1
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McKesey J, Mazhar M, Alam M, Srivastava D, Nijhawan RI. Incidence of Bacteremia, Infective Endocarditis, or Prosthetic Joint Infection in Dermatologic Surgery: A Systematic Review. Dermatol Surg 2024; 50:428-433. [PMID: 38318842 DOI: 10.1097/dss.0000000000004101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Prophylactic antibiotic therapy is widely used in dermatologic surgery to prevent surgical site infections and bacteremia, which can lead to prosthetic joint infections (PJI) and infective endocarditis (IE) in high-risk populations. OBJECTIVE To evaluate the incidence of bacteremia, PJI, and IE after dermatologic surgery and assess the current evidence for antibiotic prophylaxis. MATERIALS AND METHODS A search of the computerized bibliographic databases was performed using key terms from the date of inception to March 21, 2021. Data extraction was performed independently by 2 data extractors. RESULTS The review resulted in 9 publications that met inclusion criteria, including 5 prospective cohort studies and 4 case reports or case series. The prospective studies reported a wide range of bacteremia incidence (0%-7%) after dermatologic surgery. No cases of PJI resulting directly from cutaneous surgery were identified, and only 1 case series reported IE after various skin procedures. CONCLUSION These findings suggest a low rate of bacteremia and a lack of direct evidence linking dermatologic surgery to PJI or IE. The scarcity of published data on this topic is a limitation, highlighting the need for further research, particularly randomized controlled trials, to guide antibiotic prophylaxis recommendations.
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Affiliation(s)
| | - Momina Mazhar
- University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Murad Alam
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Divya Srivastava
- University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas; and
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2
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Ekinci S. Tricuspid regurgitation and infective endocarditis as a cause of lead dislodgement in left bundle branch area pacing. Pacing Clin Electrophysiol 2024; 47:683-687. [PMID: 37650453 DOI: 10.1111/pace.14810] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND According to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large-scale studies reporting the data about long-term lead stability in patients with severe tricuspid regurgitation. METHODS AND RESULTS We present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP. CONCLUSIONS We concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP.
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Affiliation(s)
- Selim Ekinci
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Sciences, Konak, Izmir, Turkey
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3
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Cuervo G, Quintana E, Regueiro A, Perissinotti A, Vidal B, Miro JM, Baddour LM. The Clinical Challenge of Prosthetic Valve Endocarditis: JACC Focus Seminar 3/4. J Am Coll Cardiol 2024; 83:1418-1430. [PMID: 38599718 DOI: 10.1016/j.jacc.2024.01.037] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence in patients with transcatheter-implanted valves. Significant microbiologic (molecular biology) and imaging diagnostic (fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography) advances have been incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria, thus increasing the diagnostic sensitivity for PVE without sacrificing specificity in validation studies. PVE is a life-threatening disease requiring management by multidisciplinary endocarditis teams in cardiac centers to improve outcomes. Novel surgical options are now available, and an increasing set of patients may avoid surgical intervention despite indication. Selected patients may complete parenteral or oral antimicrobial treatment at home. Finally, patients with prosthetic valves implanted surgically or by the transcatheter approach are candidates for antibiotic prophylaxis before invasive dental procedures.
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Affiliation(s)
- Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Network Research Center for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS) and Biomedical Research Networking Center of Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Carlos III Health Institute, Barcelona, Spain
| | - Barbara Vidal
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Network Research Center for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain.
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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4
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Dayer MJ, Quintero-Martinez JA, Thornhill MH, Chambers JB, Pettersson GB, Baddour LM. Recent Insights Into Native Valve Infective Endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol 2024; 83:1431-1443. [PMID: 38599719 DOI: 10.1016/j.jacc.2023.12.043] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 04/12/2024]
Abstract
This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group. New pathogens were designated as typical, and findings on computed tomography imaging were included as diagnostic criteria. It is now recognized that a multidisciplinary approach to care is vital, and the role of an "endocarditis team" is highlighted. Recent studies have suggested that a transition from intravenous to oral antibiotics in selected patients may be reasonable, and the role of long-acting antibiotics is discussed. It is also now clear that an aggressive surgical approach can be life-saving in some patients. Finally, results of several recent studies have suggested there is an association between dental and other invasive procedures and an increased risk of developing infective endocarditis. Moreover, data indicate that antibiotic prophylaxis may be effective in some scenarios.
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Affiliation(s)
- Mark J Dayer
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland; Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
| | - Juan A Quintero-Martinez
- Department of Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Martin H Thornhill
- Department of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - John B Chambers
- Emeritus Professor of Clinical Cardiology at Guy's and St Thomas' NHS Trust, London, United Kingdom, and Kings College, London, United Kingdom
| | | | - Larry M Baddour
- Department of Medicine and Department of Cardiovascular Medicine, Division of Public Health, Infectious Diseases and Occupational Health, Mayo Clinic, Rochester, Minnesota, USA
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5
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Wurcel AG, Suzuki J, Schranz AJ, Eaton EF, Cortes-Penfield N, Baddour LM. Strategies to Improve Patient-Centered Care for Drug Use-Associated Infective Endocarditis: JACC Focus Seminar 2/4. J Am Coll Cardiol 2024; 83:1338-1347. [PMID: 38569764 DOI: 10.1016/j.jacc.2024.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 04/05/2024]
Abstract
Drug use-associated infective endocarditis (DUA-IE) is a major cause of illness and death for people with substance use disorder (SUD). Investigations to date have largely focused on advancing the care of patients with DUA-IE and included drug use disorder treatment, decisions about surgery, and choice of antibiotics during the period of hospitalization. Transitions from hospital to outpatient care are relatively unstudied and frequently a key factor of uncontrolled infection, continued substance use, and death. In this paper, we review the evidence supporting cross-disciplinary care for people with DUA-IE and highlight domains that need further clinician, institutional, and research investment in clinicians and institutions. We highlight best practices for treating people with DUA-IE, with a focus on addressing health disparities, meeting health-related social needs, and policy changes that can support care for people with DUA-IE in the hospital and when transitioning to the community.
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Affiliation(s)
- Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen F Eaton
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | | | - Larry M Baddour
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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6
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Chesdachai S, Esquer Garrigos Z, DeSimone CV, DeSimone DC, Baddour LM. Infective Endocarditis Involving Implanted Cardiac Electronic Devices: JACC Focus Seminar 1/4. J Am Coll Cardiol 2024; 83:1326-1337. [PMID: 38569763 DOI: 10.1016/j.jacc.2023.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/26/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024]
Abstract
Cardiac implantable electronic device-related infective endocarditis (CIED-IE) encompasses a range of clinical syndromes, including valvular, device lead, and bloodstream infections. However, accurately diagnosing CIED-IE remains challenging owing in part to diverse clinical presentations, lack of standardized definition, and variations in guideline recommendations. Furthermore, current diagnostic modalities, such as transesophageal echocardiography and [18F]-fluorodeoxyglucose positron emission tomography-computed tomography have limited sensitivity and specificity, further contributing to diagnostic uncertainty. This can potentially result in complications and unnecessary costs associated with inappropriate device extraction. Six hypothetical clinical cases that exemplify the diverse manifestations of CIED-IE are addressed herein. Through these cases, we highlight the importance of optimizing diagnostic accuracy and stewardship, understanding different pathogen-specific risks for bloodstream infections, guiding appropriate device extraction, and preventing CIED-IE, all while addressing key knowledge gaps. This review both informs clinicians and underscores crucial areas for future investigation, thereby shedding light on this complex and challenging syndrome.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Zerelda Esquer Garrigos
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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7
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Hutt E, Canosa FJM, Unai S, Jaber WA. Manifestations of Prosthetic Valve Endocarditis: Lessons From Multimodality Imaging and Pathological Correlation. Circ Cardiovasc Imaging 2024; 17:e016435. [PMID: 38626096 DOI: 10.1161/circimaging.123.016435] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024]
Abstract
Heart valve replacement has steadily increased over the past decades due to improved surgical mortality, an aging population, and the increasing use of transcatheter valve technology. With these developments, prosthetic valve complications, including prosthetic valve endocarditis, are increasingly encountered. In this review, we aim to characterize the manifestations of prosthetic valve endocarditis using representative case studies from our institution to highlight the advances and contributions of modern multimodality imaging techniques.
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Affiliation(s)
- Erika Hutt
- Departments of Cardiovascular Imaging (E.H., W.A.J.), Cleveland Clinic Foundation, OH
| | | | - Shinya Unai
- Cardiothoracic Surgery (S.U.), Cleveland Clinic Foundation, OH
| | - Wael A Jaber
- Departments of Cardiovascular Imaging (E.H., W.A.J.), Cleveland Clinic Foundation, OH
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8
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Eghbalzadeh K, Kuhn EW, Gerfer S, Djordjevic I, Rahmanian P, Mader N, Wahlers TCW. Ten-Year Long-Term Analysis of Mechanical and Biological Aortic Valve Replacement. Thorac Cardiovasc Surg 2024; 72:167-172. [PMID: 35667381 DOI: 10.1055/s-0042-1744477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND For patients undergoing aortic valve replacement (AVR), structural valve deterioration (SVD) of a bioprosthesis (BP) is substantially accelerated in younger patients and valve-in-valve implantation is not always a considerable option. The risk-benefit assessment between SVD versus the risk of bleeding and thromboembolic events in patients with a mechanical prosthesis (MP) resulted in an age limit shift irrespective of inconsistent results reported in literature. METHOD This retrospective single-center study compared 10-year long-term outcomes in patients undergoing isolated AVR with MP or BP. The risk-adjusted comparison of patients undergoing isolated AVR (n = 121) was performed after 1:1 propensity score matching (PSM) for age, sex, endocarditis, and chronic renal impairment (caliper of 0.2) leading to 29 pairs. Short- and long-term outcomes with respect to reoperation, major bleeding, stroke, all-cause and cardiovascular mortality, and overall survival at 10 years were analyzed. RESULTS After PSM, groups were comparable with respect to preoperative characteristics, including patients with a mean age of 65 ± 3 years (MP) and 66 ± 4 years (BP) and an incidence rate of 6.9% for infective endocarditis in both cohorts. Short-term outcomes (transient neurologic disorder = 0.0 vs. 6.9%; stroke = 0.0%; in-hospital mortality = 3.4%) and in-hospital stays were comparable between MP and BP. CONCLUSION After isolated AVR with MP and BP, 10-year long-term outcomes were comparable in the reported single-center cohort. MP can still be implanted safely without a disadvantage as regards long-term survival.
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Affiliation(s)
- Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
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9
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Ramadan MS, Bertolino L, Boccia F, Hamieh M, Peluso AM, Gallo R, Patauner F, De Santo LS, Carozza A, Zampino R, Durante-Mangoni E. Features of infective endocarditis in a contemporary cohort of persons who inject drugs: a matched comparison analysis of long-term prognostic factors. Intern Emerg Med 2024; 19:455-464. [PMID: 38129537 DOI: 10.1007/s11739-023-03502-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
- Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Filomena Boccia
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Mahmoud Hamieh
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Anna Maria Peluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Luca Salvatore De Santo
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Antonio Carozza
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Rosa Zampino
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy.
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
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Javorski MJ, Rosinski BF, Shah S, Thompson MA, Streem D, Gordon SM, Insler S, Houghtaling PL, Griffin B, Blackstone EH, Unai S, Svensson LG, Pettersson GB, Elgharably H. Infective Endocarditis in Patients Addicted to Injected Opioid Drugs. J Am Coll Cardiol 2024; 83:811-823. [PMID: 38383096 DOI: 10.1016/j.jacc.2023.12.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death. OBJECTIVES The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors. METHODS From January 2010 to June 2020, 227 persons who inject drugs, age 36 ± 9.9 years, underwent surgery for infective endocarditis at a quaternary hospital having special interest in developing addiction management programs. Postsurgery loss to follow-up, relapse, and death were assessed as competing risks and risk factors identified parametrically and by machine learning. CIs are 68% (±1 SE). RESULTS Heroin was the most self-reported drug injected (n = 183 [81%]). Psychosocial issues included homelessness (n = 56 [25%]), justice system involvement (n = 150 [66%]), depression (n = 118 [52%]), anxiety (n = 104 [46%]), and post-traumatic stress disorder (n = 33 [15%]). Four (1.8%) died in-hospital. Medication for opioid use disorder prescribed at discharge increased from 0% in 2010 to 100% in 2020. At 1 and 5 years, conditional probabilities of loss to follow-up were 16% (68% CI: 13%-22%) and 59% (68% CI: 44%-65%), relapse 32% (68% CI: 28%-34%) and 79% (68% CI: 74%-83%), and mortality 21% (68% CI: 18%-23%) and 68% (68% CI: 62%-72%). Younger age, heroin use, and lower education level were predictors of relapse. CONCLUSIONS Infective endocarditis surgery can be performed with low mortality in persons who inject drugs, but addiction is far more lethal. Risk of loss to follow-up and relapse require more effective addiction strategies without which this major loss to society will continue.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shawn Shah
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Thompson
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - David Streem
- Department of Psychiatry, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven Insler
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
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11
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Kwan TN, Brieger D, Chow V, Ng ACT, Kwan G, Hyun K, Sy R, Kritharides L, Ng ACC. Healthcare exposures and associated risk of endocarditis after open-heart cardiac valve surgery. BMC Med 2024; 22:61. [PMID: 38331876 PMCID: PMC10854101 DOI: 10.1186/s12916-024-03279-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/31/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE). METHODS In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis. RESULTS In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002). CONCLUSIONS The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.
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Affiliation(s)
- Timothy N Kwan
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Arnold Chin Tse Ng
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gemma Kwan
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Raymond Sy
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, St Luke's International Hospital, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St Luke's International Hospital, Japan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St Luke's International Hospital, Japan
| | - Hiroyasu Misumi
- Department of Cardiovascular Surgery, St Luke's International Hospital, Japan
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13
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French R, Boccelli A, Valosky K, Oliver E, Uritsky T, McCullion J, Zwiebel S, Andrews T. A Promising Approach to Addressing the Needs of Patients with Endocarditis Secondary to Injection Drug Use: A Case Report. Health Soc Work 2024; 49:55-58. [PMID: 38124507 DOI: 10.1093/hsw/hlad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/28/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Rachel French
- PhD, RN, is a registered nurse and postdoctoral fellow, Center for Mental Health, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Amanda Boccelli
- LCSW of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn Valosky
- LCSW of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emilie Oliver
- LCSW, are social workers of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tanya Uritsky
- PharmD, CPE, is pharmacist of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica McCullion
- BSN, RN, is registered nurse of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Samantha Zwiebel
- MD, is psychiatrist of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy Andrews
- DNP, ACNP, APRN-BC, is manager of advanced practice providers, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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14
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Panagides V, Cuervo G, Llopis J, Abdel-Wahab M, Mangner N, Habib G, Regueiro A, Mestres CA, Tornos P, Durand E, Selton-Suty C, Ihlemann N, Bruun N, Urena M, Cecchi E, Thiele H, Durante-Mangoni E, Pellegrini C, Eltchaninoff H, Athan E, Søndergaard L, Linke A, Tattevin P, Del Val D, Quintana E, Chu V, Rodés-Cabau J, Miro JM. Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement. Clin Infect Dis 2024; 78:179-187. [PMID: 37552784 DOI: 10.1093/cid/ciad464] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. METHODS Data were collected from the "Infectious Endocarditis after TAVR International" (enrollment from 2005 to 2020) and the "International Collaboration on Endocarditis" (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. RESULTS A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). CONCLUSIONS Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Guillermo Cuervo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology, and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Norman Mangner
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Gilbert Habib
- Cardiology Department, Assistance Publique des Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Ander Regueiro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Pilar Tornos
- Department of Cardiology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Eric Durand
- Department of Cardiology, Normandie University, CHU Rouen, France
| | | | | | - Niels Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Marina Urena
- Cardiology Department, Bichat Hospital, Paris, France
| | - Enrico Cecchi
- Cardiology Department, Hospital Maria Vittoria, Turin, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Axel Linke
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eduard Quintana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian Chu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Cader T, Wójcik A, Ciszek M, Wiśniewska M, Wróbel K, Pruszczyk P, Kurnicka K. Serious consequences of enterococcal endocarditis in an active diving instructor. Kardiol Pol 2024; 82:93-94. [PMID: 38230474 DOI: 10.33963/v.kp.98262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Tomasz Cader
- Students` Scientific Association by Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Agnieszka Wójcik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Michał Ciszek
- Department of Transplantology, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | | | - Krzysztof Wróbel
- Department of Cardiac Surgery, Medicover Hospital, Lazarski University, Warszawa, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland.
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Kaemmel J, Heck R, Lanmüeller P, Wert L, Falk V, Starck CT. Treatment of cardiac implantable electronic device endocarditis in pacemaker-dependent patients utilizing a percutaneous aspiration system. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38193462 DOI: 10.1510/mmcts.2023.082] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
With the increasing use of cardiac implantable electronic devices, the number of patients with cardiac implantable electronic device-related endocarditis is also rising. The treatment of this type of endocarditis is a challenging clinical task, in particular if device removal is required in patients who are pacemaker dependent. This video tutorial describes a treatment strategy for cardiac implantable electronic device-related endocarditis involving the tricuspid valve in pacemaker-dependent patients. The proposed treatment strategy consists of implanting an epicardial pacemaker via a minimally invasive subxiphoid approach, percutaneous aspiration of tricuspid valve vegetations and complete transvenous explantation of the infected cardiac implantable electronic device system using advanced lead extraction tools.
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Affiliation(s)
- Julius Kaemmel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Pia Lanmüeller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin Augustenburger Platz 1 13353 Berlin
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
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17
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Glaser N, Sartipy U, Dismorr M. Prosthetic Valve Endocarditis After Aortic Valve Replacement With Bovine Versus Porcine Bioprostheses. J Am Heart Assoc 2024; 13:e031387. [PMID: 38156596 PMCID: PMC10863842 DOI: 10.1161/jaha.123.031387] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/05/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Whether a bovine or porcine aortic valve bioprosthesis carries a higher risk of endocarditis after aortic valve replacement is unknown. The aim of this study was to compare the risk of prosthetic endocarditis in patients undergoing aortic valve replacement with a bovine versus porcine bioprosthesis. METHODS AND RESULTS This nationwide, population-based cohort study included all patients who underwent surgical aortic valve replacement with a bovine or porcine bioprosthesis in Sweden from 1997 to 2018. Regression standardization was used to account for intergroup differences. The primary outcome was prosthetic valve endocarditis, and the secondary outcomes were all-cause mortality and early prosthetic valve endocarditis. During a maximum follow-up time of 22 years, we included 21 022 patients, 16 603 with a bovine valve prosthesis and 4419 with a porcine valve prosthesis. The mean age was 73 years, and 61% of the patients were men. In total, 910 patients were hospitalized for infective endocarditis: 690 (4.2%) in the bovine group and 220 (5.0%) in the porcine group. The adjusted cumulative incidence of prosthetic valve endocarditis at 15 years was 9.5% (95% CI, 6.2%-14.4%) in the bovine group and 2.8% (95% CI, 1.4%-5.6%) in the porcine group. The absolute risk difference between the groups at 15 years was 6.7% (95% CI, 0.8%-12.5%). CONCLUSIONS The risk of endocarditis was higher in patients who received a bovine compared with a porcine valve prosthesis after surgical aortic valve replacement. This association should be considered in patients undergoing both surgical and transcatheter aortic valve replacement.
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Affiliation(s)
- Natalie Glaser
- Department of CardiologyStockholm South General HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
| | - Michael Dismorr
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
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18
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Alhuarrat MAD, Garg V, Borkowski P, Nazarenko N, Alhuarrat MR, Abushairah A, Al Zyoud B, Bitsis EM, Barzallo D, Alemu R, Kharawala A, Nagraj S, Abdou C, Faillace RT, Rai D, Minuti A, Palaiodimos L. Epidemiologic and Clinical Characteristics of Marantic Endocarditis: A Systematic Review and Meta-analysis of 416 Reports. Curr Probl Cardiol 2024; 49:102027. [PMID: 37557941 DOI: 10.1016/j.cpcardiol.2023.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a distinctive condition marked by the presence of aseptic fibrin depositions on cardiac valves due to hypercoagulability and endocardial damage. There is a scarcity of large cohort studies clarifying factors associated with morbidity and mortality of this condition. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve case reports and series documenting cases of NBTE from inception until September-2022. A descriptive analysis of basic characteristics was carried out, followed by multivariate regression analysis to identify risk factors associated with morbidity and mortality. A total of 416 case reports and series were identified, of which 450 patients were extracted. The female-to-male ratio was around 2:1 with an overall sample median age of 48 (interquartile range [IQR]:34-61). Stroke-like symptoms were the most common presentation and embolic phenomena occurred in 70% of cases, the majority of which were due to stroke. Cancer was associated with higher embolic complications (aOR:6.38, 95% CI = 3.75-10.83, p < 0.01) in comparison to other NBTE etiologies, while age, sex, and vegetation size were not (p > 0.05). All-cause in-hospital mortality was 36%, with cancer etiology being associated with higher mortality: 56% (aOR:3.64, 95% CI = 1.57-8.43, p < 0.01) in comparison to other NBTE etiologies:19%. A significant decrease in NBTE mortality was seen in recent years in comparison to admissions that occurred during the 20th century (aOR:0.07, 95% CI = 0.04-0.15, p < 0.01). While there has been an observed improvement in overall in-hospital mortality rates for patients admitted with NBTE in recent years, it is important to note that cases associated with a cancer etiology are still linked to high morbidity and mortality during hospitalization.
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Affiliation(s)
- Majd Al Deen Alhuarrat
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY.
| | - Vibhor Garg
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Pawel Borkowski
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Natalia Nazarenko
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | | | - Batool Al Zyoud
- Division of Pharmacy, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | - Diego Barzallo
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Rebeca Alemu
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Amrin Kharawala
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Sanjana Nagraj
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Devash Rai
- Department of Cardiology, Rochester Regional Health, Rochester, NY
| | - Aurelia Minuti
- Head, Research & Education, D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, NY
| | - Leonidas Palaiodimos
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
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19
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Timmermans N, Lam KY, van Straten A, van 't Veer M, Soliman-Hamad M. Prosthetic Valve Endocarditis After Aortic Valve Replacement: Differences Between Biological and Mechanical Prostheses. Heart Lung Circ 2024; 33:130-137. [PMID: 38158265 DOI: 10.1016/j.hlc.2023.11.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
AIMS Prosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis associated with a high mortality rate. Whether PVE affects biological and mechanical aortic valves to the same extent remains controversial. This study aimed to compare the incidence of re-intervention because of PVE between bioprosthetic and mechanical valves. METHODS Patients undergoing isolated surgical aortic valve replacement (AVR) or combined AVR in a single cardiac surgery centre between January 1998 and December 2019 were analysed. All patients who underwent re-intervention because of PVE were identified. The primary endpoint was the rate of explants. Freedom from re-intervention and variables associated with re-intervention were analysed using Cox regression analysis including correction for competing risk. RESULTS During the study period, 5,983 aortic valve prostheses were implanted, including 3,620 biological (60.5%) and 2,363 mechanical (39.5%) prostheses. The overall mean follow-up period was 7.3±5.3 years (median, 6.5; IQR 2.9-11.2 years). The rate of re-intervention for PVE in the biological group was 1.5% (n=54) compared with 1.7% (n=40) in the mechanical group (p=0.541). Cox regression analysis revealed that younger age (HR 0.960, 95% CI 0.942-0.979; p<0.001), male sex (HR 2.362, 95% CI 1.384-4.033; p=0.002), higher creatinine (HR 1.002, 95% CI 0.999-1.004; p=0.057), and biological valve prosthesis (HR 2.073, 95% CI 1.258-3.414; p=0.004) were associated with re-intervention for PVE. After correction for competing risk of death, biological valve prosthesis was significantly associated with a higher rate of re-intervention for PVE (HR 2.011, 95% CI 1.177-3.437; p=0.011). CONCLUSIONS According to this single-centre, observational, retrospective cohort study, AVR using biological prosthesis is associated with re-intervention for PVE compared to mechanical prosthesis. Further investigations are needed to verify these findings.
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Affiliation(s)
- Naomi Timmermans
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ka Yan Lam
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Albert van Straten
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marcel van 't Veer
- Heart Center, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mohamed Soliman-Hamad
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
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Gressens SB, Souhail B, Pilmis B, Lourtet-Hascoët J, Podglajen I, Fiore A, Fihman V, Mainardi JL, Lepeule R, Lebeaux D, Dubert M. Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration. Eur J Clin Microbiol Infect Dis 2024; 43:95-104. [PMID: 37964043 DOI: 10.1007/s10096-023-04705-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. OBJECTIVES To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. METHODS This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. RESULTS The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). CONCLUSIONS Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.
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Affiliation(s)
- S B Gressens
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France.
| | - B Souhail
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
| | - B Pilmis
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J Lourtet-Hascoët
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - I Podglajen
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - A Fiore
- Service de Chirurgie Cardiaque, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 94000, Créteil, France
| | - V Fihman
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité de Bactériologie - Hygiène, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - J L Mainardi
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - R Lepeule
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
| | - D Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - M Dubert
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
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21
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Rubio LD, McFarland KA, O'Seaghdha M, Williams C. A high throughput microphysiological model of prosthetic valve endocarditis for investigating factors that influence bacterial adhesion under fluid shear stress. Biochem Biophys Res Commun 2023; 686:149155. [PMID: 37926046 DOI: 10.1016/j.bbrc.2023.149155] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Prosthetic heart valves are associated with almost one quarter of cases of infective endocarditis, a rare but serious condition with a staggering 25 % mortality rate. Without the endothelium of native valves, the risk of infection is exacerbated for implanted devices exposed to blood. There are currently no physiologically relevant in vitro or animal models of prosthetic valve endocarditis (PVE). Of particular importance, Staphylococcus aureus, a common agent of PVE, has demonstrated enhanced binding to blood plasma proteins (e.g., fibrinogen) and exposed matrix under fluid shear stress (FSS). An in vitro platform that mimics the multiple physiological determinants for S. aureus adhesion to prosthetic valve materials would facilitate the discovery of new treatments to minimize PVE. To this end, we developed a first-of-its-kind microphysiological model of PVE to study the effects of several key variables (endothelial cell coverage, fibrinogen deposition, surface treatments, and FSS) on S. aureus adhesion to bioprosthetic material surfaces. Our model demonstrated that viable endothelial monolayers diminished the deposition of fibrinogen and that fibrinogen was required for the subsequent adhesion of S. aureus to the bioprosthetic surface model. Next, we examined factors that affected endothelial cell coverage, such as FSS and glutaraldehyde, a common chemical treatment for bioprosthetic materials. In particular, glutaraldehyde treatment obstructed endothelialization of otherwise biocompatible collagen-coated surfaces, further enabling fibrinogen and S. aureus deposition. In future work, this model could impact multiple research areas, such as screening candidate bioprosthetic valve materials and new surface treatments to prevent PVE and further understanding host-pathogen interactions.
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Affiliation(s)
- Logan D Rubio
- Bioengineering Division, The Charles Stark Draper Laboratory, Inc., Cambridge, MA, United States
| | - Kirsty A McFarland
- Bioengineering Division, The Charles Stark Draper Laboratory, Inc., Cambridge, MA, United States
| | | | - Corin Williams
- Bioengineering Division, The Charles Stark Draper Laboratory, Inc., Cambridge, MA, United States.
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22
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Strange JE, Østergaard L, Køber L, Bundgaard H, Iversen K, Voldstedlund M, Gislason GH, Olesen JB, Fosbøl EL. Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation. Clin Infect Dis 2023; 77:1617-1625. [PMID: 37470442 PMCID: PMC10724461 DOI: 10.1093/cid/ciad431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI. METHODS Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared. RESULTS We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age: 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates. CONCLUSIONS Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.
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Affiliation(s)
- Jarl Emanuel Strange
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lauge Østergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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23
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Grambow-Velilla J, Mahida B, Benali K, Deconinck L, Chong-Nguyen C, Cimadevilla C, Duval X, Iung B, Rouzet F, Hyafil F. Prognosis and follow-up of patients with prosthetic valve endocarditis treated conservatively in relation to WBC-SPECT imaging. J Nucl Cardiol 2023; 30:2633-2643. [PMID: 37430176 DOI: 10.1007/s12350-023-03335-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Our objective was to evaluate in patients with prosthetic valve endocarditis (PVE) treated conservatively, the prognostic value of white blood cell (WBC) signal intensity on SPECT and to describe the evolution of the WBC signal under antibiotics. METHODS Patients with PVE treated conservatively and positive WBC-SPECT imaging were identified retrospectively. Signal intensity was classified as intense if equal to or higher, or mild if lower, than the liver signal. Clinical, biological, imaging and follow-up information were collected from medical files. RESULTS Among 47 patients, WBC signal was classified as intense in 10 patients and as mild, in 37. The incidence of the primary composite endpoint (death, late cardiac surgery, or relapse) was significantly higher in patients with intense vs. mild signal (90% vs. 11%). Twenty-five patients underwent a second WBC-SPECT imaging during follow-up. The prevalence of WBC signal decreased progressively from 89% between 3 and 6 weeks to 42% between 6 and 9 weeks and 8% more than 9 weeks after initiation of antibiotics. CONCLUSIONS In patients with PVE treated conservatively, intense WBC signal was associated with poor outcome. WBC-SPECT imaging appears as an interesting tool for risk stratification and to monitor locally the efficacy of antibiotic treatment.
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Affiliation(s)
- Julia Grambow-Velilla
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
| | - Besma Mahida
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Laurene Deconinck
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Claire Cimadevilla
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Center for Clinical Investigation, AP-HP, Bichat University Hospital, University of Paris-CIté, 75018, Paris, France
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
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24
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Todt K. Caring for Appalachians With Intravenous Drug Use-Associated Infective Endocarditis at End of Life: A Phenomenological Secondary Data Analysis. J Hosp Palliat Nurs 2023; 25:330-335. [PMID: 37697471 DOI: 10.1097/njh.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
The purpose of this study was to describe the experiences of nurses caring for patients with intravenous drug use-associated infective endocarditis at the end of life in Appalachia. This study was a secondary analysis of 9 phenomenological unstructured interviews conducted by the author with nurses as part of a study exploring their lived experiences caring for this population. Data were analyzed using van Manen's 6-step approach. The analysis revealed 5 themes: (1) care at the end of life as a resolve to care for lost causes, (2) care at the end of life as an act of courageous communication, (3) care at the end of life as a resolve to endure chaos, (4) care at the end of life as a resolve to protect self and others, and (5) care at the end of life as a resolve to carry on and let go. Nurses perceived patients who use injection drugs as being at the end of life with eventual death. Patients with recurrent infective endocarditis from drug use are viewed as lost causes. To empower nurses, they need to be at the table of surgical decision making. Communication being one of a nurse's greatest tools, end-of-life communication education is needed. Administrative support should be a standard to safeguard nurses when dealing with emotionally challenging situations.
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Affiliation(s)
- Kendrea Todt
- Kendrea Todt, PhD, RN, CNE, is assistant professor and honors coordinator, College of Nursing, East Tennessee State University, Johnson City
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25
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Pechenenko A, Rzhanyi M, Pruna-Guillen R, Ascaso M, Alcocer J, Quintana E. Root-commando operation with a modified self-assembled aortic root conduit for endocarditis after sutureless aortic valve replacement. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37929628 DOI: 10.1510/mmcts.2023.073] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
We present a case of a Staphylococcus epidermidis early prosthetic valve endocarditis after minimally invasive sutureless aortic valve replacement. The patient developed a root abscess with a fistula, severe mitral and periprosthetic regurgitations, with a large mitral vegetation and a residual patent foramen ovale. The surgical approach consisted of a redo median sternotomy, explantation of a sutureless aortic prosthesis, resection of an intervalvular fibrosa and anterior mitral leaflet and debridement of an aortic root-left ventricle outflow tract abscess. These procedures were followed by a root-commando procedure with mitral and aortic root placement using a self-assembled mechanical aortic root conduit. The technique used is an alternative to a root-commando procedure performed with an allograft or a Medtronic Freestyle bioprosthesis. The same technique can be utilized with a commercially available stented bioprosthesis.
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Affiliation(s)
- Anton Pechenenko
- Cherkasy Regional Cardiology Center, Cherkasy, Ukraine. This is a municipal non-profit enterprise
| | - Maksym Rzhanyi
- М.M. Amosov National Institute of Cardio-vascular Surgery, Kyiv, Ukraine
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
| | | | - Jorge Alcocer
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
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26
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Gong CL, Duong A, Zangwill KM. Estimating the cost of inappropriate antibiotic prophylaxis prior to dental procedures. Infect Control Hosp Epidemiol 2023; 44:1850-1853. [PMID: 37424225 DOI: 10.1017/ice.2023.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Inappropriate dental antibiotic prescriptions to prevent infective endocarditis in the United States results in ∼$31 million in excess costs to the healthcare system and patients. This includes out-of-pocket costs ($20.5 million), drug costs ($2.69 million) and adverse event costs (eg, Clostridioides difficile and hypersensitivity) of $5.82 million (amoxicillin), $1.99 million (clindamycin), and $380,849 (cephalexin).
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Affiliation(s)
- Cynthia L Gong
- Division of Neonatology, Fetal & Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anh Duong
- Alfred E. Mann School of Pharmacy, University of Southern California, Los Angeles, California
| | - Kenneth M Zangwill
- Division of Pediatric Infectious Diseases, Department of Infection Prevention and Control, and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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27
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Bertolino L, Ramadan MS, Zampino R, Durante-Mangoni E. Infective endocarditis involving MitraClip © devices: a systematic literature review. Infection 2023; 51:1241-1248. [PMID: 37386329 PMCID: PMC10545607 DOI: 10.1007/s15010-023-02067-y] [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: 01/14/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Progress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional surgical prostheses, but little data are currently available. In this systematic review (SR), we summarize current literature regarding the clinical characteristics, management, and outcomes of patients with MitraClip-related infective endocarditis (IE). METHODS We conducted a SR of PubMed, Google Scholar, Embase, and Scopus between January 2003 and March 2022. MitraClip-related IE was defined according to 2015 ESC criteria whereas MitraClip involvement as vegetation on the device or on the mitral valve. Risk of bias was assessed through standardized checklist and potential bias of underestimation cannot be excluded. Data regarding clinical presentation, echocardiography, management, and outcome were collected. RESULTS Twenty-six cases of MitraClip-related IE were retrieved. The median age of patients was 76 [61-83] years with a median EuroScore of 41%. Fever was present in 65.8% of patients followed by signs and symptoms of heart failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time between MitraClip implantation and IE symptom onset of 5 [2-16] months. Staphylococcus aureus was the major causative microorganism (46%). Surgical mitral valve replacement was needed in 50% of patients. A conservative medical approach was considered in the remainder. The overall in-hospital mortality rate was 50% (surgical group: 38.4%; medical group: 58.3%; p = 0.433). CONCLUSION Our results suggest that MitraClip-related IE affects elderly, comorbid patients, is mostly due to Staphylococcus aureus, and has a poor prognosis irrespective of the therapeutic approach. Clinicians must be aware of the features of this new entity among cardiovascular infections.
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Affiliation(s)
- Lorenzo Bertolino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Mohammad Said Ramadan
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
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28
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Yoshitake M, Bando K. Commentary: Greater risk of infective endocarditis after biologic valve replacement: A word of caution before expanding the indications to younger patients. J Thorac Cardiovasc Surg 2023; 166:1069-1070. [PMID: 35337678 DOI: 10.1016/j.jtcvs.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
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29
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Stahl A, Havers-Borgersen E, Østergaard L, Petersen JK, Bruun NE, Weeke PE, Kristensen SL, Voldstedlund M, Køber L, Fosbøl EL. Hemodialysis and its impact on patient characteristics, microbiology, cardiac surgery, and mortality in infective endocarditis. Am Heart J 2023; 264:106-113. [PMID: 37271357 DOI: 10.1016/j.ahj.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Patients with chronic renal failure on hemodialysis carry a significant risk of infective endocarditis (IE), but data on whether these patients differ from other patients with IE in terms of comorbidity, microbiology, rates of surgery and mortality are sparse. METHODS Using Danish nationwide registries, all patients with IE diagnosed between February 1, 2010, and May 14, 2018 were identified and categorized into a "hemodialysis group" and a "non-hemodialysis group." Patient groups were compared by comorbidities, microbiological etiology, cardiac surgery, and mortality. Risk factors associated with mortality were assessed in multivariable Cox regression analysis. RESULTS In total, 4,366 patients with IE were included with 226 (5.2%) patients in the hemodialysis group. Patients in the hemodialysis group were younger (66.0 years [IQR 53.8-74.9] vs 72.2 years [IQR 62.2-80.0]), had more comorbidities and were surgically treated less often (10.6% vs 20.8%), compared with patients from the nonhemodialysis group. Staphylococcus aureus was more than twice as prevalent (58.0% vs 26.5%). No difference in in-hospital mortality was found between the 2 groups (20.8% vs 18.5%), but 1- and 5-year mortality were significantly higher in the hemodialysis group than in the nonhemodialysis group (37.7% vs 17.7% and 72.1% vs 42.5%, respectively). In adjusted analysis, hemodialysis was associated with higher 1-year (HR = 2.71, 95% CI 2.07-3.55) and 5-year mortality (HR = 2.72, 95% CI 2.22-3.34) CONCLUSIONS: Patients with IE on chronic hemodialysis were younger, had more comorbidity, a higher prevalence of Staphylococcus aureus IE, and a higher mortality than patients without hemodialysis.
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Affiliation(s)
- Anna Stahl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Lauge Østergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jeppe K Petersen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Peter E Weeke
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institute, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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30
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Oh N, Guariento A, Vida VL. Commentary: Prosthetic infective endocarditis: Do we have the solution in our back pocket? J Thorac Cardiovasc Surg 2023; 166:1071-1072. [PMID: 35249760 DOI: 10.1016/j.jtcvs.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Nicholas Oh
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alvise Guariento
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
| | - Vladimiro L Vida
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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31
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Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Karchmer AW, Mestres CA, Petti CA, Pizzi MN, Preston SD, Roque A, Vandenesch F, van der Meer JTM, van der Vaart TW, Miro JM. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis 2023; 77:518-526. [PMID: 37138445 PMCID: PMC10681650 DOI: 10.1093/cid/ciad271] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [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: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of "typical" microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a "Living Document."
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Affiliation(s)
- Vance G Fowler
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - David T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health and School of Medicine, Deakin University, Geelong, Australia
| | - Arnold S Bayer
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA, Torrance, California, USA
- Department of Medicine, The Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anna Lisa Chamis
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Louis DiBernardo
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, INSERM CIC 1425, Université Paris Cité, IAME, INSERM, Paris, France
| | - Claudio Querido Fortes
- Infectious Diseases Department, Hospital Universitário Clementino Fraga Filho—Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Emil Fosbøl
- The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Margaret M Hannan
- Clinical Microbiology Department, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, Université de Lorraine, APEMAC, Nancy, France
| | - Adolf W Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Cathy A Petti
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- HealthSpring Global Inc, Bradenton, Florida, USA
| | | | | | - Albert Roque
- Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Francois Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, INSERM, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
- Institut des agents infectieux, Hospices Civils de Lyon, Lyon, France
| | | | | | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Al-Chalabi S, Tay T, Chinnadurai R, Kalra PA. Risk factors for infective endocarditis in patients receiving hemodialysis: A propensity score matched cohort study. Clin Nephrol 2023; 100:51-59. [PMID: 37288830 DOI: 10.5414/cn111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 06/09/2023] Open
Abstract
In patients receiving hemodialysis, infective endocarditis (IE) may present in a similar way to other causes of bacteremia, which may delay early diagnosis and can lead to worse outcomes. In this study, we aimed to identify the risk factors for IE in hemodialysis patients with bacteremia. This study was conducted on all patients diagnosed with IE and receiving hemodialysis between 2005 and 2018 in Salford Royal Hospital. Patients with IE were propensity score matched with similar hemodialysis patients with episodes of bacteremia between 2011 and 2015 (non-IE bacteremic (NIEB)). Logistic regression analysis was used to predict the risk factors associated with infective endocarditis. There were 35 cases of IE, and these were propensity matched with 70 NIEB cases. The median age of the patients was 65 years with a predominance of males (60%). The IE group had higher peak C-reactive protein compared to the NIEB group (median, 253 mg/L vs. 152, p = 0.001). Patients with IE had a longer duration of prior dialysis catheter use than NIEB patients (150 vs. 28.5 days: p = 0.004). IE patients had a much higher 30-day mortality rate (37.1% vs. 17.1%, p = 0.023). Logistic regression analysis showed previous valvular heart disease (OR: 29.7; p < 0.001), and a higher baseline C-reactive protein (OR: 1.01; p = 0.001) as significant predictors for infective endocarditis. Bacteremia in patients receiving hemodialysis through a catheter access should be actively investigated with a high index of suspicion for infective endocarditis, particularly in those with known valvular heart disease and a higher baseline C-reactive protein.
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French R, McFadden R, Stewart R, Christian H, Compton P. "I Just Need Proper Treatment": Being Hospitalized for Endocarditis among Individuals Who Inject Drugs Being Hospitalized for Endocarditis. J Gen Intern Med 2023; 38:2470-2477. [PMID: 36941420 PMCID: PMC10465454 DOI: 10.1007/s11606-023-08133-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Rates of hospitalization for injection drug use-associated infective endocarditis (IDU-IE) are increasing. Much is known about the poor outcomes of patients with IDU-IE; less is known about the patient experience during hospitalization. OBJECTIVE To explore the experience of being hospitalized for endocarditis among individuals who inject drugs, providing a foundation on which to develop strategies to improve care for these patients. DESIGN Qualitative interviews with hospitalized patients undergoing cardiothoracic surgery with a history of injection drug use between February 2021 and May 2022 at the Hospital of the University of Pennsylvania. PARTICIPANTS Cardiothoracic surgery patients with a documented history of injection drug use and the ability to speak English were recruited during their hospital stay. APPROACH Thematic analysis of interviews guided by phenomenology and harm reduction theory was used to identify recurrent themes. Interviews were digitally recorded and transcribed and analyzed using NVIVO software. KEY RESULTS Interviews from 13 participants resulted in four major themes around Hospital Experience: (1) Kindness as an Antidote to Dehumanizing Treatment; (2) Relationships with the Care Team; (3) Withdrawal and Pain Management; and (4) Anticipating and Experiencing the Transition out the Hospital. Participants recounted long histories of dehumanizing care during previous hospitalizations, noted the value of open, sincere, and non-judgmental communication with clinical teams, expressed overall satisfaction with the management of their symptoms during the current hospitalization, reported self-discharging during previous hospitalizations due to undertreated pain and withdrawal, and noted significant challenges around discharge planning and execution. CONCLUSIONS Participants noted structural (e.g., discharge planning) and interpersonal (e.g., stigma from care team) barriers to quality hospital care. They also noted that expressions of kindness from hospital staff were meaningful and comforting. Patients with IDU-IE face multi-dimensional challenges in the hospital. Their perspectives can meaningfully inform programs and initiatives to improve their outcomes and support recovery.
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Affiliation(s)
- Rachel French
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA.
| | - Rachel McFadden
- Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rebecca Stewart
- Center for Mental Health, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Hanna Christian
- Center for Mental Health, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
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Segura-Méndez B, Blanco M, Carrascal Y. [Persistent fever after hospital intervention: nosocomial endocarditis in mitral bioprostheses]. Arch Cardiol Mex 2023; 93:360-361. [PMID: 35687845 PMCID: PMC10406471 DOI: 10.24875/acm.22000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bárbara Segura-Méndez
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Miriam Blanco
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Yolanda Carrascal
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Assabbi P, Tonet E, Campo G. [TAVI injuries: not only endocarditis]. G Ital Cardiol (Rome) 2023; 24:e. [PMID: 37227211 DOI: 10.1714/4041.40211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Paolo Assabbi
- Malattie dell'Apparato Cardiovascolare, Università degli Studi di Ferrara
| | - Elisabetta Tonet
- Malattie dell'Apparato Cardiovascolare, Università degli Studi di Ferrara
| | - Gianluca Campo
- Malattie dell'Apparato Cardiovascolare, Università degli Studi di Ferrara
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Flores-Patiño JJ, Durán-Pacheco MJ, Cázares-Marroquín AM, Gastélum-Cano JM, Islas-Osuna MA, Arízaga-Berber JA. Endocarditis due to Candida albicans in an immunocompromised patient: A case report. Rev Iberoam Micol 2023; 40:31-34. [PMID: 37770333 DOI: 10.1016/j.riam.2023.06.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%. CASE REPORT Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. CONCLUSIONS Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.
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Affiliation(s)
| | | | | | - José M Gastélum-Cano
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - María A Islas-Osuna
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - José A Arízaga-Berber
- Escuela de Medicina, Universidad de Celaya, Celaya, Guanajuato, Mexico; Hospital General Zona 4 del Instituto Mexicano del Seguro Social (IMSS), Celaya, Guanajuato, Mexico.
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Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but potentially fatal event. In this systematic review, we searched PubMed and Embase for large TAVI studies and registries to identify the incidence, presentation, microbiology, risk factors, and outcomes of IE in this population. After application of the selection criteria and quality assessment, 8 studies representing 255,310 TAVR cases and 4218 cases of IE qualified for this review. IE following TAVI is uncommon with an incidence of 0.87 to 1.7 events per 100 person-years. Most events occur in the first year following valve implantation. Staphylococcus , Enterococcus , and Streptococcus species are the most common pathogens. Risk factors include age, sex, concomitant comorbidities, and procedural factors. Outcomes are dismal, and surgical intervention is rare in this population.
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Affiliation(s)
- Ahmed Hassanin
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Hesham Afify
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY
| | - Salma Zook
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - William H Frishman
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Liñares AR, Marschall AF, Del Castillo Carnevalli H, Sanz CF, Torres DR, Sánchez DM, Antón SÁ. Atrioesophageal fistula following pulmonary vein isolation presenting as uncommon infective endocarditis. J Echocardiogr 2023; 21:42-44. [PMID: 34287792 DOI: 10.1007/s12574-021-00536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/27/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Rueda Liñares
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain.
| | - Alexander Felix Marschall
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
| | - Hugo Del Castillo Carnevalli
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
| | - Cristina Fraile Sanz
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
| | - Diego Rodríguez Torres
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
| | - David Martí Sánchez
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
| | - Salvador Álvarez Antón
- Cardiology Department, University Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército 1, 28047, Madrid, Spain
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Selitsky L, Racha S, Rastegar D, Olsen Y. Infective endocarditis in people who inject drugs: A scoping review of clinical guidelines. J Hosp Med 2023; 18:169-176. [PMID: 36349984 DOI: 10.1002/jhm.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The incidence of infective endocarditis (IE) among people who inject drugs (PWID) is rising worldwide. Multiple clinical guidelines differ on the management of this condition, and few guidelines comment on treatment for primary substance use disorder (SUD). A comprehensive comparison of these guidelines is lacking. OBJECTIVES To perform a critical review identifying key differences in clinical guideline recommendations for treating IE among PWID, focusing on the inclusion of recommendations for SUD treatment and the presence of stigmatizing language. ELIGIBILITY CRITERIA Recently published, English-language, society-developed clinical guidelines for the treatment of IE among PWID. SOURCES OF EVIDENCE PubMed, Google Scholar, and CINAHL Plus databases. CHARTING METHODS In line with Arksey and O'Malley's framework, a scoping review was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Two reviewers independently performed database searches for clinical guidelines published between 2007 and 2020 that commented on the management of IE among PWID. RESULTS Ten clinical guidelines were included in the final analysis. Treatment recommendations varied with some societies proposing nonstandard care due to concern for return to drug use. Three guidelines include reference to addiction treatment. Only one guideline specifies the use of opioid agonist therapy for treating opioid use disorder and identifies the benefits of an addiction specialist consultation. Acute withdrawal management is not mentioned in any guideline. All guidelines utilized stigmatizing language to describe PWID. CONCLUSIONS Most guidelines do not address SUD treatment, despite its effectiveness in reducing adverse health outcomes. Future guidelines should address SUD treatment using patient-first language.
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Affiliation(s)
- Lea Selitsky
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Savitha Racha
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darius Rastegar
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yngvild Olsen
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland, USA
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40
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van Melle JP, Roos-Hesselink JW, Bansal M, Kamp O, Meshaal M, Pudich J, Luksic VR, Rodriguez-Alvarez R, Sadeghpour A, Hanzevacki JS, Sow R, Timóteo AT, Morgado MT, De Bonis M, Laroche C, Boersma E, Lancellotti P, Habib G. Infective endocarditis in adult patients with congenital heart disease. Int J Cardiol 2023; 370:178-185. [PMID: 36273665 DOI: 10.1016/j.ijcard.2022.10.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.
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Affiliation(s)
- Joost P van Melle
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | | | - Manish Bansal
- Medanta, The Medicity, Gurgaon, Haryana 120001, India
| | - Otto Kamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands
| | - Marwa Meshaal
- Department of Cardiology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Jiri Pudich
- Department of Cardiovascular Diseases, University Hospital Ostrava, University of Ostrava, Faculty of Medicine, Czech Republic
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Croatia
| | | | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran; Duke Cardiovascular MR Center, Durham, NC, United States of America
| | - Jadranka Separovic Hanzevacki
- Department of Cardiovascular Diseases, University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Croatia
| | - Rouguiatou Sow
- Department of Cardiology, Laboratory of Echocardiography, Luxembourg Hospital Centre, Luxembourg
| | - Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Marisa Trabulo Morgado
- Cardiology Department, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Heart House. 2035 Route des Colles, CS80179 Biot, 06903 Sophia-Antipolis, France
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- La Timone Hospital, Cardiology Department, Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Agrawal A, Arockiam AD, Jamil Y, El Dahdah J, Honnekeri B, Chedid El Helou M, Kassab J, Wang TKM. Contemporary risk models for infective endocarditis surgery: a narrative review. Ther Adv Cardiovasc Dis 2023; 17:17539447231193291. [PMID: 37646184 PMCID: PMC10469256 DOI: 10.1177/17539447231193291] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasser Jamil
- Yale-Waterbury, Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bianca Honnekeri
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michel Chedid El Helou
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH 44195, USA
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Mishra AK, Abraham BM, Sahu KK, George AA, Sargent J, Kranis MJ, George SV, Abraham GM. Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis. J Patient Saf 2022; 18:756-759. [PMID: 35797474 DOI: 10.1097/pts.0000000000001055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Patients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015. OBJECTIVES In this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment. RESULTS A total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus ( P < 0.001), the need for recurrent admissions ( P = 0.002), recurrent bacteremia ( P < 0.001), developing new embolus ( P < 0.001), and overall morbidity ( P = 0.002) among IE patients leaving AMA. CONCLUSIONS Infective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non-Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.
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Affiliation(s)
- Ajay Kumar Mishra
- From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester
| | | | - Kamal K Sahu
- Division of Hematology and Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Jennifer Sargent
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
| | - Mark J Kranis
- From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester
| | - Susan V George
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
| | - George M Abraham
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
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43
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Crociani P, Schivazappa L. [Epidemiology of infective endocarditis in intravenous drug users]. G Ital Cardiol (Rome) 2022; 23:845-853. [PMID: 36300388 DOI: 10.1714/3900.38824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Recently, five North American studies have reported 471 persons who injected drugs intravenously (PWID) (25.34%) out of a total of 1858 patients with infective endocarditis (IE) and three European studies have reported 263 PWID out of 1225 patients with IE (21.46%). Both in North America and Europe the mean age of PWID with IE was 32-38 years and 41-44 years, respectively. Both in North America and in Europe Staphylococcus aureus was the leading cause of IE in PWID (67.30% and 66.15%, respectively). IE involves the tricuspid valve in 90% of cases and mitral and/or aortic valves in less than 15% of cases; the mortality rate is 2.0-2.5%. In North America and in Europe, streptococci caused IE in 10.61% and 10.64% of PWID, respectively, enterococci in 6.58% and 9.50%. Other etiologies accounted for 1-2%. Almost 6% of North American cases and almost 10% of European cases were polymicrobial. New episodes (25-32%) were mostly reinfections (up to 86.4%). PWID's in-hospital mortality was not significantly different from non-PWID's. Ten-year survival of PWID and non-PWID with IE was comparable in an American surgical study (69.5% vs 68.7%) and significantly different in a British study (43.8% vs 83.5%).
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Affiliation(s)
- Paolo Crociani
- Specialista Cardiologo, Associazione Regionale Cardiologi Ambulatoriali - Sezione del Veneto
| | - Luciano Schivazappa
- Già Professore Associato di Angiologia, Policlinico dell'Università degli Studi di Padova
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Nuis RJ, Yee J, Adrichem R, Hokken TW, Lenzen M, Daemen J, de Jaegere PP, Van Mieghem NM. Incidence and mechanisms of bioprosthetic dysfunction after transcatheter implantation of a mechanically-expandable heart valve. EUROINTERVENTION 2022; 18:769-776. [PMID: 35712763 PMCID: PMC10331974 DOI: 10.4244/eij-d-22-00193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mechanically-expandable transcatheter valve is no longer commercially available, yet clinical and echocardiographic surveillance is imperative for thousands of patients who received transcatheter aortic valve implantation (TAVI) with this platform. AIMS We aimed to determine the incidence and mechanism of bioprosthetic valve dysfunction (BVD) following TAVI with mechanically-expandable valves. METHODS From 2013 to 2020, all 234 patients who underwent TAVI with the LOTUS valve were included. BVD was categorised as (i) structural valve deterioration (SVD), (ii) non-structural valve dysfunction (NSVD), (iii) clinical valve thrombosis and (iv) endocarditis, according to the Valve Academic Research Consortium-3 criteria. RESULTS The mean age was 79±7 years, 60% were male, and the mean Society of Thoracic Surgeons score was 4.2±2.9%. The technical success rate was 94% and the 30-day device success rate was 78%. All-cause mortality at 1 year was 15%; median follow-up duration was 36 (IQR 18-60) months during which 47% of patients died. One hundred and three patients had ≥1 type of BVD (44%), which predominantly consisted of NSVD (39%, mostly because of ≥moderate patient-prosthesis mismatch). BVD during follow-up included endocarditis (3.4%), clinical valve thrombosis (3.4%) and SVD (1.3%). Both endocarditis and clinically apparent valve thrombosis occurred early and late after TAVI and resulted in valve-related deaths in 38% and 13% of patients, respectively. Overall, ≥moderate haemodynamic valve deterioration occurred in 5.5% and bioprosthetic failure in 7.3%, leading to valve-related deaths in 36% of cases. CONCLUSIONS BVD represents a relevant health issue after TAVI with a mechanically-expandable valve. Serious but reversible causes of BVD include endocarditis and clinically apparent valve thrombosis, both carrying a time-independent hazard post-TAVI.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jay Yee
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mattie Lenzen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Baddour LM, Weimer MB, Wurcel AG, McElhinney DB, Marks LR, Fanucchi LC, Esquer Garrigos Z, Pettersson GB, DeSimone DC. Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e187-e201. [PMID: 36043414 DOI: 10.1161/cir.0000000000001090] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis-related documents. METHODS A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. CONCLUSIONS Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.
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Sanchez-Nadales A, Diaz-Sierra A, Mocadie M, Asher C, Gordon S, Xu B. Advanced Cardiovascular Imaging for the Diagnosis of Mycobacterium chimaera Prosthetic Valve Infective Endocarditis After Open-heart Surgery: A Contemporary Systematic Review. Curr Probl Cardiol 2022; 47:101392. [PMID: 36100093 DOI: 10.1016/j.cpcardiol.2022.101392] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
Mycobacterium chimaera is an opportunistic and emerging pathogen, which has been recognized to cause prosthetic valve infective endocarditis and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnostic evaluation of suspected prosthetic valve infective endocarditis due to Mycobacterium chimaera is challenging and requires a very high index of suspicion. This systematic review aims to evaluate prosthetic valve infective endocarditis due to Mycobacterium chimaera. Based on the current literature review, transesophageal echocardiography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography are the most common imaging modalities used to establish the diagnosis. Based on twenty-two published cases, the reported cases of Mycobacterium chimaera endocarditis have occurred almost entirely in males. Within this cohort, the patients developed endocarditis on average 2.7 years after exposure to contaminated heater-cooler systems during cardiac surgery. Mycobacterium chimaera infection is associated with significant morbidity and mortality.
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Affiliation(s)
| | | | - Michele Mocadie
- Department of Infectious Diseases, University Hospitals, Cleveland, OH
| | - Craig Asher
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston FL
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
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Shah MA, Soofi MA, Alsmadi F, Ur Rehman MA, Alghamdi FA. Cutaneous T-cell Lymphoma Predisposing to Recurrent Infective Endocarditis by Methicillin-resistant Staphylococcus Aureus (MRSA) in a Patient with Intracardiac Defibrillator (ICD). J Coll Physicians Surg Pak 2022; 32:S95-S97. [PMID: 36210659 DOI: 10.29271/jcpsp.2022.supp2.s95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
Cutaneous T-cell lymphoma (CTCL) is a rare group of extra-nodal non-Hodgkin's lymphomas resulting in infiltration of the skin by the malignant cells. Sézary syndrome (SS) and mycosis fungoides (MF) are the most common subtypes, and infectious complications are the major cause of death in such patients. The presence of implantable cardiac devices (ICD) and CTCL make the patient more vulnerable to the device-related infective endocarditis (IE) caused by methicillin-resistant staphylococcus aureus (MRSA). The need for reimplantation of ICD should be assessed in detail and non-cardiac conditions should be considered while making such decisions. Herein, we report a unique case of non-ischemic cardiomyopathy with an implantable cardiac defibrillator (ICD), who later developed CTCL, complicated by the recurrent right-sided IE which is caused by MRSA. Key Words: Cutaneous T-cell lymphoma, Methicillin-resistant staphylococcus aureus (MRSA), Infective endocarditis.
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Affiliation(s)
- Muhammad Azam Shah
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Adil Soofi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Alsmadi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Faisal Abdullah Alghamdi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
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48
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Judson GL, Mahadevan VS. Valves, Vegetations, and Valves. J Invasive Cardiol 2022; 34:E580. [PMID: 35772932] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We present a novel method for the treatment of right-sided bioprosthetic valve endocarditis with AngioVac debulking followed by percutaneous pulmonic and tricuspid valve replacement for residual transcatheter valve degeneration and right ventricular dysfunction.
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Affiliation(s)
- Gregory L Judson
- University of California, San Francisco, Department of Medicine, Division of Cardiology, San Francisco, CA USA.
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Vervoort D, An KR, Elbatarny M, Tam DY, Quastel A, Verma S, Connelly KA, Yanagawa B, Fremes SE. Dealing with the epidemic of endocarditis in people who inject drugs. Can J Cardiol 2022; 38:1406-1417. [PMID: 35691567 DOI: 10.1016/j.cjca.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-sided IE compared to those with non-IDU-IE and a majority are a result of S. aureus. While most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part related to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons but also infectious disease specialists, drug addiction experts, social workers, neurologists and/or neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns such as overdoses. In this review, we describe the pathophysiological, clinical, surgical, social, and ethical characteristics of IDU-IE and the management thereof. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Quastel
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Brandariz-Núñez D, Suanzes J, Gutiérrez-Urbón JM, Fernández-Oliveira C, Margusino L, Martín-Herranz I. Incidence and risk factors for mortality in patients treated with combined ceftaroline for Gram-positive infective endocarditis. Eur J Clin Microbiol Infect Dis 2022; 41:827-834. [PMID: 35435629 DOI: 10.1007/s10096-022-04443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ceftaroline is a fifth-generation cephalosporin and represents an alternative in the treatment of infective endocarditis (IE). The main objective of this study was to describe the incidence of in-hospital and 42-day mortality in patients with IE treated with ceftaroline. METHODS An observational retrospective study included adult patients with IE admitted during a 3.5-year period (January 2018-June 2021) and treated with ceftaroline in a single center. All cases were definite or possible IE according to the modified Duke criteria. RESULTS Seventy cases were analyzed. The mean age was 67.35 ± 16.62 (16-89) and 39 (55.7%) were males. The mean number of days of treatment with ceftaroline was 21.26 ± 16.17 (1-75). Overall mortality at 42 days was 30%, 20.7% in the first line, and 36.6% in rescue therapy. Predictors of 42 days-mortality were increased Charlson comorbidity index (CCI) (OR of 1.7 per 1 point increment, 95% CI 1.2-2.4, P 0.001), presence of methicillin-resistance (OR 6.8, 95% CI 1.3-36.8, P 0.026) and evidence of septic shock (OR 8.6 95% CI 1.7-44.2, P 0.01). Predictors of 42 days of therapeutic failure were the increase in the CCI (OR of 1.6 per 1 point increment, 95% CI 1.3-2.1, P 0.000) and septic shock (OR 4.5 95% CI 1.1-18 P 0.036). Adverse effects were described in 6/70 (8.6%) of the patients, precipitating in 4/70 (5.7%) the definitive withdrawal of the antibiotic. CONCLUSIONS The incidence of in-hospital and 42 day-mortality of IE patients treated with ceftaroline remains similar to literature data. Increased CCI, septic shock, and methicillin resistance are associated with poor prognosis.
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Affiliation(s)
- D Brandariz-Núñez
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain.
| | - J Suanzes
- Research Support Unit, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
- Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - J M Gutiérrez-Urbón
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - C Fernández-Oliveira
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - L Margusino
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - I Martín-Herranz
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
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