1
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Lindberg H, Snygg-Martin U, Berge A, Rasmussen M. Consequences of Excluding Enterococcus faecium as a Typical Endocarditis Pathogen in the Duke-ISCVID Criteria: Endocarditis Is Endocarditis Even if the Bacterium Is Uncommon. Clin Infect Dis 2023; 77:1216-1217. [PMID: 37384563 PMCID: PMC10573721 DOI: 10.1093/cid/ciad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Helena Lindberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Hospital of Halland, Halmstad, Sweden
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Head of Swedish Registry of Infective Endocarditis, Swedish Society of Infectious Diseases, Gothenburg, Sweden
| | - Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden
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2
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Fedchenko M, Giang KW, Snygg-Martin U, Dellborg M, Mandalenakis Z. Risk predictors and outcomes of infective endocarditis among adult patients with congenital heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) is a serious disease associated with increased morbidity and mortality. Patients with adult congenital heart disease (ACHD) have been reported to be at a particularly increased risk of infective endocarditis (IE).
Purpose
To investigate the risk predictors of IE, and the long-term risk of IE among ACHD patients aged 18–65 years, compared with matched controls without ACHD, in a nationwide setting.
Methods
All patients with ACHD in Sweden born in years 1952–1999 and who survived until 18 years of age were followed in the National Patient Register and Cause of Death Register until year 2017. For each case of ACHD, approximately ten controls without ACHD were randomly selected from the Total Population Register and matched by birth year and sex. The study population was followed from 18 years of age and until a first time diagnosis of IE, death or end of study. Both comorbidities and occurrence of ACHD related surgery were collected from 1970 and onwards. Cox proportional hazard models were used to predict the risk of IE.
Results
Altogether, 36,189 ACHD patients and 403,962 controls without ACHD were included. A total of 706 (1.95%) ACHD patients and 147 (0.04%) controls developed IE during a median follow-up of 15.5 (interquartile range (IQR) 6.9–28.5) years (ACHD) and 15.5 (IQR 7.5–28.5) years (controls). ACHD patients were somewhat younger at age of IE diagnosis compared with controls, median age 33.9 (IQR 25.4–44.1) years in ACHD vs 39.8 (IQR 30.6–52.0) years in controls. The overall risk of IE was markedly higher among ACHD patients compared with controls, with a hazard ratio (HR) of 54.8 (95% confidence interval (CI), 45.9–65.5). More than one third of the ACHD patients with IE (n=272, 38.5%) had undergone any kind of previous congenital heart surgery whereof 122 (44.9%) had undergone valve replacement (mechanical/biological) prior to IE.
In ACHD patients, the most important risk predictors for IE were ACHD related cardiac surgery and valve replacement surgery, HR 117 (95% CI 93.0–148) and HR 74.8 (95% CI 56.4–99.2), respectively. Diabetes mellitus, previous ischemic stroke and presence of an intracardiac electronic device also predicted the risk of IE, however, they were less important predictors (diabetes: HR 1.69, 95% CI 1.01–2.82, ischemic stroke: HR 1.75, 95% CI 1.21–2.52, electronic device: HR 1.59, 95% CI 1.05–2.39).
Conclusion
The risk of developing IE was found to be almost 55 times higher in patients with ACHD aged 18–65 years compared with matched controls. Previous ACHD related surgery and valve replacement were the most significant risk predictors. These results underscore the need of continuous clinical follow-up as well as the need of further research to prevent this serious complication of ACHD.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The work was supported by grants from the Swedish state under an agreement between the Swedish government and country councils, the ALF-agreement (grant numbers 236611 and 917361); and the Swedish Heart-Lung Foundation (grant number: 20180644 and 20200521).
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Affiliation(s)
- M Fedchenko
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Department of Molecular and Clinical Medicine/Cardiology , Gothenburg , Sweden
| | - K W Giang
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Department of Molecular and Clinical Medicine/Cardiology , Gothenburg , Sweden
| | - U Snygg-Martin
- Institute of Biomedicine, Sahlgrenska Academy, Department of Infectious Diseases , Gothenburg , Sweden
| | - M Dellborg
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Department of Molecular and Clinical Medicine/Cardiology , Gothenburg , Sweden
| | - Z Mandalenakis
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Department of Molecular and Clinical Medicine/Cardiology , Gothenburg , Sweden
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3
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace 2021; 22:515-549. [PMID: 31702000 PMCID: PMC7132545 DOI: 10.1093/europace/euz246] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [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: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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4
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2021; 57:e1-e31. [PMID: 31724720 DOI: 10.1093/ejcts/ezz296] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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5
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Snygg-Martin U, Giang KW, Dellborg M, Robertson J, Mandalenakis Z. Cumulative incidence of infective endocarditis in patients with congenital heart disease: a nationwide, case-control study over nine decades. Clin Infect Dis 2021; 73:1469-1475. [PMID: 34036324 PMCID: PMC8528398 DOI: 10.1093/cid/ciab478] [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: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is a lifelong predisposing condition for infective endocarditis (IE). As a consequence of advances in pediatric care, the number of adults with CHD is now exceeding the number of children. The goal of the present study was to determine the cumulative incidence of IE in patients with CHD and detect temporal changes compared with controls. METHODS Nationwide registry-based case-control study of patients with CHD born 1930-2017 matched with 10 random controls. Infective endocarditis episodes were linked using the Swedish 10-digit personal identification number. RESULTS In total, 89,541 patients with CHD and 890,470 matched controls were included. In patients with CHD, 1477 IE episodes were registered and 447 episodes in controls. Patients with CHD had 8.5% cumulative incidence of IE at age 87 years, compared with 0.7% in matched controls. Incidence rate of IE per 100,000 person-years was 65.5 (95% confidence interval [CI] 62.2-68.9) and 1.8 (95% CI 1.7-2.0) in CHD patients and controls, respectively. By age 18 years, patients with CHD had an IE incidence similar to that of 81-year-old controls. Incidence of IE differed by age but not by birth year. Bacterial etiology was registered from 1997 in half of the IE episodes; among CHD IE cases, 43.3% were caused by streptococci, 29.8% by Staphylococcus aureus. CONCLUSIONS Infective endocarditis remains an important complication in patients with CHD. Incidence correlate with age and the number of IE episodes are expected to increase as the CHD population grow older.
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Affiliation(s)
- Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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6
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [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: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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7
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Louca A, Shahnavaz A, Florin Ljungkvist J, Snygg-Martin U, Tygesen H. [Q fever endocarditis - a rare condition with high mortality]. Lakartidningen 2021; 118:20052. [PMID: 33788204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coxiella burnetii is the causative agent of Q fever. It can manifest in both acute and chronic forms. Culture-negative endocarditis is the most common and serious presenting form of chronic Q fever. This occurs almost exclusively in patients with a pre-existing valvulopathy including valve prosthesis or immunocompromised patients as well as in pregnant women. Diagnosis is often delayed or missed due to the nonspecific symptoms of the condition. Without the proper antimicrobial therapy, the mortality is high. Q fever endocarditis should be suspected especially in people who recently had acute Q fever, people who come from endemic areas as well as people with occupational contact with sheep, goats and cattle and endocarditis symptoms. In this article we present a case with a patient who died of unknown cause and where PCR performed on autopsy of the valve revealed Q fever endocarditis.
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Affiliation(s)
- Antros Louca
- spe-cialistläkare, medicin-kliniken, Södra Älvsborgs sjukhus, Borås
| | | | | | - Ulrika Snygg-Martin
- med dr, överläkare, infektionskliniken, Sahlgrenska universitetssjukhuset/Östra
| | - Hans Tygesen
- med dr, överläkare, medicinkliniken, hjärtsektionen, Södra Älvsborgs Sjukhus, Borås
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8
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Traykov V, Bongiorni MG, Boriani G, Burri H, Costa R, Dagres N, Deharo JC, Epstein LM, Erba PA, Snygg-Martin U, Nielsen JC, Poole JE, Saghy L, Starck C, Strathmore N, Blomström-Lundqvist C. Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association. Europace 2020; 21:1270-1279. [PMID: 31209483 DOI: 10.1093/europace/euz137] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 01/07/2019] [Accepted: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. METHODS AND RESULTS A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively. CONCLUSION Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory.
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Affiliation(s)
- Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Maria Grazia Bongiorni
- Cardiology and Arrhythmology Division, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- System Director, Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa, AOUP, Italy and Department on Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Laszlo Saghy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia
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9
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Snygg-Martin U, Ruus C, Skovbjerg S, Studahl M, Andersson LM. Does extraction of cardiac implantable electronic devices improve outcome in patients with Staphylococcus aureus bacteraemia? Infect Dis (Lond) 2020; 52:877-882. [PMID: 32735155 DOI: 10.1080/23744235.2020.1799070] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) is recognized as an infection that is difficult to treat and with high risk of device related infection. Extraction/explantation of cardiac implantable electronic devices (CIED) is recommended in SAB patients but studies evaluating long-term prognosis are scarce. MATERIALS AND METHODS In this retrospective cohort study, 626 consecutive SAB patients were identified in routine diagnostics (November 2014-October 2016). Patient characteristic, infective endocarditis (IE) incidence and mortality were compared for patients with and without CIED. RESULTS SAB patients with CIED (n = 33) compared to non-CIED patients (n = 593) were older (83 versus 70 years, p = .0001), had a higher 30-day mortality (12/33, 36% versus 119/593, 20%, p = .044) and higher incidence of IE (9/33, 27% versus 41/593, 7%, p = .0006). One-year mortality was 19/33 (58%) among the SAB CIED patients. Echocardiography was performed in all nine patients with CIED-IE but only in 14/24 (58%) of the 24 SAB CIED patients that were considered not having IE. However, if patients with very early mortality were excluded, echocardiography was performed in 14/17 (82%) of SAB CIED-non-IE patients. CIED extraction/explantation during intravenous antibiotic treatment was only performed in three patients with SAB CIED-IE and in one non-IE patient. One year post treatment initiation, 14 out of 33 SAB CIED patients were alive of whom only one had CIED extraction/explantation performed as part of treatment. CONCLUSION Staphylococcus aureus bacteraemia in CIED patients is associated with poor prognosis but in a subgroup of patients survival beyond one year was seen despite retainment of the electronic device.
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Affiliation(s)
- Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Christoffer Ruus
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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Robertson J, Ahlgren E, Rydberg F, Snygg-Martin U, Westin J, Studahl M. [The virtual ward - the students' clinical education during the current pandemic]. Lakartidningen 2020; 117:20077. [PMID: 32633809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
On March 17, 2020, the Swedish Government recommended all higher education institutions to move to online and distance learning during the COVID-19 pandemic. The integrated course in Infection, Microbiology, and Immunity at the Programme in Medicine at University of Gothenburg had to be completely transformed. Creative solutions have now replaced the clinical training that normally takes place during the students' clinical education at the hospital. We developed a digital concept entitled "the virtual ward", in which we interact with the students in real time. Here, the students are able to follow their patients on a daily basis during teacher-guided sessions.
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Affiliation(s)
- Josefina Robertson
- med dr, ST-läkare, avdelningen för infektionssjukdomar, institutionen för biomedicin, Sahlgrenska akademin, Göteborgs universitet; infektionskliniken, Sahlgrenska universitetssjukhuset/Östra, Göteborg
| | - Erika Ahlgren
- doktorand, avdelningen för infektionssjukdomar, institutionen för biomedicin, Sahlgrenska akademin, Göteborgs universitet; infektionskliniken, Sahlgrenska universitetssjukhuset/Östra, Göteborg
| | - Frida Rydberg
- ST-läkare, avdelningen för infektionssjukdomar, institutionen för biomedicin, Sahlgrenska akademin, Göteborgs universitet; infektionskliniken, Sahlgrenska universitetssjukhuset/Östra, Göteborg
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11
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Fernández Hidalgo N, Gharamti AA, Aznar ML, Almirante B, Yasmin M, Fortes CQ, Plesiat P, Doco-Lecompte T, Rizk H, Wray D, Lamas C, Durante-Mangoni E, Tattevin P, Snygg-Martin U, Hannan MM, Chu VH, Kanafani ZA. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort. Open Forum Infect Dis 2020; 7:ofaa120. [PMID: 32462042 PMCID: PMC7240340 DOI: 10.1093/ofid/ofaa120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/25/2019] [Accepted: 04/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.
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Affiliation(s)
| | - Amal A Gharamti
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Mohamad Yasmin
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | | | | | | | | - Dannah Wray
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cristiane Lamas
- Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil
| | | | | | | | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina, USA
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12
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Ruus C, Skovbjerg S, Magnusson T, Snygg-Martin U, Studahl M, Andersson LM. [Not Available]. Lakartidningen 2018; 115:ETD9. [PMID: 29337337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Automatic infectious disease consultant alert is associated with decreased mortality and readmission rate in Staphylococcus aureus bacteriemia A management plan was implemented at a 2000 bed teaching hospital where positive blood cultures with growth of Staphylococcus aureus were reported simultaneously to the ordering unit and to the Infectious Disease Consultant. Readmission rate and 30-day mortality were compared one year before and one year after introduction of the management plan. Out of totally 320 respectively 321 patients with SAB 252 and 244 were included in the study. 30-day mortality decreased from 26/252 (10%) to 14/244 (5,7%) (p=0.059) when all patients with SAB were included and to 9/193 (4,7%) (p=0,026) when only patients who received a formal consultation after introduction of the management plan were included. The rate of readmission within 30 days declined from 38/227 (17%) in 2014-2015 to 24/230 (10%) in 2015-2016 (p=0,049).
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Affiliation(s)
- Christoffer Ruus
- Ostra sjukhuset - Infektion Göteborg, Sweden - Gothenburg, Sweden
| | - Susann Skovbjerg
- Sahlgrenska universitetssjukhuset - Klinisk mikrobiologi Göteborg, Sweden Sahlgrenska universitetssjukhuset - Klinisk mikrobiologi Göteborg, Sweden
| | - Tim Magnusson
- Sahlgrenska universitetssjukhuset - Klinisk mikrobiologi Göteborg, Sweden Sahlgrenska universitetssjukhuset - Klinisk mikrobiologi Göteborg, Sweden
| | - Ulrika Snygg-Martin
- Ostra sjukhuset - Infektion Göteborg, Sweden Ostra sjukhuset - Infektion Göteborg, Sweden
| | - Marie Studahl
- Ostra sjukhuset - Infektion Göteborg, Sweden - Infectious Diseases Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Ostra sjukhuset - Infektion Göteborg, Sweden Ostra sjukhuset - Infektion Göteborg, Sweden
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13
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Tissot-Dupont H, Casalta JP, Gouriet F, Hubert S, Salaun E, Habib G, Fernandez-Gerlinger MP, Mainardi JL, Tattevin P, Revest M, Lucht F, Botelho-Nevers E, Gagneux-Brunon A, Snygg-Martin U, Chan KL, Bishara J, Vilacosta I, Olmos C, San Román JA, López J, Tornos P, Fernández-Hidalgo N, Durante-Mangoni E, Utili R, Paul M, Baddour LM, DeSimone DC, Sohail MR, Steckelberg JM, Wilson WR, Raoult D. International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines. Clin Microbiol Infect 2017; 23:736-739. [PMID: 28323194 DOI: 10.1016/j.cmi.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 06/29/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. METHODS Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. RESULTS The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. CONCLUSION Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics.
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Affiliation(s)
- H Tissot-Dupont
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - J P Casalta
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - F Gouriet
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - S Hubert
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - E Salaun
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - G Habib
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - M P Fernandez-Gerlinger
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - J L Mainardi
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - P Tattevin
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - M Revest
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - F Lucht
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - E Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - A Gagneux-Brunon
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - U Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K L Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - J Bishara
- Infectious Disease Unit Rabin Medical Centre, Beilinson Hospital Sackler Faculty of Medicine, Tel-Aviv University, Jabotinsky 39, Petah-Tiqva, Israel
| | - I Vilacosta
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - C Olmos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - J A San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - J López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - P Tornos
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - E Durante-Mangoni
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - R Utili
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - M Paul
- Ramban Health Care Campus, Haifa, Israel
| | - L M Baddour
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D C DeSimone
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Sohail
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J M Steckelberg
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Raoult
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
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14
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. [2015 ESC Guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)]. G Ital Cardiol (Rome) 2016; 17:277-319. [PMID: 27093212 DOI: 10.1714/2214.23904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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15
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Fagman E, Flinck A, Snygg-Martin U, Olaison L, Bech-Hanssen O, Svensson G. Surgical decision-making in aortic prosthetic valve endocarditis: the influence of electrocardiogram-gated computed tomography. Eur J Cardiothorac Surg 2016; 50:1165-1171. [PMID: 27242355 DOI: 10.1093/ejcts/ezw177] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/29/2016] [Revised: 04/08/2016] [Accepted: 04/19/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the value of electrocardiogram (ECG)-gated computed tomography (CT) in the surgical decision-making and preoperative evaluation in patients with aortic prosthetic valve endocarditis (PVE). METHODS Sixty-eight prosthetic valves in 67 patients with aortic PVE were prospectively evaluated with ECG-gated CT and transoesophageal echocardiography (TEE). Imaging findings considered indications for surgery were as follows: (i) abscess/pseudoaneurysm formation; (ii) prosthetic valve dehiscence; (iii) valve destruction with valvular regurgitation; (iv) large vegetations (>1.5 cm). The coronary arteries were evaluated with ECG-gated CT. Clinical data including surgical reports and mortality data were collected. RESULTS Fifty-eight of 68 cases had indication for surgery based on imaging findings (ECG-gated CT/TEE). In 8 of these cases (14%), there was indication for surgery based on CT but not on TEE findings (all had perivalvular pseudoaneurysms). In 11 cases (19%), there was indication for surgery based on TEE but not on CT findings [non-drained abscess (n = 5), prosthetic valve dehiscence (n = 4), large vegetation (n = 1), valve destruction (n = 1)]. In 31 of 32 patients with indication for preoperative coronary angiography, ECG-gated CT coronary angiography was diagnostic. In 1 patient, ECG-gated CT coronary angiography was inconclusive and invasive coronary angiography was performed. CONCLUSIONS In patients with aortic PVE, ECG-gated CT provides additional information over TEE regarding perivalvular extension of infection, which can influence surgical decision-making. Furthermore, ECG-gated CT provides a non-invasive coronary angiogram and can in most cases replace invasive coronary angiography in the preoperative evaluation.
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Affiliation(s)
- Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden .,Department of Radiology, Sahlgrenska Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Flinck
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Zotti FD, Dulgheru R, Khoury GE, Erba PA, Iung B, Miró JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Mas PT, Vilacosta I, Zamorano JL, Erol Ç, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, de Backer J, de Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM. Guía ESC 2015 sobre el tratamiento de la endocarditis infecciosa. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2015.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Płońska-Gościniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Mas PT, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis. Kardiol Pol 2015; 73:963-1027. [DOI: 10.5603/kp.2015.0227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/25/2022]
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18
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Fagman E, van Essen M, Fredén Lindqvist J, Snygg-Martin U, Bech-Hanssen O, Svensson G. 18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis. Int J Cardiovasc Imaging 2015; 32:679-86. [PMID: 26611107 DOI: 10.1007/s10554-015-0814-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
Recent studies have shown promising results using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the diagnosis of prosthetic valve endocarditis (PVE). However, previous studies did not include negative controls. The aim of this study was to compare (18)F-FDG-uptake around prosthetic aortic valves in patients with and without PVE and to determine the diagnostic performance of (18)F-FDG PET/CT in the diagnosis of PVE. (18)F-FDG PET/CT examinations in patients with a prosthetic aortic valve performed 2008-2014 were retrieved. Eight patients with a final diagnosis of definite PVE were included in the analysis of the diagnostic performance of (18)F-FDG PET/CT. Examinations performed on suspicion of malignancy in patients without PVE (n = 19) were used as negative controls. Visual and semi-quantitative analysis was performed. Maximal standardized uptake value (SUVmax) in the valve area was measured and SUVratio was calculated by dividing valve SUVmax by SUVmax in the descending aorta. The sensitivity was 75 %, specificity 84 %, positive likelihood ratio [LR(+)] 4.8 and negative likelihood ratio [LR(-)] 0.3 on visual analysis. Both SUVmax and SUVratio were significantly higher in PVE patients [5.8 (IQR 3.5-6.5) and 2.4 (IQR 1.7-3.0)] compared to non-PVE patients [3.2 (IQR 2.8-3.8) and 1.5 (IQR 1.3-1.6)] (p < 0.001). ROC-curve analysis of SUVratio yielded an area under the curve of 0.90 (95 % CI 0.74-1.0). (18)F-FDG-uptake around non-infected aortic prosthetic valves was low. The level of (18)F-FDG-uptake in the prosthetic valve area showed a good diagnostic performance in the diagnosis of PVE.
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Affiliation(s)
- Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martijn van Essen
- Department of Clinical Physiology, Nuclear Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Fredén Lindqvist
- Department of Clinical Physiology, Nuclear Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Gunnar Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3046] [Impact Index Per Article: 338.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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Olaison L, Johansson N, Snygg-Martin U, Sandberg T. Nephrotoxicity during aminoglycoside therapy for infective endocarditis. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1148] [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: 11/16/2022] Open
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Johansson N, Sandberg T, Snygg-Martin U, Olaison L. P70 NEPHROTOXICITY DURING AMINOGLYCOSIDE THERAPY FOR ENDOCARDITIS. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70094-3] [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: 11/27/2022]
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Snygg-Martin U. SY.4.4 EMBOLIZATIONS OF THE CENTRAL NERVOUS SYSTEM IS THERE MORE THAN WE OBSERVE? Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70014-1] [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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Bjurman C, Snygg-Martin U, Olaison L, Fu MLX, Hammarsten O. Cystatin C in a composite risk score for mortality in patients with infective endocarditis: a cohort study. BMJ Open 2012; 2:bmjopen-2012-000856. [PMID: 22798251 PMCID: PMC3400063 DOI: 10.1136/bmjopen-2012-000856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop a multimarker prognostic score for infective endocarditis (IE). DESIGN Retrospective case-control. SETTING Secondary care. Single centre. PARTICIPANTS 125 patients with definite IE. PRIMARY OUTCOME MEASURES 90-day and 5-year mortality. RESULTS Mean age was 62.7±17 years. The 90-day and 5-year mortality was 10.4% and 33.6%, respectively. CysC levels at admission and over 20% increases in CysC levels during 2 weeks of treatment were prognostic for 90-day and 5-year mortality independent of creatinine estimated glomerular filtration rate. In multivariate analyses, CysC (OR 5.42, 95% CI 1.90 to 15.5, p=0.002) and age (OR 1.06, 95% CI 1.02 to 1.10, p=0.002) remained prognostic for 5-year mortality. NT-proBNP, TnT, C reactive protein and interleukin 6 were also linked to prognosis. A composite risk scoring system using levels of CysC, NT-proBNP, age and presence of mitral valve insufficiency was able to separate a high-risk and a low-risk group. CONCLUSIONS CysC levels at admission and increase in CysC after 2 weeks of treatment were independent prognostic markers for both 90-day and 5-year mortality in patients with IE. A multimarker composite risk scoring system including CysC identified a high-risk group.
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Affiliation(s)
- Christian Bjurman
- Department of Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Snygg-Martin
- Department of Infectious diseases, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars Olaison
- Department of Infectious diseases, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael L X Fu
- Department of Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L. The relationship between cerebrovascular complications and previously established use of antiplatelet therapy in left-sided infective endocarditis. ACTA ACUST UNITED AC 2011; 43:899-904. [DOI: 10.3109/00365548.2011.603742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L. Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis. Eur J Clin Microbiol Infect Dis 2011; 30:151-7. [PMID: 20857163 DOI: 10.1007/s10096-010-1063-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 08/28/2010] [Indexed: 12/31/2022]
Abstract
Anticoagulant therapy has been anticipated to increase the risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and the incidence of symptomatic CVC in left-sided NVE. In a prospective cohort study, the CVC incidence was compared between NVE patients with and without ongoing warfarin. Among 587 NVE episodes, 48 (8%) occurred in patients on warfarin. A symptomatic CVC was seen in 144 (25%) patients, with only three on warfarin. CVC were significantly less frequent in patients on warfarin (6% vs. 26%, odds ratio [OR] 0.20, 95% confidence interval [CI] 0.06-0.6, p = 0.006). No increase in haemorrhagic lesions was detected in patients on warfarin. Staphylococcus aureus aetiology (adjusted OR [aOR] 6.3, 95% CI 3.8-10.4) and vegetation length (aOR 1.04, 96% CI 1.01-1.07) were risk factors for CVC, while warfarin on admission (aOR 0.26, 95% CI 0.07-0.94), history of congestive heart failure (adjusted OR 0.22, 95% CI 0.1-0.52) and previous endocarditis (aOR 0.1, 95% CI 0.01-0.79) correlated with lower CVC frequency.
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Affiliation(s)
- U Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
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Rasmussen RV, Snygg-Martin U, Olaison L, Andersson R, Buchholtz K, Larsen CT, Hansen TF, Køber L, Hassager C, Bruun NE. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis. ACTA ACUST UNITED AC 2009; 41:456-61. [DOI: 10.1080/00365540902896061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rasmussen RV, Snygg-Martin U, Olaison L, Buchholtz K, Larsen CT, Hassager C, Bruun NE. Major Cerebral Events in Staphylococcus Aureus Infective Endocarditis: Is Anticoagulant Therapy Safe? Cardiology 2009; 114:284-91. [DOI: 10.1159/000235579] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 05/24/2009] [Indexed: 11/19/2022]
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Westling K, Aufwerber E, Ekdahl C, Friman G, Gårdlund B, Julander I, Olaison L, Olesund C, Rundström H, Snygg-Martin U, Thalme A, Werner M, Hogevik H. Swedish guidelines for diagnosis and treatment of infective endocarditis. Scand J Infect Dis 2008; 39:929-46. [PMID: 18027277 DOI: 10.1080/00365540701534517] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Swedish guidelines for diagnosis and treatment of infective endocarditis (IE) by consensus of experts are based on clinical experience and reports from the literature. Recommendations are evidence based. For diagnosis 3 blood cultures should be drawn; chest X-ray, electrocardiogram, and echocardiography preferably transoesophageal should be carried out. Blood cultures should be kept for 5 d and precede intravenous antibiotic therapy. In patients with native valves and suspicion of staphylococcal aetiology, cloxacillin and gentamicin should be given as empirical treatment. If non-staphylococcal etiology is most probable, penicillin G and gentamicin treatment should be started. In patients with prosthetic valves treatment with vancomycin, gentamicin and rifampicin is recommended. Patients with blood culture negative IE are recommended penicillin G (changed to cefuroxime in treatment failure) and gentamicin for native valve IE and vancomycin, gentamicin and rifampicin for prosthetic valve IE, respectively. Isolates of viridans group streptococci and enterococci should be subtyped and MIC should be determined for penicillin G and aminoglycosides. Antibiotic treatment should be chosen according to sensitivity pattern given 2-6 weeks intravenously. Cardiac valve surgery should be considered early, especially in patients with left-sided IE and/or prosthetic heart valves. Absolute indications for surgery are severe heart failure, paravalvular abscess, lack of response to antibiotic therapy, unstable prosthesis and multiple embolies. Follow-up echocardiography should be performed on clinical indications.
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Affiliation(s)
- Katarina Westling
- Infective Endocarditis Working Group, Swedish Society of Infectious Diseases, Sweden.
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