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Wang Q, Qiu J, Huang JL, Jiang M, Lu JQ, Wu D, Wei XB, Yu DQ. Prognostic Value of Blood Urea Nitrogen for Short-Term Mortality in Patients with Infective Endocarditis. Infect Dis Ther 2023; 12:2353-2366. [PMID: 37751020 PMCID: PMC10600074 DOI: 10.1007/s40121-023-00867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Blood urea nitrogen (BUN) is a metabolic product validated to be an independent risk factor in the prognosis of several diseases. However, the prognostic value of BUN in patients with infective endocarditis (IE) remains unevaluated. METHODS A total of 1371 patients with a diagnosis of IE were included and divided into four groups according to BUN (mmol/L) at admission: < 3.5 (n = 343), 3.5-4.8 (n = 343), 4.8-6.8 (n = 341), and ≥ 6.8 (n = 344). Restricted cubic spline was used to assess the association of BUN with in-hospital mortality. Multivariate analysis was performed to identify the independent risk factors for adverse outcomes. RESULTS The in-hospital mortality reached 7.4%, while the 6-month mortality was 9.8%. The restricted cubic spline plot exhibited an approximately linear relationship between BUN and in-hospital mortality. Receiver operating characteristics curve analysis showed that the optimal cut-off of BUN for predicting in-hospital death was 6.8 mmol/L. Kaplan-Meier analysis showed that patients with BUN > 6.8 mmol/L had a higher 6-month mortality than other groups (log rank = 97.9, P < 0.001). Multivariate analysis indicated that BUN > 6.8 mmol/L was an independent predictor indicator for both in-hospital [adjusted odds ratio (aOR) = 2.365, 95% confidence interval (CI) 1.292-4.328, P = 0.005] and 6-month mortality [adjusted hazard ratio (aHR) = 2.171, 95% CI 1.355-3.479, P = 0.001]. CONCLUSIONS BUN is suitable for independently predicting short-term mortality in patients with IE.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jia Qiu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Mei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jun-Quan Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Di Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Xue-Biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Low serum albumin: A neglected predictor in patients with cardiovascular disease. Eur J Intern Med 2022; 102:24-39. [PMID: 35537999 DOI: 10.1016/j.ejim.2022.05.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
Albumin, the most abundant circulating protein in blood, is an essential protein which binds and transports various drugs and substances, maintains the oncotic pressure of blood and influences the physiological function of the circulatory system. Albumin also has anti-inflammatory, antioxidant, and antithrombotic properties. Evidence supports albumin's role as a strong predictor of cardiovascular (CV) risk in several patient groups. Its protective role extends to those with coronary artery disease, heart failure, hypertension, atrial fibrillation, peripheral artery disease or ischemic stroke, as well as those undergoing revascularization procedures or with aortic stenosis undergoing transcatheter aortic valve replacement, and patients with congenital heart disease and/or endocarditis. Hypoalbuminemia is a strong prognosticator of increased all-cause and CV mortality according to several cohort studies and meta-analyses in hospitalized and non-hospitalized patients with or without comorbidities. Normalization of albumin levels before discharge lowers mortality risk, compared with hypoalbuminemia before discharge. Modified forms of albumin, such as ischemia modified albumin, also has prognostic value in patients with coronary or peripheral artery disease. When albumin is combined with other risk factors, such as uric acid or C-reactive protein, the prognostic value is enhanced. Although albumin supplementation may be a plausible approach, its efficacy has not been established and in patients with hypoalbuminemia, priority is focused on diagnosing and managing the underlying condition. The CV effects of hypoalbuminemia and relevant issues are considered in this review. Large cohort studies and meta-analyses are tabulated and the physiologic effects of albumin and the deleterious effects of low albumin are pictorially illustrated.
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Affiliation(s)
| | - Theodora A Manolis
- Aiginiteio University Hospital, Athens University School of Medicine, Athens, Greece
| | - Helen Melita
- Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Chen GB, Lu HZ. Brain abscess due to Aggregatibacter aphrophilus in association with atrial septal defect:Case report and literature review. Clin Neurol Neurosurg 2022; 219:107337. [PMID: 35717764 DOI: 10.1016/j.clineuro.2022.107337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aggregatibacter aphrophilus(A. aphrophilus)is one of the organisms of the HACEK group. Previously reported cases of brain abscesses caused by A. aphrophilus infection have occurred in children with a basis for congenital heart disease, or in adults with a basis for dental disease. Rare cases of brain abscess caused by A. aphrophilus have been reported in adults with congenital heart disease or in patients without dental disease history. Herein we present a rare case of brain abscess caused by A. aphrophilus, who was in association with atrial septal defect for more than 20 years, and had no dental disease and did not develop infective endocarditis. CASE PRESENTATION A 51-year-old female was admitted due to progressively worsening headache and left limb weakness for more than 10 days. She denied the history of chronic diseases such as hypertension and diabetes, and no periodontal disease. While she had a history of atrial septal defect, a form of congenital heart disease with severe pulmonary hypertension for more than 20 years. After admission, echocardiographic illustrated congenital heart disease with severe pulmonary hypertension. CT and MRI showed brain abscess. Cerebrospinal fluid (CSF) results also confirmed the presence of intracranial infection. Empirical therapy with vancomycin 1.0 g i.v q12h and meropenem 2.0 g i.v q8h was initiated from the day of admission. On the fourth day after admission, brain abscess resection and decompressive craniectomy were performed, and the pus drained on operation were cultured and Gram-negative bacilli grew, which was identified as A.aphrophilus. Vancomycin was discontinued and meropenem was continued(2.0 g i.v q8h)for 5 weeks, followed by oral levofloxacin 0.5 qd for 4 weeks of out-patient antibiotics. The patient recovered fully within 9 weeks of treatment. CONCLUSIONS This is the first case of A. aphrophilus to cause brain abscess in adult with a history of congenital heart disease for more than 20 years, who had no dental disease and did not develop infective endocarditis. We also highlight the value of bacterial 16 S rDNA PCR amplification and sequencing in identifying bacteria in abscesses which are culture-negative, and prompt surgical treatment,choosing effective antibiotics and appropriate course of treatment will get better clinical effect.
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Affiliation(s)
- Guang-Bin Chen
- Department of Pharmacy, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hong-Zhou Lu
- National Center for Infectious Diseases research, The Third People's Hospital of Shenzhen, Shenzhen, China.
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Varela Barca L, Fernández-Felix BM, Navas Elorza E, Mestres CA, Muñoz P, Cuerpo-Caballero G, Rodríguez-Abella H, Montejo-Baranda M, Rodríguez-Álvarez R, Gutiérrez Díez F, Goenaga MA, Quintana E, Ojeda-Burgos G, de Alarcón A, Vidal-Bonet L, Centella Hernández T, López-Menéndez J. Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis. Eur J Cardiothorac Surg 2021; 57:724-731. [PMID: 31782783 DOI: 10.1093/ejcts/ezz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.
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Affiliation(s)
- Laura Varela Barca
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Borja M Fernández-Felix
- University of Alcalá de Henares, Madrid, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | | | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón-Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hugo Rodríguez-Abella
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Regino Rodríguez-Álvarez
- Department of Cardiovascular Surgery, University Hospital Marques de Valdecilla, Santander, Spain
| | | | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC, University Hospital Virgen del Rocío, Seville, Spain
| | - Laura Vidal-Bonet
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Tomasa Centella Hernández
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jose López-Menéndez
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
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Wassef N, Sarkar D, Viswanathan G, Hughes GM, Salisbury T, Kuo J, de Silva R. A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab003. [PMID: 33644660 PMCID: PMC7898661 DOI: 10.1093/ehjcr/ytab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/26/2020] [Accepted: 12/06/2020] [Indexed: 11/14/2022]
Abstract
Background The prevalence of culture negative infective endocarditis (IEC) is reported as 2–7% though this figure may be as high as 70% in developing countries.1 This higher rate will, at least in part, be due to reduced diagnostic facilities though some data suggests higher rates even when appropriate cultures were taken. The frequency is significantly elevated in patients who have already been exposed to antibiotics prior to blood cultures.1,2 A rare cause of culture negative IEC is the HACEK group of organisms that are normal habitants of the oropharyngeal flora and account for 1–3% of native valve endocarditis.3Aggregatibacter aphrophilus (A. aphrophilus) is a member of the HACEK group of organisms. Case summary A 32-year-old gentleman with a previous bioprosthetic aortic valve presented with a 1-week history of diarrhoea, vomiting, malaise, and weight loss. He was awaiting redo surgery for stenosis of the bioprosthesis, which had been inserted aged 17 for aortic stenosis secondary to a bicuspid valve. The initial blood tests revealed liver and renal impairment with anaemia. A transoesophageal echocardiogram demonstrated a complex cavitating aortic root abscess, complicated by perforation into the right ventricle. He underwent emergency redo surgery requiring debridement of the aortic abscess, insertion of a mechanical aortic prosthesis (St Jude Medical, USA), annular reconstruction and graft replacement of the ascending aorta. Despite antibiotic therapy, he remained septic with negative blood and tissue cultures. Bacterial 16S rRNA gene sequencing confirmed A. aphrophilus infection, for which intravenous ceftriaxone was initiated. This was subsequently changed to ciprofloxacin due to neutropenia. The patient self-discharged from the hospital during the third week of antibiotic therapy. One week later, he was re-admitted with fever, night sweats, and dyspnoea. Transthoracic echocardiogram revealed a large recurrent aortic abscess cavity around the aortic annulus fistulating into the right heart chambers; this was confirmed by a computed tomography scan. There was dehiscence of the patch repair. Emergency redo aortic root replacement (25 mm mechanical valve conduit, ATS Medical, USA) and annular reconstruction was performed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. VA-ECMO was weaned after 3 days. The patient completed a full course of intravenous meropenem and ciprofloxacin and made a good recovery. Discussion IEC with oropharyngeal HACEK organisms is rare and difficult to diagnose, due to negative blood culture results. The broad-range polymerase chain reaction and gene sequencing with comparison to the DNA database is useful in these circumstances. This case demonstrates the importance of the 16S rRNA gene sequencing for HACEK infection diagnosis and appropriate antibiotic treatment.
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Affiliation(s)
- Nancy Wassef
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
- Corresponding author. ,
| | - David Sarkar
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - Girish Viswanathan
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - Gareth Morgan Hughes
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - Thomas Salisbury
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - James Kuo
- Cardiology & Cardiothoracic Department, University Hospitals Plymouth NHS Trust Hospital, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - Ravi de Silva
- Cardiothoracic Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0A, UKFor the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
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Arques S. Serum albumin and cardiovascular disease: State-of-the-art review. Ann Cardiol Angeiol (Paris) 2020; 69:192-200. [PMID: 32797938 DOI: 10.1016/j.ancard.2020.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.
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Affiliation(s)
- S Arques
- Service de Cardiologie, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
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Zaqout A, Mohammed S, Thapur M, Al-Soub H, Al-Maslamani MA, Al-Khal A, Omrani AS. Clinical characteristics, microbiology, and outcomes of infective endocarditis in Qatar. Qatar Med J 2020; 2020:24. [PMID: 33282709 PMCID: PMC7684547 DOI: 10.5339/qmj.2020.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Infective endocarditis (IE) is a serious and potentially life-threatening disease. The epidemiology, treatment options, and outcomes have changed considerably over the last two decades. The aim of the study was to describe the epidemiology, clinical characteristics, and outcomes of patients with IE in Qatar. Methods: Patients were identified from Hamad Medical Corporation hospitals’ electronic records, the national referral center for the State of Qatar. We included those aged ≥ 18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017. Demographic and clinical data were retrieved. Descriptive statistics were performed, and logistic regression analysis was used to describe the relationship between patient characteristics and all-cause in-hospital mortality. All potentially relevant variables were included in the univariate analysis, while those with p < 0.1 in the univariate logistic regression model were included in the multivariate analysis. For the final model, we calculated odds ratios (OR) adjusted for each of the variables included, along with their 95% confidence intervals (95% CI). Data were analyzed using STATA software version 15 (StataCorp, College Station, Texas, USA). The study was approved by the Institutional Research Board with a waiver for informed consent. Results: Fifty-seven cases were included, of which 70% were males. The mean age was 51 years ( ± 16.8 years). Eleven (19%) were associated with prosthetic valves, and 6 (11%) with implantable cardiac devices. Fever (84%), dyspnea (46%), and heart failure (37%) were the most common presentations. Only 58% of patients had known preexisting valvular heart disease or an intracardiac device. Skin infections (10 patients, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery, and implantable cardiac devices. Staphylococci were implicated in 19 (34%) and Streptococcaceae in 9 (16%) patients, whereas 21 (37%) patients were culture negative. Left-side IE (49 patients, 86%) was predominant. Acute kidney injury (AKI) (17 patients, 30%) and heart failure (11 patients, 19%) were common complications. The majority of patients received targeted antimicrobial therapy with at least two active agents. Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock [OR 57.8, 95% CI 2.6–1360.2; p < 0.01] and AKI OR 33.9, 95% CI 2.9–398.1; p < 0.01) as the only risk factors independently associated with in-hospital mortality. Conclusion: Staphylococci are the most common microbiological cause of IE in Qatar. Surgical intervention is uncommon, and mortality is relatively high. Our findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encouraging early microbiological investigations and improving medical and surgical management.
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Affiliation(s)
- Ahmed Zaqout
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Shaban Mohammed
- Department of Pharmacy Hamad Medical Corporation, Doha, Qatar
| | - Maliha Thapur
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al-Soub
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ali S Omrani
- Infectious Diseases, Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
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Hall R, Shaughnessy M, Boll G, Warner K, Boucher HW, Bannuru RR, Wurcel AG. Drug Use and Postoperative Mortality Following Valve Surgery for Infective Endocarditis: A Systematic Review and Meta-analysis. Clin Infect Dis 2020; 69:1120-1129. [PMID: 30590480 DOI: 10.1093/cid/ciy1064] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/11/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) often requires surgical intervention. An increasingly common cause of IE is injection drug use (IDU-IE). There is conflicting evidence on whether postoperative mortality differs between people with IDU-IE and people with IE from etiologies other than injection drug use (non-IDU-IE). In this manuscript, we compare short-term postoperative mortality in IDU-IE vs non-IDU-IE through systematic review and meta-analysis. METHODS The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Publication databases were queried for key terms included in articles up to September 2017. Randomized controlled trials, prospective cohorts, or retrospective cohorts that reported on 30-day mortality or in-hospital/operative mortality following valve surgery and that compared outcomes between IDU-IE and non-IDU-IE were included. RESULTS Thirteen studies with 1593 patients (n = 341 [21.4%] IDU-IE) were included in the meta-analysis. IDU-IE patients more frequently had tricuspid valve infection, Staphylococcus infection, and heart failure before surgery. Meta-analysis revealed no statistically significant difference in 30-day postsurgical mortality or in-hospital mortality between the 2 groups. CONCLUSIONS Despite differing preoperative clinical characteristics, early postoperative mortality does not differ between IDU-IE and non-IDU-IE patients who undergo valve surgery. Future research on long-term outcomes following valve replacement is needed to identify opportunities for improved healthcare delivery with IDU-IE.
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Affiliation(s)
- Ryan Hall
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Griffin Boll
- Division of Cardiac Surgery, Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Kenneth Warner
- Division of Cardiac Surgery, Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Helen W Boucher
- Tufts University School of Medicine, Boston, Massachusetts.,Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Park BS, Lee WY, Ra YJ, Lee HK, Gu BM, Yang JT. Surgical Outcomes for Native Valve Endocarditis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:1-7. [PMID: 32090051 PMCID: PMC7006608 DOI: 10.5090/kjtcs.2020.53.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022]
Abstract
Background The aim of this study was to evaluate the short-term and long-term results of surgical treatment for native valve endocarditis (NVE) and to investigate the risk factors associated with mortality. Methods Data including patients’ characteristics, operative findings, postoperative results, and survival indices were retrospectively obtained from Hallym University Sacred Heart Hospital. Results A total of 29 patients underwent surgery for NVE (affecting the mitral valve in 20 patients and the aortic valve in 9) between 2003 and 2017. During the follow-up period (median, 46.9 months; interquartile range, 19.1–107.0 months), the 5-year survival rate was 77.2%. In logistic regression analysis, body mass index (p=0.031; odds ratio [OR], 0.574; 95% confidence interval [CI], 0.346–0.951), end-stage renal disease (ESRD) (p=0.026; OR, 24.0; 95% CI, 1.459–394.8), and urgent surgery (p=0.010; OR, 34.5; 95% CI, 2.353–505.7) were significantly associated with in-hospital mortality. Based on Cox proportional hazard regression analysis, the statistically significant predictors of long-term outcomes were hypertension, ESRD, and urgent surgery. Conclusion Surgical treatment for NVE is associated with considerable mortality. The in-hospital mortality and 5-year survival rates of this study were 13.8% and 77.2%, respectively. Underlying conditions, including hypertension and ESRD, and urgent surgery were independent risk factors for unfavorable outcomes.
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Affiliation(s)
- Bong Suk Park
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Won Yong Lee
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Joon Ra
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hong Kyu Lee
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byung Mo Gu
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jun Tae Yang
- Department of Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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Rodrigues ME, Gomes F, Rodrigues CF. Candida spp./Bacteria Mixed Biofilms. J Fungi (Basel) 2019; 6:jof6010005. [PMID: 31861858 PMCID: PMC7151131 DOI: 10.3390/jof6010005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/21/2022] Open
Abstract
The ability to form biofilms is a common feature of microorganisms, such as bacteria or fungi. These consortiums can colonize a variety of surfaces, such as host tissues, dentures, and catheters, resulting in infections highly resistant to drugs, when compared with their planktonic counterparts. This refractory effect is particularly critical in polymicrobial biofilms involving both fungi and bacteria. This review emphasizes Candida spp.-bacteria biofilms, the epidemiology of this community, the challenges in the eradication of such biofilms, and the most relevant treatments.
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Affiliation(s)
- Maria Elisa Rodrigues
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Fernanda Gomes
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Célia F. Rodrigues
- LEPABE–Dep. of Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Correspondence:
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11
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Goodman-Meza D, Weiss RE, Gamboa S, Gallegos A, Bui AAT, Goetz MB, Shoptaw S, Landovitz RJ. Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:918. [PMID: 31699053 PMCID: PMC6839097 DOI: 10.1186/s12879-019-4558-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/11/2019] [Indexed: 02/18/2023] Open
Abstract
Background In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05–2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25–4.50) than non-PWID. Conclusion PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA. .,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Abel Gallegos
- Universidad Autónoma de Baja California, Tijuana, USA
| | - Alex A T Bui
- Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Matthew B Goetz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Raphael J Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,UCLA Center for Clinical AIDS Research & Education, David Geffen School of Medicine, Los Angeles, CA, USA
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12
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Salem A, Azeez S, Stirrup J, Lawrence D, Ruparelia N. Streptococcus intermedius masquerading as fungal infective endocarditis. Br J Hosp Med (Lond) 2019; 80:674-675. [PMID: 31707889 DOI: 10.12968/hmed.2019.80.11.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infective endocarditis remains an important clinical entity with an incidence of 1.7–10/100 000 person years (Marks et al, 2015). Despite improvements in health care, it still results in significant morbidity and in-hospital mortality approaches 16% (Marks et al, 2015). There are likely multiple causes including late diagnosis, poor response to therapy and the challenges in identifying the causative pathogen and instigating the correct treatment. This is particularly the case for causative organisms that are difficult to culture or identify using routine laboratory methods.
An example of this is Streptococcus intermedius, which belongs to the S. milleri group along with other two species (S. anginosus group and S. constellatus). It is a commensal organism that can turn into an opportunistic pathogen (Whiley et al, 1992). It is a rare cause of infective endocarditis and may initially present with abscesses in the liver, spleen or brain which may mimic fungal infection (Woo et al, 2004; Rashid et al, 2007; Tran et al, 2008). Difficulty in identifying this organism has led to the development of molecular testing to aid diagnosis. To the authors' knowledge, there are very few cases in the literature of infective endocarditis caused by S. intermedius that have been confirmed using 16S polymerase chain reaction (Woo et al, 2004). This article describes a patient presenting with S. intermedius infective endocarditis which was diagnosed using this method.
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Affiliation(s)
- A Salem
- Specialist Registrar in Cardiology, Department of Cardiology, Milton Keynes University Hospital, Milton Keynes MK9 1LA
| | - S Azeez
- Specialist Registrar in Cardiology, Department of Cardiology, Royal Berkshire Hospital, Reading
| | - J Stirrup
- Consultant Cardiologist, Department of Cardiology, Royal Berkshire Hospital, Reading
| | - D Lawrence
- Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London
| | - N Ruparelia
- Consultant Cardiologist, Department of Cardiology, Royal Berkshire Hospital, Reading
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13
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(Infective endocarditis in a cardiovascular centre with no cardiac surgery unit: epidemiological changes and mortality predictors). COR ET VASA 2019. [DOI: 10.33678/cor.2019.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Prognostic factors of mortality after surgery in infective endocarditis: systematic review and meta-analysis. Infection 2019; 47:879-895. [PMID: 31254171 DOI: 10.1007/s15010-019-01338-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors. METHODS We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI). RESULTS The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00-1.05), female sex (OR 1.56, 95% CI 1.35-1.81), urgent or emergency surgery (OR 2.39 95% CI 1.91-3.00), previous cardiac surgery (OR 2.19, 95% CI 1.84-2.61), NYHA ≥ III (OR 1.84, 95% CI 1.33-2.55), cardiogenic shock (OR 4.15, 95% CI 3.06-5.64), prosthetic valve (OR 1.98, 95% CI 1.68-2.33), multivalvular affection (OR 1.35, 95% CI 1.01-1.82), renal failure (OR 2.57, 95% CI 2.15-3.06), paravalvular abscess (OR 2.39, 95% CI 1.77-3.22) and S. aureus infection (OR 2.27, 95% CI 1.89-2.73). CONCLUSIONS After a systematic review, we identified 11 preoperative factors related to an increased postoperative mortality. The meta-analysis of each of these factors showed a significant association with an increased in-hospital mortality after surgery for active infective endocarditis. Graph summary of the Pooled Odds Ratios of the 11 preoperative factors analyzed after the systematic review and meta-analysis.
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15
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Dissanayake O, Merriman RC, Alnajar S, Hunter A, Burns F, Miller RF. Incidence and significance of an elevated red blood cell distribution width among hospitalised HIV-infected adult patients. Int J STD AIDS 2019; 30:915-918. [PMID: 31159710 DOI: 10.1177/0956462419851903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We audited the records of unselected hospitalised HIV-positive adults admitted to a University-affiliated inner London hospital to identify the frequency of elevated red blood cell distribution width (RDW), and potential associations with specific diagnoses, and with outcome. Of 259 patients audited, 188 (73%) were men. Patients’ median age was 47 years (interquartile range = 41–54). An elevated RDW was seen in 50 patients (19%); 200 (77%) had an elevated C-reactive protein (CRP), and 77 (30%) had a low haemoglobin. Only five patients had an elevated RDW without an elevated CRP and/or low haemoglobin. An elevated RDW was associated with a wide range of infectious, inflammatory, and malignant conditions similar to observed associations reported in the general non-HIV infected adult population. Additionally an elevated RDW occurred both in patients with well-controlled HIV infection and in receipt of antiretroviral therapy, as well as in those with newly diagnosed and poorly-controlled infection. Five (10%) of 50 patients with an elevated RDW needed intensive care unit (ICU) admission and two (4%) died. Two (0.95%) of 209 patients with a normal RDW needed ICU admission and four (1.9%) died. The findings of this audit are limited by the relatively small number of patients and the single site nature of the audit.
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Affiliation(s)
| | | | - Sara Alnajar
- 1 HIV Services, Royal Free London NHS Foundation Trust, London, UK
| | - Alan Hunter
- 1 HIV Services, Royal Free London NHS Foundation Trust, London, UK
| | - Fiona Burns
- 1 HIV Services, Royal Free London NHS Foundation Trust, London, UK.,2 Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Robert F Miller
- 1 HIV Services, Royal Free London NHS Foundation Trust, London, UK.,2 Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,3 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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16
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Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med 2018; 52:8-12. [PMID: 29680174 DOI: 10.1016/j.ejim.2018.04.014] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/24/2018] [Accepted: 04/13/2018] [Indexed: 12/21/2022]
Abstract
Cardiovascular diseases are the leading cause of death worldwide. Endothelial dysfunction, inflammation and oxidative stress are at the forefront in the onset and development of atherosclerosis and many cardiovascular diseases. Epidemiological evidence is that low serum albumin levels are linked to incident ischemic heart disease, heart failure, atrial fibrillation, stroke and venous thromboembolism, independent of risk factors, body mass index and inflammation. Hypoalbuminemia has also emerged as an independent prognosticator in many cardiovascular diseases, such as coronary artery disease, heart failure, congenital heart disease, infective endocarditis and stroke, even after adjusting for usual causal factors and prognostic markers. Given physiological properties of serum albumin that include anti-inflammatory, antioxidant, anticoagulant and antiplatelet aggregation activity as well as colloid osmotic effect, hypoalbuminemia could act as an unrecognized modifiable risk factor. The purpose of this review is to provide an overview of the physiological properties of serum albumin, as well as prevalence, causes, prognostic value and potential contribution to the disease emergence and progression of hypoalbuminemia, and the resulting clinical implications.
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Affiliation(s)
- Stephane Arques
- Service de Cardiologie, Centre hospitalier Edmond Garcin, Aubagne, France.
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17
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Arques S. [Serum albumin and cardiovascular diseases: A comprehensive review of the literature]. Ann Cardiol Angeiol (Paris) 2018; 67:82-90. [PMID: 29544976 DOI: 10.1016/j.ancard.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/18/2018] [Indexed: 06/08/2023]
Abstract
Cardiovascular diseases are the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory status and oxidative stress are at the forefront in the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin, the most abundant plasma protein, has many physiological properties, including anti-inflammatory, antioxidant and antiplatelet aggregation activity. It also plays an essential role in the fluid exchange across the capillary membrane. Definite evidence is that hypo-albuminemia is a powerful prognostic marker in the general population as well as in many pathological settings. In the more specific context of cardiovascular diseases, serum albumin is independently associated with the development of a variety of deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation and stroke. Serum albumin has also emerged as a powerful prognostic parameter in patients with coronary artery disease, heart failure, congenital heart disease, infective endocarditis, cardiovascular surgery and stroke, regardless of usual prognostic markers. This prognostic value probably refers mainly to the malnutrition-inflammation syndrome and the severity of comorbidities. Nevertheless, hypo-albuminemia may act as an unknown and modifiable risk factor that contributes to the emergence and the pejorative evolution of cardiovascular diseases, mainly by exacerbation of inflammation, oxidative stress and platelet aggregation, and by pulmonary and myocardial edema. This article provides an overview of the physiological properties of serum albumin, the prevalence, causes, prognostic value and potential contribution to the emergence and aggravation of cardiovascular disease of hypoalbuminemia, as well as its clinical implications.
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Affiliation(s)
- S Arques
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
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18
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Lützen L, Olesen B, Voldstedlund M, Christensen JJ, Moser C, Knudsen JD, Fuursted K, Hartmeyer GN, Chen M, Søndergaard TS, Rosenvinge FS, Dzajic E, Schønheyder HC, Nørskov-Lauritsen N. Incidence of HACEK bacteraemia in Denmark: A 6-year population-based study. Int J Infect Dis 2018; 68:83-87. [PMID: 29408674 DOI: 10.1016/j.ijid.2018.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Bacteria with common microbiological and clinical characteristics are often recognized as a particular group. The acronym HACEK stands for five fastidious genera associated with infective endocarditis (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella). Data on the epidemiology of HACEK are sparse. This article reports a 6-year nationwide study of HACEK bacteraemia in Denmark. METHODS Cases of HACEK bacteraemia occurring during the years 2010-2015 were retrieved from the national Danish microbiology database, covering an average surveillance population of 5.6 million per year. RESULTS A total of 147 cases of HACEK bacteraemia were identified, corresponding to an annual incidence of 0.44 per 100000 population. The annual incidence for males was 0.56 per 100000 and for females was 0.31 per 100000. The median age was 56 years (range 0-97 years), with variation among the genera. One hundred and forty-three isolates were identified to the species level and six to the genus level: Haemophilus spp, n=55; Aggregatibacter spp, n=37; Cardiobacterium spp, n=9; Eikenella corrodens n=21; and Kingella spp, n=27. CONCLUSIONS This is the first study on the incidence of HACEK bacteraemia in a large surveillance population and may inspire further studies on the HACEK group. Haemophilus spp other than Haemophilus influenzae accounted for most cases of HACEK bacteraemia in Denmark, with Aggregatibacter spp in second place.
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Affiliation(s)
- Lisbeth Lützen
- Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark.
| | - Bente Olesen
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Marianne Voldstedlund
- Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark.
| | - Jens J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark.
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
| | - Jenny D Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark.
| | - Kurt Fuursted
- Department of Clinical Microbiology and Infection Control, Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark.
| | - Gitte N Hartmeyer
- Department of Clinical Microbiology, Odense University Hospital, Søndre Boulevard 29, 5000 Odense, Denmark.
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400 Sønderborg, Denmark.
| | - Turid S Søndergaard
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400 Sønderborg, Denmark; Department of Microbiology, Hospitalsenheden Midt-Vest, Viborg/Herning, Heibergs Alle 4, 8800 Viborg, Denmark.
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Søndre Boulevard 29, 5000 Odense, Denmark; Department of Clinical Microbiology, Sygehus Lillebælt Vejle Sygehus, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Esad Dzajic
- Department of Clinical Microbiology, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark.
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark.
| | - Niels Nørskov-Lauritsen
- Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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19
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Mistiaen WP. What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review. SCAND CARDIOVASC J 2018; 52:58-68. [DOI: 10.1080/14017431.2018.1433318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wilhelm P. Mistiaen
- Faculty of Medicine & Health Sciences, Department of Rehabilitation Sciences and Physiotherapy Antwerp, University of Antwerp, Antwerp, Belgium
- Department of Healthcare & Wellbeing, Artesis-Plantijn University College of Antwerp, Antwerp, Belgium
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Abstract
Candida species are the most common infectious fungal species in humans; out of the approximately 150 known species, Candida albicans is the leading pathogenic species, largely affecting immunocompromised individuals. Apart from its role as the primary etiology for various types of candidiasis, C. albicans is known to contribute to polymicrobial infections. Polymicrobial interactions, particularly between C. albicans and bacterial species, have gained recent interest in which polymicrobial biofilm virulence mechanisms have been studied including adhesion, invasion, quorum sensing, and development of antimicrobial resistance. These trans-kingdom interactions, either synergistic or antagonistic, may help modulate the virulence and pathogenicity of both Candida and bacteria while uniquely impacting the pathogen-host immune response. As antibiotic and antifungal resistance increases, there is a great need to explore the intermicrobial cross-talk with a focus on the treatment of Candida-associated polymicrobial infections. This article explores the current literature on the interactions between Candida and clinically important bacteria and evaluates these interactions in the context of pathogenesis, diagnosis, and disease management.
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21
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Bínová J, Kubánek M, Koudelková E, Vrbská J, Kettner J, Kačer P, Kotulák T, Němcová D, Kautzner J, Pirk J. Changing profile of infective endocarditis in patients hospitalised in a tertiary Czech hospital from 2000 to 2013. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Abstract
The HACEK group of bacteria - Haemophilus parainfluenzae, Aggregatibacter spp. (A. actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, and A. segnis), Cardiobacterium spp. (C. hominis, C. valvarum), Eikenella corrodens, and Kingella spp. (K. kingae, K. denitrificans) - are fastidious gram-negative bacteria, part of the normal microbiota of oral and upper respiratory tract in humans. Although their pathogenicity is limited, they are responsible for 1-3% of all infective endocarditis. HACEK endocarditis mostly affect patients with underlying heart disease or prosthetic valves, and are characterized by an insidious course, with a mean diagnosis delay of 1 month (Haemophilus spp.) to 3 months (Aggregatibacter and Cardiobacterium spp.). The advent of continuously monitored blood culture systems with enriched media has erased the need for extended incubation for the diagnosis of HACEK endocarditis. Medical treatment relies on third-generation cephalosporin, with a favorable outcome in 80-90% of cases, with or without cardiac surgery.
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Affiliation(s)
- Matthieu Revest
- a Infectious Diseases and Intensive Care Unit , Pontchaillou University Hospital , Rennes , France
| | - Gérald Egmann
- b Department of Emergency Medicine, SAMU 97.3 , Centre Hospitalier Andrée Rosemon , Cayenne , French Guiana
| | - Vincent Cattoir
- c Bacteriology, Pontchaillou University Hospital , Rennes , France
| | - Pierre Tattevin
- a Infectious Diseases and Intensive Care Unit , Pontchaillou University Hospital , Rennes , France
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23
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Abramczuk E, Stępińska J, Hryniewiecki T. Twenty-Year Experience in the Diagnosis and Treatment of Infective Endocarditis. PLoS One 2015; 10:e0134021. [PMID: 26230402 PMCID: PMC4521749 DOI: 10.1371/journal.pone.0134021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/04/2015] [Indexed: 12/30/2022] Open
Abstract
Aims The aim of this study was to compare the etiology, clinical course, selected diagnostic methods and efficacy of the treatment used in patients with infective endocarditis (IE) in the nineteen eighties and nineties. Material and Methods The study group comprised 300 patients with infective endocarditis hospitalized in the Institute of Cardiology in Warsaw in the following years: from 1982 to 1987 (150 patients: 75 successive patients with IE on the prosthetic valve and 75 successive patients with IE on the native valve), as well as from 1990 to 2003 (150 patients: 75 successive patients with IE on the prosthetic valve and 75 successive patients with IE on the native valve). Results In the nineties, immunological symptoms, embolism formation and progressive heart failure were diagnosed decidedly more frequently. Early prosthetic valve endocarditis (PVE) (up to 60 days after operation) occurred significantly more frequently in the eighties. The quantity of negative blood cultures in PVE has not decreased, it is still observed in over 20% of cases. For 20 years the etiology of PVE has remained the same, the dominant pathogen remains Staphylococcus. The frequency of PVE caused by Streptococci has markedly reduced. In both the decades analyzed the etiology of native valve endocarditis (NVE) was similar. In the eighties Streptococcus was predominant. In successive years the number of infections caused by Staphylococci was the same as that caused by Streptococci. Conclusions The incidence of early PVE decreased in the nineties. More patients were treated surgically with lesser peri-operative mortality. A lower incidence of infective endocarditis on prosthetic valves caused by streptococci may signify better prophylaxis against infective endocarditis. Infective endocarditis with sterile blood cultures continues to occur frequently.
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Erwin JP, O’Gara P. Prognostic Assessment of Infective Endocarditis Using Echocardiography. Circ Cardiovasc Imaging 2015; 8:e003791. [DOI: 10.1161/circimaging.115.003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John P. Erwin
- From the Department of Internal Medicine, Texas A&M College of Medicine/Baylor Scott & White Health, Temple (J.P.E.); and Department of Internal Medicine, Division of Cardiology, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (P.O’G.)
| | - Patrick O’Gara
- From the Department of Internal Medicine, Texas A&M College of Medicine/Baylor Scott & White Health, Temple (J.P.E.); and Department of Internal Medicine, Division of Cardiology, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (P.O’G.)
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25
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Pitsiou G, Kioumis I, Zarogoulidis K, Lazaridis G, Papaiwannou A, Tsirgogianni K, Karavergou A, Lampaki S, Rapti A, Trakada G, Zissimopoulos A, Karaiskos T, Madesis A, Drosos G, Zarogoulidis P. Prophylactic antibiotic administration for post cardiothoracic surgery sternal wounds: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:56. [PMID: 25861611 DOI: 10.3978/j.issn.2305-5839.2015.03.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiothoracic surgery sternal infections are difficult to treat situations. Until now there are no clear guidelines which or if an antibiotic could be used as prophylactic treatment. PATIENTS AND METHODS We collected retrospectively data from 535 patients from our hospital which underwent cardiothoracic surgery and recorded several biological parameters and technical aspects of the surgery. RESULTS It was observed that patients to whom vancomycin was administered had less post surgery infection than those to whom begalin was administered. Male who were treated with vancomycin it was observed that they had 1.67 chances to be treated properly than female. Patients which were hospitalized for more than 7 days before surgery had 62.6% higher chances for post surgery infection. CONCLUSIONS It was observed that vancomycin can be used as a prophylactic treatment for cardiothoracic surgeries acting efficiently against sternal wounds.
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Affiliation(s)
- Georgia Pitsiou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Lazaridis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Lampaki
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Rapti
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Trakada
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Drosos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Patel SR, Patel NH, Borah A, Saltzman H. Aggregatibacter aphrophilus pacemaker endocarditis: a case report. BMC Res Notes 2014; 7:885. [PMID: 25486984 PMCID: PMC4295285 DOI: 10.1186/1756-0500-7-885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggregatibacter bacteria are a rare cause of endocarditis in adults. They are part of a group of organisms known as HACEK--Haemophilus, Aggregatibacter, Cardiobacter, Eikenella, and Kingella. Among these organisms, several Haemophilus species have been reclassified under the genus Aggregatibacter. Very few cases of Aggregatibacter endocarditis in patients with pacemaker devices have been reported. CASE PRESENTATION We present here what we believe to be the first case of Aggregatibacter aphrophilus pacemaker endocarditis. A 62-year-old African American male with a medical history significant for dual-chamber pacemaker placement in 1996 for complete heart block with subsequent lead manipulation in 2007, presented to his primary care doctor with fever, chills, night sweats, fatigue, and ten-pound weight loss over a four-month period. Physical examination revealed a new murmur and jugular venous distension which prompted initiation of antibiotics for suspicion of endocarditis. Both sets of initial blood cultures were positive for A. aphrophilus. Transesophageal echocardiogram revealed vegetations on the tricuspid valve and the right ventricular pacemaker lead (Figure 1). This case highlights the importance of identifying rare causes of endocarditis and recognizing that treatment may not differ from the standard treatment for typical presentations. The patient received intravenous ceftriaxone for his endocarditis for a total of six weeks. Upon device removal, temporary jugular venous pacing wires were placed. After two weeks of antibiotic treatment and no clinical deterioration, a new permanent pacemaker was placed and the patient was discharged home. CONCLUSIONS This is the first case of A. aphrophilus endocarditis in a patient with a permanent pacemaker. Our patient had no obvious risk factors other than poor dentition and a history of repeated pacemaker lead manipulation. This suggests that valvulopathies secondary to repeated lead manipulation can be clinically significant factors in morbidity and mortality in this patient population.
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Affiliation(s)
| | - Nishi H Patel
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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