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Ramos-Martínez A, González-Merino P, Suanzes-Martín E, la Fuente MMD, Escudero-López G, Andrés-Eisenhofer A, Expósito-Palomo E, Gutierrez-Villanueva A, Diego-Yagüe I, Múñez E, Fernandez-Cruz A, Calderón-Parra J. Risk of endocarditis among patients with coagulase-negative Staphylococcus bacteremia. Sci Rep 2023; 13:15613. [PMID: 37730691 PMCID: PMC10511700 DOI: 10.1038/s41598-023-41888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Coagulase-negative staphylococci (CoNS) are currently considered typical microorganisms causing infective endocarditis (IE) in patients with prosthetic valves. The objective was to determine variables associated with IE in patients with CoNS bacteremia. We performed an analysis of the clinical characteristics of patients with CoNS bacteremia admitted to a university hospital in Madrid (Spain) from 2021 to December 2022 according to the occurrence of IE. This study is an evaluation of a bacteremia registry. During the study period, 106 patients with CoNS bacteremia were detected. In 85 patients an echocardiogram was performed during hospital admission to rule out IE. Among them, 12 episodes were detected that met IE criteria (14.2%). Of the 6 patients with heart valve prostheses, 5 patients (83.3%) had IE (p < 0.001). Patients with IE more frequently had positive blood cultures more than 12 h after the first draw (58.3% versus 13.4%; p < 0.001). There was a tendency to associate community-acquired bacteremia and to that all blood culture bottles obtained were positive with an increased risk of IE (p = 0.091 and p = 0,057, respectively). Attributable mortality to infection was higher in patients with IE relative to all other patients (16.7% vs. 0%; p = 0.033). The multivariable analysis included having valve prosthesis and persistent bacteremia for more than 12 h. Both were independently associated with IE: valve prosthesis OR 38.6 (95% CI 5.8-258; p < 0.001) and persistent bacteremia OR 2.6 (95% CI 1.1-6.8; p = 0.046). In conclusion, a high percentage of cases of CoNS bacteremia may be due to IE. Some of the variables related to a higher risk of IE, such as having a valvular prosthesis or presenting positive blood cultures for more than 12 h, should lead to rule out or confirm the presence of IE by performing echocardiography.
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Affiliation(s)
- Antonio Ramos-Martínez
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain.
| | | | - Elena Suanzes-Martín
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Gabriela Escudero-López
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ane Andrés-Eisenhofer
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Esther Expósito-Palomo
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Itziar Diego-Yagüe
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Elena Múñez
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ana Fernandez-Cruz
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain
| | - Jorge Calderón-Parra
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Biezma MI, Muñoz P, De la Villa S, Fariñas-Álvarez MC, Arnáiz de las Revillas F, Gutierrez-Carretero E, De Alarcón A, Rodríguez-García R, Llopis J, Goenaga MÁ, Gutierrez-Villanueva A, Plata A, Vidal L, Martínez-Sellés M. Infective Endocarditis in Diabetic Patients: A Different Profile with Prognostic Consequences. J Clin Med 2022; 11:jcm11092651. [PMID: 35566777 PMCID: PMC9103728 DOI: 10.3390/jcm11092651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023] Open
Abstract
Background. Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyze the prognostic relevance of DM-related organ damage. Methods. Retrospective analysis of the Spanish IE Registry (2008−2020). Results. The cohort comprises 5590 IE patients with a mean age of 65.0 ± 15.5 years; 3764 (67.3%) were male. DM was found in 1625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p = 0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs. 924 [23.3%], p < 0.001) and higher one-year mortality (640 [39.4%] vs. 1131 [28.5%], p < 0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs. 321 [28.9%], p < 0.001) and one-year mortality (247 [48.0%] vs. 393 [35.4%], p < 0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16−1.55, p < 0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21−1.59, p < 0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06−1.76, p = 0.015) and one-year mortality (OR = 1.59, 95% CI = 1.26−2.01, p < 0.001) Conclusions. The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.
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Affiliation(s)
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- CIBERES (CIBER Enfermedades Respiratorias)—Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Sofía De la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
| | - Mª Carmen Fariñas-Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, IDIVAL (Instituto de Investigación Sanitaria Valdecilla), CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain
| | - Francisco Arnáiz de las Revillas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, IDIVAL (Instituto de Investigación Sanitaria Valdecilla), CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain
| | - Encarnación Gutierrez-Carretero
- Cardiac Surgery Service, CIBERCV (CIBER Enfermedades Cardiovasculares), Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío Seville, 41013 Sevilla, Spain
| | - Arístides De Alarcón
- Cardiac Surgery Service, CIBERCV (CIBER Enfermedades Cardiovasculares), Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío Seville, 41013 Sevilla, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology and Statistics, University of Barcelona, 08007 Barcelona, Spain
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, 20014 San Sebastian, Spain
| | - Andrea Gutierrez-Villanueva
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, 28222 Majadahonda, Spain
| | - Antonio Plata
- UGC Enfermedades Infecciosas, Microbiología y Medicina Preventiva, IBIMA (Instituto de Investigación Biomédica de Málaga), Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Laura Vidal
- Servicio de Cardiología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Manuel Martínez-Sellés
- Escuela de Doctorado, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV (CIBER Enfermedades Cardiovasculares), Universidad Complutense, 28040 Madrid, Spain
- Correspondence:
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