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Karaçam K, Erdem RZ. The level of knowledge of medical and dental students regarding prophylaxis for infective endocarditis. J Dent Educ 2024. [PMID: 38634197 DOI: 10.1002/jdd.13553] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Infective endocarditis is a rarely seen disease, but has a high mortality rate. Therefore, it is extremely important that the guidelines are followed correctly. The main aim of this study was to evaluate and compare the level of knowledge and attitude of infective endocarditis of fourth- and fifth-year dentistry students in clinical residency and fifth- and sixth-year medical students. METHODS A 42-item questionnaire evaluating the type and dosage of antibiotics administered as infective endocarditis prophylaxis in medical conditions and dentistry procedures was delivered online to the study participants. The data obtained were examined using descriptive statistics and analyzed with the chi-square test. RESULTS The questionnaire was completed by a total of 332 participants. The statistical analyses showed a good level of knowledge in 55% of the dentistry faculty students and in 43.5% of the medical faculty students. CONCLUSIONS When considering that dental and medical faculty students are not expected to receive additional training on antimicrobial management after graduation, the findings of this study have raised significant attitude for the improvement of our education system in this field.
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Affiliation(s)
- Kübra Karaçam
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Rahime Zeynep Erdem
- Department of Restorative Dentistry, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Safia O, Asma J, Hana H, Sarra J, Aymen Z, Mouna J, Amal M, Rym BK. [Infective endocarditis : In-hospital mortality predictive factors]. Ann Cardiol Angeiol (Paris) 2024; 73:101740. [PMID: 38417204 DOI: 10.1016/j.ancard.2024.101740] [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: 07/28/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality. PATIENTS AND METHODS A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology. RESULTS Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90]). CONCLUSIONS Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.
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Affiliation(s)
- Othmani Safia
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jendoubi Asma
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie.
| | - Hedhli Hana
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jouini Sarra
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Zoubli Aymen
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jemai Mouna
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Maaref Amal
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie
| | - Ben Kaddour Rym
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
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Sun N, Zhao J, Luo W, Luo X, Wu S, Wang Z, Li P, Li J, Zhou R, Ou S, Qin Z. B-type natriuretic peptide levels at admission predict the prognosis of patients with infective endocarditis undergoing cardiac surgery. Biomark Med 2024; 18:93-102. [PMID: 38358345 DOI: 10.2217/bmm-2023-0590] [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] [Indexed: 02/16/2024] Open
Abstract
Purpose: The objective of this study was to explore the relationship between elevated B-type natriuretic peptide (BNP) levels and the prognosis of patients with infective endocarditis (IE) undergoing cardiac surgery. Methods: In total, 162 IE patients with recorded BNP levels upon admission were included in the present study. The primary end point was all-cause mortality. Results: Multivariate Cox analysis revealed a significant association between log BNP and all-cause mortality. Kaplan-Meier analysis revealed a poorer prognosis for patients with BNP levels ≥ the 75th percentile. Furthermore, the linear trend test indicated a significant link between BNP quartiles and the primary end point within the models. Conclusion: Elevated BNP levels upon admission could predict all-cause mortality in IE patients undergoing cardiac surgery.
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Affiliation(s)
- Ning Sun
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Junyong Zhao
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Wenjian Luo
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Xiaolin Luo
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Shaofa Wu
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Zelan Wang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Pengda Li
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Jia Li
- Department of Emergency, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Renjie Zhou
- Department of Emergency, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Shulin Ou
- Department of Cardiology, People's Hospital of Nanchuan District, Chongqing, 408400, China
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
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Tamura Y, Abe T. Infective endocarditis associated with atopic dermatitis. Clin Case Rep 2023; 11:e8321. [PMID: 38130851 PMCID: PMC10733789 DOI: 10.1002/ccr3.8321] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
Infective endocarditis caused by atopic dermatitis is common in young patients and has a high potential for causing embolism. Because of the high risk of mediastinitis postoperatively, minimally invasive cardiac surgery could be effective.
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Affiliation(s)
- Yamato Tamura
- Department of Cardiovascular SurgeryNara Prefectural Seiwa Medical CenterNaraJapan
| | - Takehisa Abe
- Department of Cardiovascular SurgeryNara Prefectural Seiwa Medical CenterNaraJapan
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Caldonazo T, Kirov H, Doenst T, Tasoudis P, Moschovas A, Faerber G, Treml RE, Sá MP, Mukharyamov M, Diab M. Outcomes of Concomitant Coronary Artery Bypass Grafting in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 205:354-359. [PMID: 37639761 DOI: 10.1016/j.amjcard.2023.07.164] [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: 05/24/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
It is current practice to perform concomitant coronary artery bypass grafting (CABG) in patients with infective endocarditis who have relevant coronary artery disease. However, CABG may add complexity to the operation. We performed a systematic review and a meta-analysis of studies that presented outcomes from patients who underwent valve surgery because of infective endocarditis with or without concomitant CABG. Three databases were assessed. Perioperative mortality was the primary outcome. Long-term mortality and postoperative stroke were the secondary outcomes. Inverse variance method and random model were performed. Five studies with a total of 5,408 patients were included. Mean follow-up was 8.2 years. Just 1 study addressed exclusively patients with documented coronary artery disease. Perioperative mortality did not differ between patients with or without concomitant CABG (odds ratio 1.53, 95% confidence interval 0.52 to 4.48, p = 0.44). Long-term mortality did not differ between patients who received and those who did not receive concomitant CABG (odds ratio 1.79, confidence interval 0.88 to 3.65, p = 0.11). Only 1 study from a multicenter registry reported data on the occurrence of postoperative stroke, which demonstrated that its incidence after adjustment was 26% in patients with concomitant CABG versus 21% in patients without concomitant CABG (p = 0.003). The results suggest that in endocarditis patients, adding CABG to valve surgery does not affect perioperative or long-term mortality. Data available on the impact of concomitant CABG on neurologic outcomes are limited to a retrospective multicenter registry and suggest that concomitant CABG may be associated with higher postoperative stroke.
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Affiliation(s)
- Tulio Caldonazo
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Hristo Kirov
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Torsten Doenst
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Gloria Faerber
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ricardo E Treml
- Departments of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Murat Mukharyamov
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Mahmoud Diab
- Departments of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany; Department of Cardiac Surgery, Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany.
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Graversen PL, Østergaard L, Voldstedlund M, Wandall-Holm MF, Smerup MH, Køber L, Fosbøl EL. Microbiological Etiology in Patients with IE Undergoing Surgery and for Patients with Medical Treatment Only: A Nationwide Study from 2010 to 2020. Microorganisms 2023; 11:2403. [PMID: 37894060 PMCID: PMC10608926 DOI: 10.3390/microorganisms11102403] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 and examined the microbiological etiology of IE according to treatment choice. To identify factors associated with surgery during initial admission, we used the Aalen-Johansen estimator and an adjusted cause-specific Cox model. One-year mortality stratified by microbiological etiology and treatment choice was assessed using unadjusted Kaplan-Meier estimates and an adjusted Cox proportional hazard model. A total of 6255 patients were included, of which 1276 (20.4%) underwent surgery during admission. Patients who underwent surgery were younger (65 vs. 74 years) and less frequently had cerebrovascular disease, cardiovascular disease, diabetes, and chronic kidney disease. Patients with Staphylococcus aureus IE were less likely to undergo surgery during admission (13.6%) compared to all other microbiological etiologies. One-year mortality according to microbiological etiology in patients who underwent surgery was 7.0%, 5.3%, 5.5%, 9.6%, 13.2, and 11.2% compared with 24.2%, 19.1%, 27,6%, 25.2%, 21%, and 16.9% in patients who received medical therapy for Staphylococcus aureus, Streptococcus spp., Enterococcus spp., coagulase-negative Staphylococci, "other microbiological etiologies", and blood culture-negative infective endocarditis, respectively. Patients with IE who underwent surgery differed in terms of microbiology, more often having Streptococci than those who received medical therapy. Contrary to expectations, Staphylococcus aureus was more common among patients who received medical therapy only.
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Affiliation(s)
- Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institut, 2300 Copenhagen, Denmark;
| | - Malthe Faurschou Wandall-Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen—Rigshospitalet, 2600 Glostrup, Denmark;
| | - Morten Holdgaard Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Mir T, Uddin MM, Shanah L, Hussain T, Parajuli T, Shafi O, Ullah W, Rab T, Sheikh M, Eltahawy E. Outcomes of Cardiac Arrest with Valve Surgery Among Infective Endocarditis Patients: A United States National Cohort Study. Cardiovasc Revasc Med 2023; 49:49-53. [PMID: 36460570 DOI: 10.1016/j.carrev.2022.11.004] [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: 09/17/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Cardiac arrest can complicate infective endocarditis (IE) and is associated with significant in-hospital complications and mortality rates. We report the characteristics, outcomes, and readmission rates for IE patients with cardiac arrest in the United States. METHODS We surveyed the Nationwide Readmission Database (NRD), a database designed to support national level readmission analyses, for patients admitted with IE and who had cardiac arrest during index admission between 2016 and 2019. Baseline demographics, comorbidities, surgical procedures, and outcomes were identified using their respective International Classification of Diseases (ICD) codes. RESULTS There were 663 index admissions (mean age 55.87 ± 17.21 years;34.2 % females) for IE with cardiac arrest in the study period, with an overall mortality rate of 55.3 %. Of these, 270 (40.7 %) had surgical procedures performed during the hospitalization encounter. In patients who had a surgical procedure, 72 (26.8 %) patients had in-hospital mortality while 293 (74.9 %) patients without surgical procedures had in-hospital mortality (p < 0.001). After coarsened matching for baseline characteristics, surgical valve procedures were less likely to be associated with mortality (OR = 0.09, 95%CI 0.04-0.24; p < 0.001). Among the 295 alive discharges associated with cardiac arrest, 76 (38.57 %) were readmitted within 30-days, with a mortality rate of 22 % noted for readmissions. CONCLUSION Among IE patients who had cardiac arrest, surgical procedures subgroup had low mortality despite having higher complication rates. However, due to chances of bias more randomized trials are needed evaluate the hypothesis.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University. Detroit, MI, USA; Internal Medicine, Baptist Health System. Montgomery, AL, USA.
| | | | - Layla Shanah
- Internal Medicine, Wayne State University. Detroit, MI, USA
| | - Tanveer Hussain
- Internal Medicine, Wayne State University. Detroit, MI, USA; Critical Care Medicine, Summa Health System, Akron, OH, USA
| | | | - Obeid Shafi
- Clinical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Waqas Ullah
- Division of Cardiology, Thomas Jefferson Hospital, PA, USA
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica Toledo Hospital, OH, USA
| | - Ehab Eltahawy
- Division of Cardiology, University of Toledo College of Medicine, and Life Sciences, OH, USA
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Luque-Paz D, Cuervo G, Miró JM, Tattevin P. Which trial do we need? Aminopenicillin-gentamicin versus aminopenicillin-ceftriaxone for Enterococcus faecalis endocarditis. Clin Microbiol Infect 2023:S1198-743X(23)00113-1. [PMID: 36889644 DOI: 10.1016/j.cmi.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Affiliation(s)
- David Luque-Paz
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Inserm U1230, Université Rennes-I, Rennes, France
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Inserm U1230, Université Rennes-I, Rennes, France.
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Lisi M, Flamigni F, Russo M, Cameli M, Mandoli GE, Pastore MC, Mele D, Campo G, Henein MY, Rubboli A. Incidence and mortality of infective endocarditis in the last decade: a single center study. J Cardiovasc Med (Hagerstown) 2023; 24:105-112. [PMID: 36574285 DOI: 10.2459/jcm.0000000000001410] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a significant disease characterized by high mortality and complications. The aim of this study was to evaluate the incidence/100 000 inhabitants and the in-hospital mortality/100 000 inhabitants of IE during the last 10 years in the province of Ravenna. METHODS AND RESULTS We reviewed the public hospitals discharge database from January 2010 to December 2020 using the international classification of disease codification (ICD-9) for IE. We used the Italian national statistical institute (ISTAT) archive to estimate the number of Ravenna inhabitants/year. In 10 years, we identified a total of 407 patients with diagnosis of IE.The incidence of IE increased significantly from 6.29 cases/100 000 inhabitants in 2010 to 19.58 cases/100 000 inhabitants in 2020 ( P < 0.001). Also, the in-hospital mortality from IE increased over the same number of years, from 1.8 deaths/100 000 inhabitants in 2010 to 4.4 deaths/100 000 inhabitants in 2020 ( P < 0.001). The mortality rate (%) of IE over the years did not increase ( P = 0.565). Also, over the years there was no difference in the site of infection ( P = 0.372), irrespective of the valve localization or type, native valve ( P = 0.347) or prosthetic valve ( P = 0.145). On logistic regression analysis, age was the only predictor of in-hospital mortality (odds ratio 1.045, 95% confidence interval: 1.015; 1.075, P = 0.003). CONCLUSIONS Ravenna-based data on IE showed increased disease incidence but unchanged mortality rate over 10 years of follow-up. Age remains the sole predictor of population-based mortality, irrespective of the nature of the valve, native or substitute, and the organism detected on microbiology.
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Affiliation(s)
- Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Filippo Flamigni
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
- Cardiology Unit and LTTA Centre, University of Ferrara, Ferrara
| | - Michele Russo
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianluca Campo
- Cardiology Unit and LTTA Centre, University of Ferrara, Ferrara
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Andrea Rubboli
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ravenna
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Cimmino G, Bottino R, Formisano T, Orlandi M, Molinari D, Sperlongano S, Castaldo P, D’Elia S, Carbone A, Palladino A, Forte L, Coppolino F, Torella M, Coppola N. Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life (Basel) 2023; 13:life13020377. [PMID: 36836734 PMCID: PMC9965398 DOI: 10.3390/life13020377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: or ; Tel.: +39-0815664141
| | - Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Saverio D’Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Lavinia Forte
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
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Mutagaywa RK, Vroon JC, Fundikira L, Wind AM, Kunambi P, Manyahi J, Kamuhabwa A, Kwesigabo G, Chamuleau SAJ, Cramer MJ, Chillo P. Infective endocarditis in developing countries: An update. Front Cardiovasc Med 2022; 9:1007118. [PMID: 36172579 PMCID: PMC9510687 DOI: 10.3389/fcvm.2022.1007118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Despite advances in diagnostic and treatment, morbidity and mortality due to infective endocarditis (IE) has not decreased. There is a discrepancy in epidemiology of IE between developed and developing countries. Over the last years, increased early detection and consequently prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) which are considered predisposing conditions for IE, is noted. Here, we present a review of literature on IE in developing countries. Methods We conducted a systematic literature search of IE studies in developing countries through PubMed and Embase. We have divided the studies into two groups: studies published before 2015 (group 1) and studies ≥ 2015 (group 2). The outcome was defined as a difference in epidemiology, microbiology, treatment, and mortality over time. The Scale for Assessment of Narrative Review Articles guidelines was applied. Findings In total, 16 studies were included. The total number of IE cases was 1,098 and 1,505 in groups 1 and 2, respectively. We compared 4/7 cohorts from group 1 (n = 789) with 5/9 cohorts from group 2 (n = 636). Six studies were not included in the comparison because they were interacting between the two cohorts. Males predominated in all studies. Rheumatic heart disease was higher in group 1 than in group 2 (42.3% vs. 30.3%, p < 0.001) while for CHD there was no change (17.6% vs. 16.7%, p = 0.672). Streptococci infections was lower in group 1 than group 2 (26.2% vs. 37.7%, p < 0.001). The proportion of Staphylococcus aureus was 15.3% in group 1 and 23.6% in group 2, p < 0.001. Negative blood culture (NBC) was higher in group 1 than in group 2 (42.2% vs. 34.1%, p = 0.002). Patients in group 1 received more surgery than in group 2 (38.8% vs. 28.8%, p < 0.001). Mortality was similar in the two groups (20.9% vs. 22.3%, p = 0.518). Conclusion This review shows a scarcity of studies on IE in developing countries. Rheumatic heart disease and congenital heart disease are common predisposing conditions. Other risk factors are prosthetic valves, degenerative valve disease (DVD), intravenous drug use, and human immunodeficiency virus infection. While the proportion of IE cases caused by Streptococcus and Staphylococcus has increased, the number of NBC and patients getting surgery has decreased. Mortality has not changed over time. Timely diagnosis and management of patients with RHD and CHD and comprehensive management of IE are warranted.
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Affiliation(s)
- Reuben K. Mutagaywa
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Reuben K. Mutagaywa
| | - Josephine C. Vroon
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lulu Fundikira
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Maria Wind
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Cardiology, Diakonessen Hospital, Utrecht, Netherlands
| | - Peter Kunambi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Apollinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Steven A. J. Chamuleau
- Amsterdam UMC Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Maarten J. Cramer
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Pilly Chillo
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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El-Sayed Ahmad A, Salamate S, Amer M, Abdullaahi A, Bayram A, Sirat S, Bakhtiary F. Modification of Reconstruction of Left Ventricular Outflow Tract, Aortic Root and the Intervalvular Fibrous Body for Extensive Infective Endocarditis: A Single Center Experience. Eur J Cardiothorac Surg 2022; 62:6588715. [PMID: 35587170 DOI: 10.1093/ejcts/ezac311] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/13/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extensive infective endocarditis stays a serious life-threatening disease with high mortality and morbidity. The aim of this study is to analyze our experience with our modified surgical technique for extensive infective endocarditis during the last 4 years. METHODS Between March 2017 and February 2021, all patients with extensive infective endocarditis required our modified technique consisting of a radical surgical resection of all infected cardiac tissues, the replacement of infected valves, and a reconstruction of the intervalvular fibrous body, the aortic root and the left ventricular outflow tract with modified elephant trunk were included in this study. RESULTS Our modified technique was performed on 41 patients during the study period. The age median was 74 (IQR: 66.5 - 76.5) and 61.0% (n = 25) were female. 33 patients (80.5%) were in New York Heart Association Class III-IV and 7 patients (17.1%) in cardiogenic shock. The median logistic EuroSCORE II as predicted risk of mortality was 35% (IQR: 28% - 78%). Median cardiopulmonary bypass time and cross-clamping time were 126 (IQR: 86.5-191) min and 78 (IQR: 55.5-108) min, respectively. Intraoperative mortality and 30-day mortality were 4.8% (2 patients) and 19.5% (8 patients), respectively. Low cardiac output with necessity for mechanical support, stroke and new renal dialysis developed in 9.8% (4 patients), 17.1% (7 patients), and 22.0% (9 patients), respectively. New pacemaker implantation was noted in 39.0% (16 patients). Intensive care stay and hospital stay had medians of 6 (IQR: 5-12) and 14 (IQR: 12.5-20.5) days, respectively. One-year mortality and 4-years mortality were 34.1% (14 patients) and 39.0% (16 patients), respectively. Kaplan-Meier survival estimates were 60.3% (95% CI: 46.2 - 78.6%) at 3 years. CONCLUSIONS Our modified technique can be performed in patients with extensive infective endocarditis with acceptable early and mid-term morbidity and mortality. We believe that this technique is an available option for this ill-fated group of patients.
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Affiliation(s)
- Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Saad Salamate
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Mohamed Amer
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Abdisalan Abdullaahi
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Ali Bayram
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Sami Sirat
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany.,Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
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13
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Sousa C, Pinto FJ. Endocardite Infecciosa: Ainda mais Desafios que Certezas. Arq Bras Cardiol 2022; 118:976-988. [PMID: 35613200 PMCID: PMC9368884 DOI: 10.36660/abc.20200798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.
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14
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Bohbot Y, Habib G, Laroche C, Stöhr E, Chirouze C, Hernandez-Meneses M, Melissopoulou M, Mutlu B, Scheggi V, Branco L, Olmos C, Reyes G, Pazdernik M, Iung B, Sow R, Mirocevic M, Lancellotti P, Tribouilloy C; EORP EURO-ENDO Registry Investigators Group. Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: A substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry. Eur J Heart Fail 2022. [PMID: 35508915 DOI: 10.1002/ejhf.2525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. METHODS AND RESULTS Among the 3116 patients enrolled in this prospective registry, 2449 (mean age:60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations>10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day(OR95%CI=2.37[1.73-3.24];p<0.001) and one-year mortality(HR95%CI=1.69[1.40-2.05];p<0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity(n=618[88.5%] for each group, both p<0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size>10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE(OR95%CI=0.22[0.12-0.38];p<0.001) and in one-year mortality(HR95%CI=0.29[0.20-0.41];p<0.001). CONCLUSION CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.
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15
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Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z, Elmadi J, Satish Kumar L. Malignancy and Endocarditis: Divulging Into the Intertwined Association. Cureus 2022; 14:e24089. [PMID: 35573527 PMCID: PMC9098766 DOI: 10.7759/cureus.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Cancer is an immunosuppressive disorder with characteristic features of unchecked cell growth, invasion, and sometimes thromboembolism leading to multiple systemic sequelae, including infective endocarditis. This article has compiled some of the crucial mechanisms by which infective endocarditis occurs in cancer patients, its risk factors, and the existing treatment interventions. It has focused on the necessity of being aware that these multiple pathogeneses are involved in the development of infective endocarditis (IE) in cancer patients, which would help delineate the risk factors associated with the condition and help physicians screen better for specific red flags. Identifying these risk factors and patient-oriented therapy, targeting the necessary elements such as causative organism, patient immune status, type of cancer, choosing evidence-based treatment modalities, and to improve the outcome of the disease in an already exasperating condition called cancer.
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16
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Eder MD, Upadhyaya K, Park J, Ringer M, Malinis M, Young BD, Sugeng L, Hur DJ. Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review. Front Cardiovasc Med 2022; 8:750573. [PMID: 34988125 PMCID: PMC8720921 DOI: 10.3389/fcvm.2021.750573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.
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Affiliation(s)
- Maxwell D Eder
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krishna Upadhyaya
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States.,Ascension Medical Group, Section of Cardiovascular Medicine, Milwaukee, WI, United States
| | - Jakob Park
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, United States
| | - Matthew Ringer
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Maricar Malinis
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Bryan D Young
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - David J Hur
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
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17
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Cosyns B, Roosens B, Lancellotti P, Laroche C, Dulgheru R, Scheggi V, Vilacosta I, Pasquet A, Piper C, Reyes G, Mahfouz E, Kobalava Z, Piroth L, Kasprzak JD, Moreo A, Faucher JF, Ternacle J, Meshaal M, Maggioni AP, Iung B, Habib G. Cancer and Infective Endocarditis: Characteristics and Prognostic Impact. Front Cardiovasc Med 2021; 8:766996. [PMID: 34859076 PMCID: PMC8631931 DOI: 10.3389/fcvm.2021.766996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry. Methods: Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients. Results: In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were S. aureus (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, P = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, P = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, P = 0.006, and 18.0 vs. 10.2%; P < 0.001, respectively. In IE cancer patients, predictors of mortality by multivariate analysis were creatinine > 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Conclusions: Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.
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Affiliation(s)
- Bernard Cosyns
- Centrum Voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,In vivo Cellular and Molecular Imaging (ICMI) Center, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bram Roosens
- Centrum Voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Patrizio Lancellotti
- Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire (CHU) Sart Tilman, Liège, Belgium
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Antibes, France
| | - Raluca Dulgheru
- Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire (CHU) Sart Tilman, Liège, Belgium
| | - Valentina Scheggi
- Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW), Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Graciela Reyes
- Echo Lab Department, Hospital de Alta Complejidad en red El Cruce, Florencio Varela, Buenos Aires, Argentina
| | - Essam Mahfouz
- Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - Zhanna Kobalava
- Department of Cardiology, Rossiyskiy Universitet Druzhby Narodov (RUDN) University Moscow, Moscow, Russia
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, INSERM CIC1432, University of Burgundy, Dijon, France
| | | | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jean-François Faucher
- CHU Limoges, Department of Infectious Diseases and Tropical Medicine, Limoges France INSERM, U1094, Limoges, France
| | - Julien Ternacle
- Cardiology Department, Henri Mondor Hospital, SOS Endocardites, DHU ATVB, INSERM U955 Team 8, Université Paris-Est Créteil, Créteil, France.,Fellow Equipe, Team du Dr Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute Université Laval, Quebec City, QC, Canada
| | - Marwa Meshaal
- Cardiology Department, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Antibes, France.,Maria Cecilia Hospital, Gruppo Villa Maria (GVM) Care & Research, Cotignola, Italy
| | - Bernard Iung
- Bichat Hospital, APHP, DHU Fire, Paris Diderot University, Paris, France
| | - Gilbert Habib
- AP-HM, La Timone Hospital, Cardiology Department, Marseille, France.,Aix Marseille University, IRD, AP-HM, MEPHI, IHU-Mediterranean Infection, Marseille, France
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18
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Kouijzer JJP, Lattwein KR, Beekers I, Langeveld SAG, Leon-Grooters M, Strub JM, Oliva E, Mislin GLA, de Jong N, van der Steen AFW, Klibanov AL, van Wamel WJB, Kooiman K. Vancomycin-decorated microbubbles as a theranostic agent for Staphylococcus aureus biofilms. Int J Pharm 2021; 609:121154. [PMID: 34624449 DOI: 10.1016/j.ijpharm.2021.121154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Bacterial biofilms are a huge burden on our healthcare systems worldwide. The lack of specificity in diagnostic and treatment possibilities result in difficult-to-treat and persistent infections. The aim of this in vitro study was to investigate if microbubbles targeted specifically to bacteria in biofilms could be used both for diagnosis as well for sonobactericide treatment and demonstrate their theranostic potential for biofilm infection management. The antibiotic vancomycin was chemically coupled to the lipid shell of microbubbles and validated using mass spectrometry and high-axial resolution 4Pi confocal microscopy. Theranostic proof-of-principle was investigated by demonstrating the specific binding of vancomycin-decorated microbubbles (vMB) to statically and flow grown Staphylococcus aureus (S. aureus) biofilms under increasing shear stress flow conditions (0-12 dyn/cm2), as well as confirmation of microbubble oscillation and biofilm disruption upon ultrasound exposure (2 MHz, 250 kPa, and 5,000 or 10,000 cycles) during flow shear stress of 5 dyn/cm2 using time-lapse confocal microscopy combined with the Brandaris 128 ultra-high-speed camera. Vancomycin was successfully incorporated into the microbubble lipid shell. vMB bound significantly more often than control microbubbles to biofilms, also in the presence of free vancomycin (up to 1000 µg/mL) and remained bound under increasing shear stress flow conditions (up to 12 dyn/cm2). Upon ultrasound insonification biofilm area was reduced of up to 28%, as confirmed by confocal microscopy. Our results confirm the successful production of vMB and support their potential as a new theranostic tool for S. aureus biofilm infections by allowing for specific bacterial detection and biofilm disruption.
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19
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Gruss ZP, Baumeister T, Smith J. The Use of Long-Acting Lipoglycopeptides for the Treatment of Serious, Off-label Infections: a Review of the Literature. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Garcia Granja PE, Lopez J, Vilacosta I, Saéz C, Cabezón G, Olmos C, Jerónimo A, Pérez JB, De Stefano S, Maroto L, Carnero M, Monguio E, Pulido P, de Miguel M, Gomez Salvador I, Carrasco-Moraleja M, San Román JA. Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile. Heart 2021; 107:1987-1994. [PMID: 34509995 DOI: 10.1136/heartjnl-2021-319661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. METHODS 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. RESULTS Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). CONCLUSIONS Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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Affiliation(s)
- Pablo Elpidio Garcia Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain .,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Lopez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Saéz
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Adrián Jerónimo
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Javier B Pérez
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Salvatore De Stefano
- Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Luis Maroto
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
| | - Paloma Pulido
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María de Miguel
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco-Moraleja
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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21
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Abstract
Corynebacterium jeikeium is a gram-positive, aerobic, pleomorphic, nonspore forming bacillus, commonly present on the skin surface. Infective endocarditis secondary to C. jeikeium most commonly affects left-sided heart valves and has a higher likelihood to require valve replacement compared to other Corynebacterium endocarditis. C. jeikeium endocarditis is extremely difficult to treat as it is characteristically resistant to penicillin, cephalosporins and aminoglycosides, and sensitivity to quinolones, macrolides, tetracyclines and rifampin is variable. Despite treatment, mortality rates as high as 33% have been reported. We hereby review the literature regarding the epidemiology, diagnosis and treatment of this deadly microorganism.
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Affiliation(s)
- Rahul Gupta
- From the Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Tarun Popli
- Division of Infectious Disease, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Purva Ranchal
- From the Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Jagjit Khosla
- From the Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- From the Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Marc Y El Khoury
- Division of Infectious Disease, Westchester Medical Center and New York Medical College, Valhalla, NY
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22
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Ahtela E, Oksi J, Vahlberg T, Sipilä J, Rautava P, Kytö V. Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland. PLoS One 2021; 16:e0254553. [PMID: 34265019 PMCID: PMC8282023 DOI: 10.1371/journal.pone.0254553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18–39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.
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Affiliation(s)
- Elina Ahtela
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland.,Clinical Neurosciences, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland
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23
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Diab M, Lehmann T, Weber C, Petrov G, Luehr M, Akhyari P, Tugtekin SM, Schulze PC, Franz M, Misfeld M, Borger MA, Matschke K, Wahlers T, Lichtenberg A, Hagl C, Doenst T. Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis. J Clin Med 2021; 10:jcm10132867. [PMID: 34203358 PMCID: PMC8267636 DOI: 10.3390/jcm10132867] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is current practice to perform concomitant coronary artery bypass grafting (CABG) in patients with infective endocarditis (IE) who have relevant coronary artery disease (CAD). However, CABG may add complexity to the operation. We aimed to investigate the impact of concomitant CABG on perioperative outcomes in patients undergoing surgery for IE. METHODS We retrospectively used data of surgically treated IE patients between 1994 and 2018 in six German cardiac surgery centers. We performed inverse probability weighting (IPW), multivariable adjustment, chi-square analysis, and Kaplan-Meier survival estimates. RESULTS CAD was reported in 1242/4917 (25%) patients. Among them, 527 received concomitant CABG. After adjustment for basal characteristics between CABG and no-CABG patients using IPW, concomitant CABG was associated with higher postoperative stroke (26% vs. 21%, p = 0.003) and a trend towards higher postoperative hemodialysis (29% vs. 25%, p = 0.052). Thirty-day mortality was similar in both groups (24% vs. 23%, p = 0.370). Multivariate Cox regression analysis after IPW showed that CABG was not associated with better long-term survival (HR: 1.00, 95% CI: 0.82-1.23, p = 0.998). CONCLUSION In endocarditis patients with CAD, adding CABG to valve surgery may be associated with a higher likelihood of postoperative stroke without adding long-term survival benefits. Therefore, in the absence of critical CAD, concomitant CABG may be omitted without impacting outcome. The results are limited due to a lack of data on the severity of CAD, and therefore there is a need for a randomized trial.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany;
| | - Thomas Lehmann
- Center of Clinical Studies, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany;
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, 50937 Colonge, Germany; (C.W.); (M.L.); (T.W.)
| | - Georgi Petrov
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, 40225 Duesseldof, Germany; (G.P.); (P.A.); (A.L.)
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, 50937 Colonge, Germany; (C.W.); (M.L.); (T.W.)
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, 40225 Duesseldof, Germany; (G.P.); (P.A.); (A.L.)
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Heart Center Dresden, 01307 Dresden, Germany; (S.-M.T.); (K.M.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany; (P.C.S.); (M.F.)
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany; (P.C.S.); (M.F.)
| | - Martin Misfeld
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney 2050, Australia;
- Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany;
| | - Michael A. Borger
- Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany;
| | - Klaus Matschke
- Department of Cardiac Surgery, Heart Center Dresden, 01307 Dresden, Germany; (S.-M.T.); (K.M.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, 50937 Colonge, Germany; (C.W.); (M.L.); (T.W.)
| | - Artur Lichtenberg
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, 40225 Duesseldof, Germany; (G.P.); (P.A.); (A.L.)
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, 80539 Munich, Germany;
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany;
- Correspondence:
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24
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Del Giudice C, Vaia E, Liccardo D, Marzano F, Valletta A, Spagnuolo G, Ferrara N, Rengo C, Cannavo A, Rengo G. Infective Endocarditis: A Focus on Oral Microbiota. Microorganisms 2021; 9:1218. [PMID: 34199916 PMCID: PMC8227130 DOI: 10.3390/microorganisms9061218] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria entering the bloodstream and settling in the heart lining valves or blood vessels. Despite modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Thus, primary prevention and enhanced diagnosis remain the most important strategies to fight this disease. In this regard, it is worth noting that for over 50 years, oral microbiota has been considered one of the significant risk factors for IE. Indeed, among the disparate recommendations from the American heart association and the European Society of Cardiology, there are good oral hygiene and prophylaxis for high-risk patients undergoing dental procedures. Thus, significant interest has grown in the role of oral microbiota and it continues to be a subject of research interest, especially if we consider that antimicrobial treatments can generate drug-resistant mutant bacteria, becoming a severe social problem. This review will describe the current knowledge about the relationship between oral microbiota, dental procedures, and IE. Further, it will discuss current methods used to prevent IE cases that originate from oral pathogens and how these should be focused on improving oral hygiene, which remains the significant persuasible way to prevent bacteremia and systemic disorders.
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Affiliation(s)
- Carmela Del Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Emanuele Vaia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Daniela Liccardo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandra Valletta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
- Istituti Clinici Scientifici ICS-Maugeri, 82037 Telese Terme, Italy
| | - Carlo Rengo
- Department of Prosthodontics and Dental Materials, School of Dental Medicine, University of Siena, 53100 Siena, Italy;
| | - Alessandro Cannavo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
- Istituti Clinici Scientifici ICS-Maugeri, 82037 Telese Terme, Italy
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25
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Giannitsioti E, Pefanis A, Gogos C, Lekkou A, Dalekos GN, Gatselis N, Georgiadou S, Nikou P, Vrettou A, Rigopoulos A, Tryfonopoulos C, Tsaganos T, Karofilakis E, Psarrakis C, Argyriou M, Gargalianos-Kakolyris P, Adamis G, Lourida P, Kofteridis D, Andrianaki A, Loupa C, Kostis E, Sinapidis D, Sympardi S, Alexiou N, Karaiskos I, Masgala A, Maltezos E, Panagopoulos P, Sachpekidis V, Evdoridis C, Sipsas NV, Daikos G, Giamarellou H; Hellenic Society of Chemotherapy. Evolution of epidemiological characteristics of infective endocarditis in Greece. Int J Infect Dis 2021; 106:213-20. [PMID: 33711517 DOI: 10.1016/j.ijid.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. METHODS A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. RESULTS Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. CONCLUSIONS A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.
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26
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El-Dalati S, Cronin D, Riddell J, Shea M, Weinberg RL, Washer L, Stoneman E, Perry DA, Bradley S, Burke J, Murali S, Fagan C, Chanderraj R, Christine P, Patel T, Ressler K, Fukuhara S, Romano M, Yang B, Deeb GM. The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team. Ann Thorac Surg 2021; 113:118-124. [PMID: 33662308 DOI: 10.1016/j.athoracsur.2021.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/29/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infectious endocarditis is associated with substantial in-hospital mortality of 15-20%. Effective management requires coordination between multiple medical and surgical subspecialties which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality. METHODS The multidisciplinary endocarditis Team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching. RESULTS Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria definite endocarditis and at least 1 AHA indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1st, 2014 to June 30th, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (p<0.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; p=0.12). Propensity score matching demonstrated similar results. CONCLUSIONS Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the two studied cohorts. In conjunction with previous studies demonstrating their effectiveness, this data supports that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.
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Affiliation(s)
- Sami El-Dalati
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan.
| | - Daniel Cronin
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - James Riddell
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Michael Shea
- Department of Internal Medicine, Division of Cardiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Richard L Weinberg
- Department of Internal Medicine, Division of Cardiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Laraine Washer
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Emily Stoneman
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - D Alexander Perry
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Suzanne Bradley
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - James Burke
- Department of Neurology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Sadhana Murali
- Department of Neurology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Christopher Fagan
- Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Rishi Chanderraj
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Paul Christine
- Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Twisha Patel
- College of Pharmacy, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Kirra Ressler
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - George Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
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27
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Gopal K, Krishna N, Varma PK. Surgery for infective endocarditis-analysis of factors affecting outcome. Indian J Thorac Cardiovasc Surg 2021; 37:381-91. [PMID: 34220021 DOI: 10.1007/s12055-021-01137-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Despite advances in medical care, infective endocarditis (IE) has high mortality. Surgery for IE though recommended for complications of the disease is still not commonly offered due to conflicting reports in the literature. We reviewed our results of surgery for IE from the last 5 years to assess their outcome. Methods A retrospective review from a single center of consecutive patients who underwent surgery for infective endocarditis from September 2014 to December 2019 was done. Data was collected from hospital records and follow-up done up to May 2020. Outcomes evaluated were mortality, follow-up survival, and postoperative complications. Factors affecting mortality and survival were analyzed. Results Ninety-seven patients underwent surgery for IE during this period. Seventy-nine had native valve endocarditis (NVE) and 18 had prosthetic valve endocarditis (PVE). The overall postoperative mortality was 13%, with mortality for native valve endocarditis being 11% and that for prosthetic valve endocarditis being 22%, which was not statistically significant. Three-year survival for the overall group was 88.7% with 88.1% for NVE and 91.7% for PVE. Multivariate predictors of operative mortality were a high EuroSCORE II, diabetes mellitus, and the presence of Staphylococcus organism. Conclusion Surgery for infective endocarditis has a very acceptable early outcome and intermediate-term survival.
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28
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Zahn R, Barth PM, Kilkowski C, Fraiture B, Karcher AK, Brütsch R, Winkler R, Kleemann T, Schneider S, Sutor D, Weisse U, Sack FU. Endocarditis at a large community hospital with on-site cardiac surgery. Int J Cardiol Heart Vasc 2021; 33:100734. [PMID: 33665354 PMCID: PMC7907417 DOI: 10.1016/j.ijcha.2021.100734] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/01/2022]
Abstract
Objective Infective endocarditis (IE) is still a serious disease. The currently published EURO-ENDO registry showed a rate of surgery of 51.2% and a lower mortality in operated IE patients. We hypothesized differences between our data and the registry. Methods Retrospective single centre registry on the hospital course of patients with IE. Results In four years, 171 IE patients were treated at our hospital. Mean age of patients was 66.5 ± 13.8 years and 62.6% of patients were transferred from other hospitals. There were 85 (49.7%) patients with native valve IE (NVE), 53 (31%) with prosthetic valve IE (PVE) and 33 (19.3%) with either intra-cardiac device related IE (n = 29) or IE associated with central access lines (n = 4) (DRE). A total of 81.3% (n = 139) of patients were sent to cardiac surgery. Using a logistic regression model to analyse predictors of conservative instead of surgical therapy the only independent variables were: presence of large vegetation or abscesses (OR: 0.36, 95%CI 0.15-0.83; p = 0.016) and age (for each ten years) (OR: 1.61, 95%CI 1.11-2.32, p = 0.01). Hospital mortality was 21.6% (n = 37/171), with no difference (p = 0.97) between those who were operated (21.6%, n = 30/139) and those treated conservatively (21.9%, n = 7/32). Comparing those treated conservatively without an indication for surgery with those with an indication, mortality was 9.5% versus 45.5%, p = 0.02. Conclusions In this registry from a hospital with on-site cardiac surgery more than half of patients were referred. The rate of patients treated surgically was 81.3%. Hospital mortality was 21.6%, with no difference between operated and conservatively treated patients.
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Affiliation(s)
- Ralf Zahn
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Philippe M Barth
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Caroline Kilkowski
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Boris Fraiture
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Ann-Katrin Karcher
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - René Brütsch
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Ralph Winkler
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Kleemann
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | | | - Dorothee Sutor
- Klinik für Herzchirurgie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Udo Weisse
- Klinik für Herzchirurgie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Falk-Udo Sack
- Klinik für Herzchirurgie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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Ripa M, Chiappetta S, Castiglioni B, Agricola E, Busnardo E, Carletti S, Castiglioni A, De Bonis M, La Canna G, Oltolini C, Pajoro U, Pasciuta R, Tassan Din C, Scarpellini P. Impact of surgical timing on survival in patients with infective endocarditis: a time-dependent analysis. Eur J Clin Microbiol Infect Dis 2021; 40:1319-1324. [PMID: 33411176 DOI: 10.1007/s10096-020-04133-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to evaluate the impact of surgical timing on survival in patients with left-sided infective endocarditis (IE). This was a retrospective study including 313 patients with left-sided IE between 2009 and 2017. Surgery was defined as urgent (US) or early (ES) if performed within 7 or 28 days, respectively. A multivariable Cox regression analysis including US and ES as time-dependent variables was performed to assess the impact on 1-year mortality. ES was associated with a better survival (aHR 0.349, 95% CI 0.135-0.902), as US (aHR 0.262, 95% CI 0.075-0.915). ES and US were associated with a better prognosis in patients with left-sided IE.
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Affiliation(s)
- Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Chiappetta
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Castiglioni
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Unit of Non-invasive Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Unit of Nuclear Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Carletti
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele De Bonis
- Unit of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni La Canna
- Unit of Non-invasive Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ursola Pajoro
- Unit of Nuclear Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renée Pasciuta
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Tassan Din
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Park OJ, Kwon Y, Park C, So YJ, Park TH, Jeong S, Im J, Yun CH, Han SH. Streptococcus gordonii: Pathogenesis and Host Response to Its Cell Wall Components. Microorganisms 2020; 8:microorganisms8121852. [PMID: 33255499 PMCID: PMC7761167 DOI: 10.3390/microorganisms8121852] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Streptococcus gordonii, a Gram-positive bacterium, is a commensal bacterium that is commonly found in the skin, oral cavity, and intestine. It is also known as an opportunistic pathogen that can cause local or systemic diseases, such as apical periodontitis and infective endocarditis. S. gordonii, an early colonizer, easily attaches to host tissues, including tooth surfaces and heart valves, forming biofilms. S. gordonii penetrates into root canals and blood streams, subsequently interacting with various host immune and non-immune cells. The cell wall components of S. gordonii, which include lipoteichoic acids, lipoproteins, serine-rich repeat adhesins, peptidoglycans, and cell wall proteins, are recognizable by individual host receptors. They are involved in virulence and immunoregulatory processes causing host inflammatory responses. Therefore, S.gordonii cell wall components act as virulence factors that often progressively develop diseases through overwhelming host responses. This review provides an overview of S. gordonii, and how its cell wall components could contribute to the pathogenesis and development of therapeutic strategies.
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Affiliation(s)
- Ok-Jin Park
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Yeongkag Kwon
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Chaeyeon Park
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Yoon Ju So
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Tae Hwan Park
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Sungho Jeong
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Jintaek Im
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea;
- Institute of Green Bio Science Technology, Seoul National University, Pyeongchang 25354, Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 08826, Korea; (O.-J.P.); (Y.K.); (C.P.); (Y.J.S.); (T.H.P.); (S.J.); (J.I.)
- Correspondence: ; Tel.: +82-2-880-2310
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Abe T, De Allie G, Eyituoyo HO, Abe T, Tobun T, Asotibe JC, Hayes D, Mather P. CHA2DS2-VASc Is Associated With In-Hospital Mortality in Patients With Infective Endocarditis: A Cross-Sectional Cohort Study. Cureus 2020; 12:e11620. [PMID: 33364135 PMCID: PMC7752800 DOI: 10.7759/cureus.11620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and objective The CHA2DS2-VASc score is a stroke risk stratification tool that is used in patients with atrial fibrillation (AF). Most of its clinical variables have been associated with poor outcomes in patients with infective endocarditis (IE). In this study, we aimed to determine its utility in predicting outcomes in IE patients. Methods We included 35,570 patients with IE from the National Inpatient Sample (NIS), 2009-2012. The CHA2DS2-VASc score was calculated for each patient. Hierarchical logistic regression was used to estimate the adjusted odds ratio for in-hospital mortality for CHA2DS2-VASc scores from 1 to 9, using a score of 0 as the reference score. All clinical characteristics were defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Results The mean age of the sample was 57.81 ±14 years. Higher CHA2DS2-VASc scores were associated with increased mortality, and the scores among the sample ranged from 0 for 8.1% to 8 for 21.7%. In the hierarchical logistic regression, after adjusting for age, sex, and relevant comorbidities, as the score increased, so did the odds for overall mortality. Conclusion In patients with IE, the CHA2DS2-VASc score may serve as a risk assessment tool with which to predict outcomes. Further studies are needed to replicate these findings.
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Affiliation(s)
- Temidayo Abe
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | | | - Harry O Eyituoyo
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Tolulope Abe
- Internal Medicine, All Saints University School of Medicine, Roseau, DMA
| | - Temitope Tobun
- Internal Medicine, All Saints University School of Medicine, Roseau, DMA
| | | | - Dolphurs Hayes
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA.,Department of Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Paul Mather
- Department of Cardiovascular Disease, Perelman School of Medicine, Philadelphia, USA
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Reid KA, Barlasm RS, Mamas MA, Clark AB, Kwok CS, Wong CW, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Tiamkao S, Myint PK. Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study. Int J Clin Pract 2020; 74:e13614. [PMID: 32688452 DOI: 10.1111/ijcp.13614] [Citation(s) in RCA: 4] [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: 12/11/2019] [Accepted: 07/06/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in stroke. We aimed to compare characteristics and outcomes of stroke patients with and without IE. METHODS We retrospectively examined the above association using data obtained from an insurance database which covers ~75% of the Thai population. All hospitalised strokes between 8 January 2003 and 31 December 2013 were included in the current study. Characteristics and outcomes were compared between stroke patients with or without IE, and then between two main stroke types. Multiple logistic regression models including propensity score-matched analyses were constructed to assess study outcomes controlling for age, sex, stroke type and comorbidities. RESULTS A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (0.36%) had stroke associated with IE. After adjustment, we found that IE was significantly associated with the following complications: arrhythmias (adjusted odds ratio (95% CI) 6.94 (6.29-7.66)), sepsis (1.24 (1.01-1.52)), pneumonia (1.34 (1.17-1.53)), respiratory failure (1.43 (1.24-1.66)) and in-hospital mortality (1.29 (1.13-1.47)) (P for all <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results. CONCLUSIONS Our results suggest that stroke patients with IE differ from that of the general stroke population and these patients have worse outcomes. Future studies are needed to determine the best treatment strategies for stroke patients with IE.
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Affiliation(s)
- Katie A Reid
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Raphae S Barlasm
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chun Shing Kwok
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Chun W Wong
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Kannikar Kongbunkiat
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Narongrit Kasemsap
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, Popescu BA, Prendergast B, Tornos P, Sadeghpour A, Oliver L, Vaskelyte JJ, Sow R, Axler O, Maggioni AP, Lancellotti P. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J 2020; 40:3222-3232. [PMID: 31504413 DOI: 10.1093/eurheartj/ehz620] [Citation(s) in RCA: 349] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). METHODS AND RESULTS Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. CONCLUSION Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.
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Affiliation(s)
- Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology, Medicine University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard Iung
- Bichat Hospital, APHP, DHU Fire, Paris Diderot University, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Bernard Cosyns
- Center for Cardiovascular Diseases (CHVZ), University Hospital Brussel, Brussels, Belgium
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" Euroecolab, Emergency Institute of Cardiovascular Diseases "Prof. Dr C. C. Iliescu", Bucharest, Romania
| | - Bernard Prendergast
- Department of Cardiology, Guy's and St Thomas' Hospital, London, Great Britain
| | - Pilar Tornos
- Department of Cardiology, Hospital Quiron Barcelona
| | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leopold Oliver
- Department of Cardiovascular Medicine, SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Creteil, France
| | | | | | - Olivier Axler
- Cardiology Department, Gaston Bourret Hospital Centre, New Caledonia University, Noumea, New Caledonia, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, France
| | - Patrizio Lancellotti
- ANMCO Research Center, Florence, Italy.,Department of Cardiology, Heart Valve Clinic, University of Liege Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Vallejo Camazón N, Cediel G, Núñez Aragón R, Mateu L, Llibre C, Sopena N, Gual F, Ferrer E, Quesada MD, Berastegui E, Teis A, López Ayerbe J, Juncà G, Vivero A, Muñoz Guijosa C, Pedro-botet L, Bayés-genís A. Mortalidad a corto y largo plazo de pacientes con indicación quirúrgica no intervenidos en el curso de la endocarditis infecciosa izquierda. Rev Esp Cardiol (Engl Ed) 2020; 73:734-740. [DOI: 10.1016/j.recesp.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Infective endocarditis associated with injection drug use (IDU-IE) is markedly increasing in the United States and Canada. Long-term outcomes are dismal and stem from insufficient substance use disorder treatment. In this review, we summarize the principles of antimicrobial and surgical management for infective endocarditis associated with injection drug use. We discuss approaches to opioid use disorder care and harm reduction in the inpatient setting and review opportunities to address preventable infections among persons injecting drugs. We highlight barriers to implementing optimal treatment and consider novel approaches that may reshape infective endocarditis associated with injection drug use treatment in coming years.
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Affiliation(s)
- Asher Schranz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, 130 Mason Farm Road (Bioinformatics), CB #7030, Chapel Hill, NC 27599-7030, USA. https://twitter.com/asherjs
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
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Carino D, Fernández-Cisneros A, Hernández-Meneses M, Sandoval E, Llopis J, Falces C, Miró JM, Quintana E. The fate of active left-side infective endocarditis with operative indication in absence of valve surgery. J Card Surg 2020; 35:3034-3040. [PMID: 32827161 DOI: 10.1111/jocs.14967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although the benefits of surgery in infective endocarditis (IE) are clear, an unneglectable proportion of patients do not undergo surgery despite clear operative indication. Outcomes of these patients are poorly reported. With this study, we aim to analyze patient profiles, indication for surgery, decision-making, and outcomes of patients not undergoing surgery despite contemporary surgical indications. MATERIALS AND METHODS Retrospective review of single institution database of patients with IE was done to identify patients that, although a clear surgical indication did not receive surgery. We aimed to review the most contemporary practice from June 2014 to December 2018. Only patients who were physically evaluated at our facility were included. Follow up was 100% complete. Kaplan-Meier methods were used to estimate survival and freedom from a composite outcome of death, stroke, and heart failure. RESULTS Of the 174 patients with surgical indication during the review period, 46 (27%) did not undergo surgery. The reasons for not pursuing surgery were varied and usually multiple, with severe brain injury and end stage liver disease between the most common. The 30-day mortality was 63%, and the estimated survival at 6 months, 1 year, and 2 years was respectively 22%, 15%, and 10%. CONCLUSION The mortality of this cohort of patients is extremely high. A multidisciplinary evaluation is of paramount importance in the decision-making process with shared responsibility for denial of operative options. In a perspective of correct healthcare resources allocation an early palliative care consult may need to be considered in some of those patients.
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Affiliation(s)
- Davide Carino
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Alejandro Fernández-Cisneros
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Department of Infectious Disease, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetic, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - Carlos Falces
- Department of Cardiology, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - José M Miró
- Department of Infectious Disease, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Rieg S, von Cube M, Kaasch AJ, Bonaventura B, Bothe W, Wolkewitz M, Peyerl-Hoffmann G, Deppe AC, Wahlers T, Beyersdorf F, Seifert H, Kern WV. Investigating the Impact of Early Valve Surgery on Survival in Staphylococcus aureus Infective Endocarditis Using a Marginal Structural Model Approach: Results of a Large, Prospectively Evaluated Cohort. Clin Infect Dis 2020; 69:487-494. [PMID: 30346527 DOI: 10.1093/cid/ciy908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of valve surgery on outcomes of Staphylococcus aureus infective endocarditis (SAIE) remains controversial. We tested the hypothesis that early valve surgery (EVS) improves survival by using a novel approach that allows for inclusion of major confounders in a time-dependent way. METHODS EVS was defined as valve surgery within 60 days. Univariable and multivariable Cox regression analyses were performed. To account for treatment selection bias, we additionally used a weighted Cox model (marginal structural model) that accounts for time-dynamic imbalances between treatment groups. To address survivor bias, EVS was included as a time-dependent variable. Follow-up of patients was 1 year. RESULTS Two hundred and three patients were included in the analysis; 50 underwent EVS. All-cause mortality at day 30 was 26%. In the conventional multivariable Cox regression model, the effect of EVS on the death hazard was 0.85 (95% confidence interval [CI], .47-1.52). Using the weighted Cox model, the death hazard rate (HR) of EVS was 0.71 (95% CI, .34-1.49). In subgroup analyses, no survival benefit was observed in patients with septic shock (HR, 0.80 [CI, .26-2.46]), in NVIE (HR, 0.76 [CI, .33-1.71]) or PVIE (HR, 1.02 [CI, .29-3.54]), or in patients with EVS within 14 days (HR, 0.97 [CI, .46-2.07]). CONCLUSIONS Using both a conventional Cox regression model and a weighted Cox model, we did not find a survival benefit for patients who underwent EVS in our cohort. Until results of randomized controlled trials are available, EVS in SAIE should be based on individualized decisions of an experienced multidisciplinary team. CLINICAL TRIALS REGISTRATION German Clinical Trials registry (DRKS00005045).
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | - Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf
| | - Bastian Bonaventura
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | - Wolfgang Bothe
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center.,Department of Cardiovascular Surgery, Heart Center, Medical Center, University of Freiburg
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne
| | - Friedhelm Beyersdorf
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center.,Department of Cardiovascular Surgery, Heart Center, Medical Center, University of Freiburg
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne.,German Centre for Infection Research, Partner Site Bonn-Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
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Mabilangan C, Cole H, Hiebert B, Keynan Y, Arora RC, Shah P. Short- and Long-term Outcomes of Medically Treated Isolated Left-Sided Endocarditis: A Retrospective Study With 5-Year Longitudinal Follow-up. Can J Cardiol 2020; 36:1534-1540. [PMID: 32224079 DOI: 10.1016/j.cjca.2019.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A retrospective study of medically treated isolated left-sided infective endocarditis (LSIE) patients identifying predictors of outcomes with nonoperative management was undertaken. METHODS Medical records of 135 Manitoban medically managed LSIE patients from January 2004 to December 2016 were reviewed. Five-year survival for 135 patients and hospitalization data till March 2016 for 65 patients were collected from the Manitoba Centre for Health Policy. RESULTS In-hospital mortality was 44%. Patients with surgical indications were more likely to die in-hospital than those without (53% vs 24%; P = 0.002). Survival at 1 and 5 years was 43% and 23%, respectively. All-cause readmission at 1 and 5 years was 64% and 84%, respectively. At 1 and 5 years, readmission from major adverse events (heart failure, stroke, endocarditis) was 25% and 47%, and from recurrent endocarditis was 17% and 26%, respectively. Severe valvular regurgitation was a risk factor for in-hospital mortality (odds ratio, 3.52; P = 0.022), poor long-term survival (hazard ratio [HR], 2.57; P < 0.001), and recurrent endocarditis (HR, 5.93; P < 0.001). Prosthetic valve endocarditis was a risk factor for poor long-term survival (HR, 2.11; P = 0.002). Streptococcus viridans group was associated with better rates of in-hospital mortality (odds ratio, 0.28; P = 0.018) and long-term survival (HR, 0.34; P < 0.001). CONCLUSIONS Nonoperative management of LSIE carries a poor prognosis but may have a role in select cases. Surgical management remains the mainstay for patients with clear surgical indications, including severe regurgitation and prosthetic valve endocarditis. Further prospective analyses are required to better delineate appropriate patient selection for nonsurgical management.
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Affiliation(s)
| | - Holly Cole
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Yoav Keynan
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Pallav Shah
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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El-Sayed Ahmad A, Bakhtiary F. Modifizierte Rekonstruktion der Aortenwurzel und der aortomitralen Kontinuität nach ausgedehnter infektiöser Endokarditis. Z Herz- Thorax- Gefäßchir 2020. [DOI: 10.1007/s00398-019-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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Šutej I, Peroš K, Trkulja V, Rudež I, Barić D, Alajbeg I, Pintarić H, Stevanović R, Lepur D. The epidemiological and clinical features of odontogenic infective endocarditis. Eur J Clin Microbiol Infect Dis 2019; 39:637-645. [PMID: 31786693 DOI: 10.1007/s10096-019-03766-x] [Citation(s) in RCA: 10] [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: 07/23/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023]
Abstract
Antibiotic prophylaxis (AP) of infective endocarditis (IE) in dental practice is a controversial topic. We evaluated the characteristics of the odontogenic IE and assessed the practice and sources of information pertaining to the topic utilized by the Croatian dentists. We conducted a retrospective review of consecutive medical charts of adult patients with IE, admitted to the University Hospital for Infectious Diseases in Zagreb, Croatia, between January 2007 and December 2017. In addition, a cross-sectional, self-reporting questionnaire survey was conducted with participation of 348 Croatian dentists. Of the 811 admissions for suspected IE (40.3% of all Croatian and 92.1% of all Zagreb hospitals), 386 patients were confirmed as definite IE: 68 with odontogenic IE and 318 with IE of other origin. Their first hospital admissions were analyzed. Definite odontogenic IE was defined as a positive echocardiographic result in conjunction with two separate positive blood cultures showing exclusive oral cavity pathogen or Streptococcus viridans associated with current or recent (< 1 month) dental, periodontal, or oral cavity infection. The annual number of new odontogenic IE patients appeared constant over time. In 91.2% of the cases, odontogenic IE was not preceded by a dental procedure; poor oral health was found in 51.5% of patients, and 47.1% had no cardiac condition that increases the IE risk. In-hospital mortality was 5.1% with conservative treatment and 4.5% with cardiac surgery and was much lower for odontogenic IE than in non-odontogenic IE (14.6% and 34.4%, respectively). An increasing number of admissions for non-odontogenic IE were observed in parallel with an increasing number of staphylococcal IE. Surveyed dentists (500 invited, 69.6% responded) were aware of the AP recommendations, but were largely reluctant to treat patients at risk. In people with poor oral health, AP should be considered regardless of cardiac risk factors. Improvement of oral health should be the cornerstone of odontogenic IE prevention.
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Affiliation(s)
- Ivana Šutej
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Peroš
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Rudež
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Davor Barić
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, Zagreb, Croatia
| | - Ivan Alajbeg
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Pintarić
- Department of Internal Medicine, School of Dental Medicine, University of Zagreb; Sisters of Charity University Hospital Center, Zagreb, Croatia
| | - Ranko Stevanović
- School of Medicine, University of Rijeka; Croatian Institute of Public Health, Zagreb, Croatia
| | - Dragan Lepur
- Department of Infectious Diseases, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
- Department of Intensive Care Medicine and Neuroinfections, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10.000, Zagreb, Croatia.
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Vallejo Camazón N, Cediel G, Núñez Aragón R, Mateu L, Llibre C, Sopena N, Gual F, Ferrer E, Quesada MD, Berastegui E, Teis A, López Ayerbe J, Juncà G, Vivero A, Muñoz Guijosa C, Pedro-Botet L, Bayés-Genís A. Short- and long-term mortality in patients with left-sided infective endocarditis not undergoing surgery despite indication. ACTA ACUST UNITED AC 2019; 73:734-740. [PMID: 31767290 DOI: 10.1016/j.rec.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES In infective endocarditis (IE), decisions on surgical interventions are challenging and a high percentage of patients with surgical indication do not undergo these procedures. This study aimed to evaluate the short- and long-term prognosis of patients with surgical indication, comparing those who underwent surgery with those who did not. METHODS We included 271 patients with left-sided IE treated at our institution from 2003 to 2018 and with an indication for surgery. There were 83 (31%) surgery-indicated not undergoing surgery patients with left-sided infective endocarditis (SINUS-LSIE). The primary outcome was all-cause death by day 60 and the secondary outcome was all-cause death from day 61 to 3 years of follow-up. Multivariable Cox regression and propensity score matching were used for the analysis. RESULTS At the 60-day follow-up, 40 (21.3%) surgically-treated patients and 53 (63.9%) SINUS-LSIE patients died (P <.001). Risk of 60-day mortality was higher in SINUS-LSIE patients (HR, 3.59; 95%CI, 2.16-5.96; P <.001). Other independent predictors of the primary endpoint were unknown etiology, heart failure, atrioventricular block, and shock. From day 61 to the 3-year follow-up, there were no significant differences in the risk of death between surgically-treated and SINUS-LSIE patients (HR, 1.89; 95%CI, 0.68-5.19; P=.220). Results were consistent after propensity score matching. Independent variables associated with the secondary endpoint were previous IE, diabetes mellitus, and Charlson index. CONCLUSIONS Two-thirds of SINUS-LSIE patients died within 60 days. Among survivors, the long-term mortality depends more on host conditions than on the treatment received during admission.
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Affiliation(s)
- Nuria Vallejo Camazón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raquel Núñez Aragón
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Lourdes Mateu
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cinta Llibre
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Nieves Sopena
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Gual
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena Ferrer
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Dolores Quesada
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabeth Berastegui
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Albert Teis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge López Ayerbe
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Gladys Juncà
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ainhoa Vivero
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Lluisa Pedro-Botet
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Tattevin P, Fillâtre P, Tchamgoué S, Lesouhaitier M, Nesseler N, Tadié JM. Should we include microorganisms in scores to predict outcome in candidates for cardiac surgery during the acute phase of endocarditis? J Thorac Dis 2019; 11:E158-E162. [PMID: 31737328 DOI: 10.21037/jtd.2019.09.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Fillâtre
- Intensive Care Unit, Yves Le Foll Hospital, Saint Brieuc, France
| | - Serge Tchamgoué
- Internal Medicine and Infectious Diseases, Robert Boulin Hospital, Libourne, France
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nicolas Nesseler
- Cardiovascular Thoracic Surgery Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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Bakhtiary F, El-Sayed Ahmad A, Borger M. Modification of Reconstruction of Intervalvular Fibrous Body for Extensive Infective Endocarditis. Ann Thorac Surg 2019; 109:e211-e214. [PMID: 31610164 DOI: 10.1016/j.athoracsur.2019.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/29/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
We describe our modification of reconstruction of the aortic root, the left ventricular outflow tract, and the intervalvular fibrous body with neighboring structures after radical resection after extensive infective endocarditis. This technique may be useful for patients who otherwise would be nonoperable.
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Affiliation(s)
- Farhad Bakhtiary
- Heart Center Siegburg, Department of Cardio and Thoracic Surgery, Siegburg, Germany.
| | - Ali El-Sayed Ahmad
- Heart Center Siegburg, Department of Cardio and Thoracic Surgery, Siegburg, Germany
| | - Michael Borger
- University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany
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Saito F, Toyoda S, Arikawa T, Inami S, Watanabe R, Obi S, Sakuma M, Kanaya T, Abe S, Nakajima T, Inoue T. Prediction of Acute-phase Complications in Patients with Infectious Endocarditis. Intern Med 2019; 58:2323-2331. [PMID: 31118367 PMCID: PMC6746645 DOI: 10.2169/internalmedicine.1813-18] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Embolic events are frequent and life-threatening complications of infective endocarditis (IE). Recently, an embolic risk assessment at admission, based on the Embolic Risk (ER) French Calculator, was designed to predict the development of symptomatic emboli associated with IE. This study aimed to validate the ER French Calculator for the prediction of in-hospital events, including embolic events. Methods We retrospectively analyzed the clinical features of 52 consecutive patients with left-sided IE to identify possible predictors of in-hospital events within 30 days of admission. Results New embolic events were seen in 15 patients (29%), cardiac surgery was performed in 22 patients (42%), and 1 patient (2%) died within 30 days of admission. A composite endpoint of embolic complications, cardiac surgery, or death was observed in 28 patients (54%). The cumulative incidence of new embolic events was significantly higher in the high-risk group identified by the ER French Calculator than in the low-risk group (log-rank test; p=0.0004). The incidence of the composite endpoint was higher in the high-risk group than in the low-risk group (log-rank test; p<0.0001). A multivariate Cox proportional hazards model indicated that the high-risk designation on the ER French Calculator predicted embolic events (p=0.0410) and composite events (p=0.0371) independently of other candidate predictors. Conclusion The ER French Calculator may be a useful tool for predicting new in-hospital embolic events and other unfavorable in-hospital events in patients with IE.
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Affiliation(s)
- Fumiya Saito
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Shu Inami
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Ryo Watanabe
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Syotaro Obi
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan
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Périer A, Puyade M, Revest M, Tattevin P, Bernard L, Lemaignen A, Boutoille D, Allal J, Roblot F, Rammaert B. Prognosis of Streptococcus pneumoniae endocarditis in France, a multicenter observational study (2000-2015). Int J Cardiol 2019; 288:102-106. [PMID: 31056415 DOI: 10.1016/j.ijcard.2019.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is responsible for <2% of infective endocarditis (IE). The aim of this study was to assess the prognosis of pneumococcal IE. METHODS This multicentric observational retrospective study included adult patients presenting with definite S. pneumoniae IE according to modified Dukes criteria from four French university hospitals over a 15-year period, January 2000-December 2015. Survival rate at 90 days and 2 years after diagnosis, appropriateness of antibiotherapy, and pneumococcal vaccination status were determined. Risk factors for mortality were studied by univariate analysis. RESULTS Of 3886 patients admitted with IE during the study period, 50 (1.3%) had pneumococcal IE, mostly males (n = 38, 76%), with a mean age of 60 ± 14 years. Predisposing conditions for IE or for invasive pneumococcal disease (IPD) involved 24% and 78% of the cases, respectively. Only 2 patients were vaccinated against pneumococcus before IE and 13 (26%) after IE. Antimicrobial strategy was in accordance with the 2015 ESC Guidelines in 28%. Cardiac surgery was performed in 56%, and was associated with better survival (p = 0.012). In the 40 patients followed until 2 years, the survival rate was 67%, deaths occurring mostly before 90 days. Age ≥ 65 was a risk factor for mortality (p = 0.011). CONCLUSION Pneumococcal IE remains rare but with a poor prognosis. Resort to surgery is yet to be determined. Predisposing conditions for IPD are the main factors leading to pneumococcal IE. They could be prevented by vaccine coverage improvement.
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Affiliation(s)
- Amandine Périer
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Mathieu Puyade
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Matthieu Revest
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Pierre Tattevin
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Louis Bernard
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - Adrien Lemaignen
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - David Boutoille
- Université de Nantes, Nantes, France; CHU de Nantes, Service de Maladies Infectieuses, Nantes, France
| | - Joseph Allal
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Cardiologie, Poitiers, France
| | - France Roblot
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France
| | - Blandine Rammaert
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France.
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Ruch Y, Mazzucotelli JP, Lefebvre F, Martin A, Lefebvre N, Douiri N, Riegel P, Hoang Minh T, Petit-Eisenmann H, Hansmann Y, Argemi X. Impact of Setting up an "Endocarditis Team" on the Management of Infective Endocarditis. Open Forum Infect Dis 2019; 6:ofz308. [PMID: 31660397 PMCID: PMC6735925 DOI: 10.1093/ofid/ofz308] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this "Endocarditis Team" (ET). Methods We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality. Results We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048). Conclusions This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.
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Affiliation(s)
- Yvon Ruch
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | | | - François Lefebvre
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Aurélie Martin
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Nawal Douiri
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Riegel
- Laboratory of Bacteriology, Strasbourg University Hospital, Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Yves Hansmann
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Argemi
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
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Østergaard L, Oestergaard LB, Lauridsen TK, Dahl A, Chaudry M, Gislason G, Torp-Pedersen C, Bruun NE, Valeur N, Køber L, Fosbøl EL. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study. Eur J Cardiothorac Surg 2019; 54:860-866. [PMID: 29648662 DOI: 10.1093/ejcts/ezy156] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES It is known that patients surviving infective endocarditis have a poor long-term prognosis; however, few studies have addressed the long-term causes of death in patients surviving the initial hospitalization. METHODS Using Danish administrative registries, we identified patients admitted to a hospital with 1st time infective endocarditis in the period from January 1996 to December 2014, who were alive at the time of discharge. The study population was categorized into (i) patients undergoing medical therapy only and (ii) patients undergoing surgical and medical treatment. We examined the cardiovascular and non-cardiovascular causes of death. Using the Cox analysis, we investigated the associated risk of dying from a specific prespecified cause of death (heart failure, infective endocarditis and stroke) within the surgery group when compared with the medically treated group. RESULTS We identified 5576 patients: 4220 patients belonged to the medically treated group and 1356 patients to the surgery group. At the 10-year follow-up, the mortality rate was 63.1% and 41.6% in the medically treated group and the surgery group, respectively. Cardiovascular disease was the most frequent cause of death in both groups accounting for 52.5% in the medically treated group and 55.2% in the surgery group. Patients undergoing surgery were associated with a lower risk of dying from heart failure and stroke when compared with medically treated patients [hazard ratio = 0.66 (95% confidence interval: 0.46-0.94) and hazard ratio = 0.59 (95% confidence interval: 0.37-0.96), respectively]. CONCLUSIONS No major differences were found in the main causes of death between groups. Patients in the surgical group were associated with a lower risk of dying from heart failure and stroke when compared with medically treated patients.
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Affiliation(s)
- Lauge Østergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Louise Bruun Oestergaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Epidemiology, University of Aalborg, Aalborg, Denmark.,Department of Cardiology, University of Aalborg, Aalborg, Denmark
| | | | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mavish Chaudry
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, University of Aalborg, Aalborg, Denmark.,Department of Cardiology, University of Aalborg, Aalborg, Denmark
| | - Niels Eske Bruun
- Clinical Institute, Copenhagen University, Copenhagen, Denmark.,Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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Krajinovic V, Ivancic S, Gezman P, Barsic B. Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock. Shock 2018; 49:536-42. [PMID: 28991051 DOI: 10.1097/SHK.0000000000001013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sepsis and septic shock are common presentations of infective endocarditis (IE), but little is known about clinical characteristics in this group of patients, use of surgical treatment, and their associations with outcome. We sought to determine the influence of cardiac surgery (CS) on the outcome of patients with IE in different stages of sepsis severity. METHODS Two hundred ninety four patients with definite IE native or prosthetic valve IE admitted between 2000 and 2011. Prospective evaluation using multivariable logistic regression to evaluate clinical characteristics and outcomes (in-hospital and 1-year mortality) in surgically and medically treated patients stratified by severity of sepsis and using new Sepsis-3 definitions. RESULTS The presence of sepsis or septic shock during IE showed a statistical relationship with increased in-hospital mortality (odds ratio [OR] 8.915, P < 0.001 and OR 35.969, P < 0.001, respectively) after adjusting for other risk factors of poor outcomes (neurological complications, congestive heart failure, and Staphylococcus aureus IE). Surgical treatment had a positive influence on in-hospital mortality in patients with sepsis or septic shock and IE (OR 5.157, P < 0.001) as well as on 1-year survival (hazard ratio 3.092, P < 0.001). CONCLUSIONS The presence of sepsis or septic shock as defined in Sepsis-3 definitions is associated with unfavorable outcomes in patients with IE. Surgical treatment has a positive effect on outcomes (in-hospital mortality and 1-year survival) in patients with IE and sepsis or septic shock.
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50
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Tam DY, Yanagawa B, Verma S, Ruel M, Fremes SE, Mazine A, Adams S, Friedrich JO. Early vs Late Surgery for Patients With Endocarditis and Neurological Injury: A Systematic Review and Meta-analysis. Can J Cardiol 2019; 34:1185-1199. [PMID: 30170674 DOI: 10.1016/j.cjca.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Surgical timing in infective endocarditis (IE) with preoperative neurological events remains controversial. The relevant society guidelines are each on the basis of a small number of observational studies. This meta-analysis was designed to search the available literature broadly and assess the weight of available evidence as comprehensively as possible. METHODS We searched MEDLINE and EMBASE to April 2018 for studies that compared mortality or neurological exacerbation in early vs late surgery for IE complicated by neurological events. Random effects meta-analysis was performed. RESULTS Twenty-seven observational studies (25 unadjusted, n = 879; 2 adjusted, n = 451) met inclusion criteria. Using early and late thresholds defined in each study (7 or 14 days), early surgery in ischemic or hemorrhagic stroke was associated with elevated perioperative mortality vs late surgery (pooled relative risk [RR], 1.74; 95% confidence interval, 1.34-2.25; P < 0.0001; I2 = 0%) and greater neurological exacerbation (RR, 2.09; 95% confidence interval, 1.32-3.32; P = 0.002; I2 = 33%). In subgroup analysis, for ischemic stroke, early surgery before 7 vs before 14 days exhibited similar perioperative mortality and neurological exacerbation. For hemorrhagic stroke, performing surgery before 21 vs before 28 days showed trends toward perioperative mortality (RR, 1.77 vs 0.63, interaction P = 0.14) and neurological (RR, 2.02 vs RR, 0.44; interaction P = 0.11) exacerbation. There was no difference in long-term mortality but reporting was sparse. Early surgery was often performed for clinical deterioration, negatively biasing outcomes. CONCLUSIONS Available observational data support delaying surgery by 7-14 days if possible in IE complicated by ischemic stroke and > 21 days in hemorrhagic stroke to decrease perioperative mortality and neurological exacerbation rates. Randomized trials are needed for definitive guidance.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc Ruel
- Institute of Health Policy, Management and Evaluation, 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, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Seana Adams
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Critical Care and Medicine Departments, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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