment. A 1-y post-discharge follow-up study. ACTA ACUST UNITED AC 2010; 42:484-90. [DOI: 10.3109/00365541003694764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nunes MCP, Gelape CL, Ferrari TCA. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome. Int J Infect Dis 2009; 14:e394-8. [PMID: 19800277 DOI: 10.1016/j.ijid.2009.06.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/15/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To describe the epidemiological, clinical, and laboratory profile of infective endocarditis (IE) at a Brazilian tertiary care center, and to identify the predictors of in-hospital mortality. METHODS Data from 62 patients who fulfilled the modified Duke's criteria for IE during a seven-year period were gathered prospectively. The Cox proportional hazards model was used to identify predictive factors for death. RESULTS The mean age of patients was 45 years, and 39 patients (63%) were male. The median time from admission to diagnosis was 15 days. Rheumatic heart disease was the predominant underlying heart condition (39%), followed by valvular prosthesis (31%). Neurological complications were observed in 12 patients (19%). Echocardiography demonstrated one or more vegetations in 84% of cases. The infective agent was identified in 65% of cases, and the most frequent causative agents were staphylococci (48%), followed by streptococci (20%). The median duration of hospitalization was 39 days. Surgery was performed during the acute phase of the IE in 53% of cases. The overall in-hospital mortality was 31%. On multivariate analysis, vegetation length >13mm remained the only independent predictor of in-hospital mortality (hazard ratio 1.05 per millimeter, 95% confidence interval 1.003-1.110, p=0.038). CONCLUSIONS IE remains a severe disease affecting the young population in Brazil, and rheumatic heart disease continues to be the most common underlying heart condition. Large vegetation size, assessed early in the course of IE by transesophageal echocardiography, along with the clinical and microbiological features, may predict in-hospital death.
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Affiliation(s)
- Maria Carmo Pereira Nunes
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia 30130 100, Belo Horizonte, MG, Brazil.
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1230] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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Cheng TO. Infective endocarditis: to operate or not to operate? That's a question that is still unresolved. Int J Cardiol 2009; 135:1-3. [PMID: 19144423 DOI: 10.1016/j.ijcard.2008.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/29/2022]
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