1
|
Schwiebert DR, Atanze DS, Iroegbu DU, Wilkins DM, Sandoe JAT. Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation. Clin Med (Lond) 2024:100213. [PMID: 38643831 DOI: 10.1016/j.clinme.2024.100213] [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: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Infective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. METHODS This is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. RESULTS We identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, 6 (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1489 hospital bed days were saved. CONCLUSIONS In a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.
Collapse
Affiliation(s)
- Dr Ralph Schwiebert
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England.
| | - Dr Sokolayam Atanze
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | | | - Dr Molly Wilkins
- Department of Anaesthesia and Intensive Care Medicine, Countess of Chester Hospital, Chester, England
| | - Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England; Leeds Institute of Medical Research, University of Leeds, Leeds, England
| |
Collapse
|
2
|
Leterrier J, Iung B, de Tymoski C, Deconinck L, Para M, Duval X, Provenchere S, Mesnier J, Delhomme C, Haviari S, Urena M, Suc G. Sex differences and outcomes in surgical infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezae114. [PMID: 38521543 DOI: 10.1093/ejcts/ezae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Cardiac surgery for infective endocarditis (IE) is associated with significant hospital mortality, and female sex may be associated with worse outcomes. However, the impact of sex on the presenting characteristics, management, and outcomes of patients operated on for acute infective endocarditis (IE) has not been adequately studied. OBJECTIVES The goal of our study was to analyse differences in management and outcome of IE between women and men who undergo surgery. METHODS Clinical data of 717 patients undergoing cardiac surgery for IE between December 2005 and December 2019 were prospectively collected. Sex-related postoperative outcomes including in-hospital mortality were recorded. Univariable and multivariable analyses were performed to identify potential sex-related determinant of in-hospital mortality. RESULTS In all, 532 male patients (74.2%) and 185 female patients (25.8%) underwent surgery for IE. At baseline, women had more frequent mitral regurgitation with 63 patients (34.1%) than men with 135 patients (25.4%) (P = 0.002). Female sex was associated with higher in-hospital mortality (23.2% versus 17.3%, P = 0.049). However, multivariable analysis revealed age (P < 0.01), antibiotics < 7 days before surgery (P = 0.01) and staphylococcal IE (P < 0.01) but not female sex (P = 0.99) as independent determinants of hospital mortality. CONCLUSIONS In this study of patients operated-on for IE, female sex was associated with more severe manifestations of IE and significantly higher in-hospital mortality. However, after multivariable analysis, initial presentation, but not sex, seemed to determine clinical outcomes.
Collapse
Affiliation(s)
| | - Bernard Iung
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Christian de Tymoski
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Laurene Deconinck
- Université Paris Cité, Paris, France
- Infectious Diseases Department, Bichat Hospital, APHP, Paris, France
| | - Marylou Para
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Université Paris Cité, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
| | - Sophie Provenchere
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Anesthesia and Critical Care Department, DMU Parabol, Bichat Claude Bernard University Hospital, APHP, Paris, France
| | - Jules Mesnier
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | | | - Skerdi Haviari
- Université Paris Cité, Paris, France
- Epidemiology Biostatistics & Clinical Research Department, Bichat, APHP, Paris, France
- UPC-Inserm UMR1137 IAME, Paris, France
| | - Marina Urena
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Gaspard Suc
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| |
Collapse
|
3
|
Marvasti TB, Philip R, Parikh H, Hazan E, Liu PJ, Saeed O, Billick MJ. Reviewing Your ABCs - Acute Kidney Injury, Bartonella Endocarditis, and C-ANCA Vasculitis. Am J Med 2024; 137:e22-e25. [PMID: 37918779 DOI: 10.1016/j.amjmed.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Tina B Marvasti
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Rohan Philip
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Harsh Parikh
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Elias Hazan
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - Omar Saeed
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maxime J Billick
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Division of Infectious Diseases, University of Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Toledo H, Gimeno A, Alarcón JC, Luque-Márquez R. Dalbavancin as a treatment option for Rothia aeria endocarditis. Rev Esp Quimioter 2024; 37:100-101. [PMID: 38131630 PMCID: PMC10874656 DOI: 10.37201/req/051.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | | | | | - R Luque-Márquez
- Rafael Luque, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Hospital Virgen del Rocío de Sevilla, Spain.
| |
Collapse
|
5
|
Singh T, Mishra AK, Vojjala N, John KJ, George AA, Jha A, Hadley M. Cardiovascular complications following medical termination of pregnancy: An updated review. World J Cardiol 2023; 15:518-530. [PMID: 37900907 PMCID: PMC10600792 DOI: 10.4330/wjc.v15.i10.518] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described. AIM To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP. METHODS We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms "abortions" or "medical/legal termination of pregnancy" and "cardiac complications" or "cardiovascular complications". RESULTS The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications. CONCLUSION In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.
Collapse
Affiliation(s)
- Tejveer Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
| | - Nikhil Vojjala
- Department of Internal Medicine, Post-Graduation Institute of Medical Education and Research, Chandigarh 00000, India
| | - Kevin John John
- Department of Internal Medicine, Tufts Medical Center, Boston, MA 01212, United States
| | - Anu A George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anil Jha
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| |
Collapse
|
6
|
Ravishankar R, Hussain A, Loubani M, Chaudhry M. Acute endocarditis in a pregnant patient requiring post-partum emergency mitral valve repair: a case report. J Surg Case Rep 2023; 2023:rjad441. [PMID: 37560607 PMCID: PMC10409567 DOI: 10.1093/jscr/rjad441] [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: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 08/11/2023] Open
Abstract
A 37-year-old pregnant patient presented with symptoms of shortness of breath, cough and malaise at 36 weeks' gestation. Antibiotics were started because of suspected bilateral pneumonia. A lower segment caesarean section was undertaken and significant desaturation lead to intubation of the patient. A CTPA confirmed bilateral pneumonia but also elements of heart failure with a 32 mm dilated pulmonary artery. Severe mitral regurgitation was confirmed with trans-thoracic and trans-oesophageal echocardiogram on Day 5 and emergency mitral valve repair was undertaken for possible infective endocarditis (IE) as per the modified Duke criteria, which was confirmed intra-operatively. The patient completed 4 weeks of antibiotics and suffered mild memory impairment post-operatively. She was discharged from complex rehabilitation after 6 weeks of hospital stay at her baseline state. This case presents IE in a pregnant patient with no significant risk factors with successful recovery because of prompt diagnosis and management.
Collapse
Affiliation(s)
- Ramanish Ravishankar
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Azar Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Mubarak Chaudhry
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| |
Collapse
|
7
|
Mohammadi K, Soltani P, Davari N. Infective Endocarditis as a complication of COVID-19 infection; A case report and review of literature. J Cardiovasc Thorac Res 2023; 15:127-130. [PMID: 37654820 PMCID: PMC10466469 DOI: 10.34172/jcvtr.2023.31618] [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: 08/10/2022] [Accepted: 05/21/2023] [Indexed: 09/02/2023] Open
Abstract
COVID-19 has been known to induce systemic inflammation and hyper coagulate state leading to different complications. Cardiovascular complications are one of the most important among complications following COVID-19 infection. A 57 years old woman with past medical history of COVID-19 infection about two months ago came to our hospital with presentation of fever and dyspnea. During workup, tricuspid valve infection associated with pulmonary septic emboli was diagnosed without any obvious risk factor for infective endocarditis. It seems that COVID-19 infection may increase the rate of endocarditis in patients with or without risk factors of endocarditis.
Collapse
Affiliation(s)
- Khadije Mohammadi
- Cardiovascular Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parya Soltani
- Department of Radiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Davari
- Cardiovascular Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
8
|
Boukobza M, Raffoul R, Duval X, Laissy JP. [Not Available]. Ann Cardiol Angeiol (Paris) 2022; 71:240-242. [PMID: 35940971 DOI: 10.1016/j.ancard.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Prevotella species (i. e. P. intermedia, P. nigrescens, P. pallens, P. oris) are usually responsible for abscesses of head and neck spaces after dental procedures. P. intermedia - related infective endocarditis has never been reported. CASE REPORT A 22-year-old man, with a history of aortic valve replacement 6 years ago, presented with fever and persistent retrosternal chest pain. An empirical antibiotic therapy was started on (cefotaxime, 2gx3 - gentamicin, 5mg/kilo). Five blood cultures were positive at Prevotella Intermedia. Metronidazole was introduced (500mg X 3 by day).The oro-pharyngeal spaces were normal. The evolution was marked by a hypotension, a third degree atrio-ventricular block, and a rapidly growing aortic root abscess complicated this case of Prevotella Intermedia infective endocarditis (IE). Aortic valve redux surgery was performed at day 5 of admission. Post-operative course was unremarkable. CONCLUSION This first reported case of Prevotella Intermedia IE presented suggestive features of anaerobic IE as the patient developed both aortic-ring abscess, third degree atrio-ventricular block and hypotension.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, FRANCE.
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France ; INSERM Clinical Investigation Center 007, Paris, France ; INSERM U738, Paris, France ; Paris University, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France ; INSERM U1148, Paris, France ; Paris University, Paris, France
| |
Collapse
|
9
|
Agha A, Nazir S, Minhas AMK, Kayani W, Issa R, Moukarbel GV, DeAnda A, Cram P, Jneid H. Demographic and Regional Trends of Infective Endocarditis-Related Mortality in the United States, 1999 to 2019. Curr Probl Cardiol 2022;:101397. [PMID: 36100097 DOI: 10.1016/j.cpcardiol.2022.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to identify temporal, geographic, age and sex-based mortality trends of IE in the US over the past two decades. METHODS This population-based study utilized the CDC WONDER database to identify IE-related deaths occurring within the US between 1999 and 2019. IE-related crude and age-adjusted mortality rates (CMRs and AAMRs, respectively) were determined. Joinpoint regression was used to determine trends in CMR/AAMR using annual percent change (APC) in the overall sample in addition to demographic (sex, race/ethnicity, age) and geographic (rural/urban, statewide) subgroups. RESULTS Between 1999 and 2019, a total of 279,154 deaths related to IE were reported. The overall AAMR declined from 54.2 per 1,000,000 in 1999 to 51.4 in 2019. However, AAMRs increased among several sub-groups over the past decade including men [2009-2019 APC=0.4%, 95%CI, 0.1%-0.6%], non-Hispanic (NH) whites [APC of 0.8% from 2009 to 2019 (95%CI 0.5%-1.1%)], NH American Indians or Alaskan Natives [APC of 1.4% during the study period (95%CI, 0.7%-2.0%)], and those in rural areas [APC of 1.0% from 2009 to 2019 (95%CI 0.5%-1.5%)]. The CMRs increased among subjects 40-64 years old [APC of 2.8% from 2010 to 2019 (95%CI 2.2%-3.5%)] and 15-39 years old [APC of 16.4% from 2010 to 2017 (95%CI 13.5%-19.4%)]. CONCLUSIONS IE-related CMR/AAMR increased among men, NH whites, NH American Indian or Alaskan Natives, those <65-year-old, and those from rural areas. Discerning the reasons for the increase in IE-related mortality among these groups and examining the impact of the social determinants of health may represent important opportunities to enhance care.
Collapse
|
10
|
Serna-Gallegos D, Sultan I. Aortic root replacement: What's in your wallet? Eur J Cardiothorac Surg 2022; 62:6586294. [PMID: 35575356 DOI: 10.1093/ejcts/ezac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh.,Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh.,Heart and Vascular Institute, University of Pittsburgh Medical Center
| |
Collapse
|
11
|
Naso F, Calafiore AM, Gaudino M, Zilla P, Haverich A, Colli A, Melder RJ, Gandaglia A. Polyphenols could be Effective in Exerting a Disinfectant-Like Action on Bioprosthetic Heart Valves, Counteracting Bacterial Adhesiveness. Cardiol Cardiovasc Med 2022; 6:487-492. [PMID: 36303878 PMCID: PMC9601395 DOI: 10.26502/fccm.92920287] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of infective endocarditis in patients with bioprosthetic heart valves is over 100 times that of the general population with S. aureus recognized as the causative organism in approximately 1/3 of cases. In this study, (1) the microbicidal and virucidal effect of a polyphenolic solution was carefully evaluated. The same solution was then adopted for the treatment of a commercial bioprosthetic heart valve model for (2) the assessment of inhibition of S. aureus adhesiveness. METHODS (1) the viability of 9 microorganisms strains (colony-forming units) and the infectivity degree of 3 viral strains (cellular infection capacity) were evaluated after suspension in the polyphenolic solution. (2) Leaflets from a treated and untreated commercial surgical valve model were incubated with a known concentration of S. aureus. After incubation, the leaflets were homogenized and placed in specific culture media to quantify the bacterial load. RESULTS (1) The polyphenolic solution proved to be effective in eliminating microorganisms strains guaranteeing the killing of at least 99.9%. The effectiveness is particularly relevant against M. chelonae (99.999%). (2) The polyphenol-based treatment resulted in the inhibition of the S. aureus adhesiveness by 96% concerning untreated samples. CONCLUSIONS The data suggest an interesting protective effect against infections and bacterial adhesiveness by a polyphenolic-based solution. Further studies will plan to extend the panel of microorganisms for the evaluation of the anti-adhesive effect; however, the use of optimized polyphenolic blends could lead to the development of new treatments capable to make transcatheter-valve substitutes more resistant to infection.
Collapse
Affiliation(s)
- Filippo Naso
- Biocompatibility Innovation SRL, Este, Padua, Italy
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA
| | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | | | | |
Collapse
|
12
|
Tom C, Huang G, Kovalic AJ, Davis KA, Peacock JE. Impact of Chronic Hepatitis C virus co-infection on outcomes of infective endocarditis in people who inject drugs. Diagn Microbiol Infect Dis 2021; 101:115453. [PMID: 34339949 DOI: 10.1016/j.diagmicrobio.2021.115453] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
Injection drug use (IDU) is a risk factor for infective endocarditis (IE) and hepatitis C virus (HCV) infection. This retrospective cohort study assessed HCV's impact on outcomes of adult people who inject drugs (PWID). Those admitted due to IE using modified Duke criteria from January 2012 through May 2018 were identified. The cohort was divided into HCV seropositive and seronegative groups. The seropositive group was further stratified according to HCV viremia. Complications and mortality during the IE hospitalization, at 10 weeks, and 1 year were compared across groups. Clinical factors were similar between the cohorts, except patients without viremia (29, 81%) required more ICU admissions than with viremia (30, 60%) (P < 0.05). There was no difference in mortality at all time periods between the groups. Although several factors affect mortality in PWID with IE, neither HCV antibody positivity nor viremia appear to increase the risk for complications or death.
Collapse
Affiliation(s)
- Chloe Tom
- Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Glen Huang
- Division of Infectious Diseases, Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexander J Kovalic
- Section on Hospital Medicine, Department of Internal Medicine, Novant Health, Winston-Salem, NC, USA
| | - Kyle A Davis
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - James E Peacock
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| |
Collapse
|
13
|
Knodle R, Demers L, Simmons R. Infectious Complications in Injection Drug Use. MedEdPORTAL 2021; 17:11124. [PMID: 33816787 PMCID: PMC8015638 DOI: 10.15766/mep_2374-8265.11124] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The prevalence of opioid use disorder has increased steadily over the last decade (from 2.2 million in 2010 to 10.2 million in 2018) and with it, a surge in infectious complications associated with injection drug use (IDU). Trainees in internal medicine routinely diagnose, manage, and treat patients experiencing these infections in the hospital setting as well as screen for and immunize against other comorbid infections in the ambulatory setting. METHODS This 90-minute, case-based, interactive workshop was led by two facilitators, an infectious diseases specialist and a senior internal medicine resident. To evaluate its effectiveness, we used a pre- and postsession survey administered at the beginning and end of the workshop. Learners were asked to rate comfort level in recognizing, managing, and counseling about various IDU-related infections, as well as to answer specific, content-level questions. RESULT Thirty of 42 participants who attended the workshop completed the evaluation. There was a statistically significant change in participants' comfort level with diagnosing and managing IDU-associated infections as well as ambulatory standards of care for people who inject drugs (PWID) from pre- to postworkshop. DISCUSSION Our workshop focused on the management and prevention of infections among PWID in both the inpatient and ambulatory settings. Learners demonstrated increased comfort in managing these conditions.
Collapse
Affiliation(s)
- Ryan Knodle
- Resident, Department of Medicine, Boston University School of Medicine
| | - Lindsay Demers
- Assistant Professor, Department of Medicine, Boston University School of Medicine
| | - Rachel Simmons
- Associate Residency Program Director and Assistant Professor, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine
| |
Collapse
|
14
|
Polishchuk I, Stavi V, Awesat J, Ben Baruch Golan Y, Bartal C, Sagy I, Jotkowitz A, Barski L. Sex Differences in Infective Endocarditis. Am J Med Sci 2020; 361:83-89. [PMID: 32988595 DOI: 10.1016/j.amjms.2020.08.021] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/28/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The impact of sex on the presentation, etiology, and outcomes of infective endocarditis (IE) has not been adequately studied. The aim of the present research was to analyze the impact of sex on the presentation, etiology, and outcomes of IE. METHODS We performed a retrospective study of 214 adult patients (131 male and 83 female) with IE. All cases of IE were reviewed by two investigators- both senior physicians in internal medicine. Two groups of patients were compared: male and female patients with IE. The primary outcome was in-hospital mortality. RESULTS We found significant differences in etiologic factors of IE in male and female patients. Microbiologic etiology differences between male and female groups of patients were in coagulase negative staphylococcus (15.0% in male vs 3.8% in female groups, P = 0.011), and culture negative endocarditis (8.7% in male vs 23.8% in female groups, P = 0.004). We did not find a difference in the primary outcome between the two groups; however, all-cause mortality was significantly higher in the female group as compared to the male group (26 [31.3] vs 22 [16.8], P = 0.018). CONCLUSIONS We found that sex may have important role in both the microbial profile and the patient's outcome with IE.
Collapse
Affiliation(s)
- Ilya Polishchuk
- Internal Medicine Outpatient Ward, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Vered Stavi
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Jenan Awesat
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Yael Ben Baruch Golan
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Carmi Bartal
- Department of Internal Medicine E, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel.
| |
Collapse
|
15
|
Wengrofsky P, Soleiman A, Benyaminov F, Oleszak F, Salciccioli L, McFarlane SI. Enterobacter Cloacae Device Endocarditis: Case Report, Scoping Study, and Guidelines Review. Cardiol Vasc Res (Wilmington) 2019; 3:10.33425/2639-8486.1050. [PMID: 31245792 PMCID: PMC6594712 DOI: 10.33425/2639-8486.1050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
While traditionally an infection of the endocardial surface of heart valves, infective endocarditis (IE), can atypically present as infection of cardiac implantable electronic devices (CIED), including permanent pacemakers (PPM) or automatic implantable cardioverter-defibrillators (AICD). CIED endocarditis, similar to valvular IE, is generally caused by Gram-positive organisms such as Staphylococcus spp., most frequently S. Auerus, but is rarely caused by gram-negative bacteria, both HACEK and non-HACEK species. We present the case of Enterobacter cloacae CIED endocarditis. We also present a scoping study of previous case reports and case series highlighting the risk factors, surgical interventions, and mortality outcomes associated with E. Cloacae endocarditis. We also discuss the current guidelines and recommendations on antibiotic therapies for non-HACEK Gram-negative endocarditis and surgical management of infected CIED extraction and replacement.
Collapse
Affiliation(s)
- Perry Wengrofsky
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Aron Soleiman
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Fuad Benyaminov
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Filip Oleszak
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Louis Salciccioli
- Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Samy I. McFarlane
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A.,Correspondence: Samy I. McFarlane, Distinguished Teaching Professor and Associate Dean, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York-Downstate Medical Center, Brooklyn, New York, Tel: 718-270-3711; Fax: 718-270-6358;
| |
Collapse
|
16
|
Chroni M, Prappa E, Kokkevi I. Bilateral sudden sensorineural hearing loss as a first symptom of infective endocarditis: two case reports. J Laryngol Otol 2018; 132:368-71. [PMID: 29463328 DOI: 10.1017/S0022215118000269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. CASE REPORT This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss. CONCLUSION Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.
Collapse
|
17
|
Laganà P, Delia S, Dattilo G, Mondello C, Ventura Spagnolo E. A case of Infective Endocarditis due to Salmonella enterica phagetype 35. First report. Clin Ter 2017; 168:e397-e400. [PMID: 29209691 DOI: 10.7417/t.2017.2041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infective Endocarditis (IE) has high morbidity and mortality. To date, in addition to classic Gram-positive pathogens were isolated exigent Gram negative bacteria responsible of endocarditis as A. baumannii, A. lwoffii, C. burnetii, Bartonella, Chlamydia and Legionella. We report our experience about the isolation of Salmonella enterica phagetype 35 (PT35) from blood heart cavity of a 74-year-old woman after having consumed a portion of baked pasta bought in a rotisserie. Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. To the best of our knowledge, after careful evaluation of existing literature, this is the first report of endocarditis due S. enterica PT 35.
Collapse
Affiliation(s)
- P Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging. University of Messina
| | - S Delia
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging. University of Messina
| | - G Dattilo
- Department of Clinical and Experimental Medicine, UO Cardiology, University of Messina
| | - C Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging. University of Messina
| | - E Ventura Spagnolo
- Department for Health Promotion and Mother-Child Care. Legal Medicine Section, University of Palermo, Italy
| |
Collapse
|
18
|
Rodrigues CG, Rays J, Kanegae MY. Native-valve endocarditis caused by Achromobacter xylosoxidans: a case report and review of literature. Autops Case Rep 2017; 7:50-55. [PMID: 29043211 PMCID: PMC5634435 DOI: 10.4322/acr.2017.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 04/28/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
Abstract
Achromobacter xylosoxidans is a Gram-negative aerobic bacterium first described by Yabuuchi and Ohyama in 1971. A. xylosoxidans is frequently found in aquatic environments. Abdominal, urinary tract, ocular, pneumonia, meningitis, and osteomyelitis are the most common infections. Infective endocarditis is rare. As far as we know, until now, only 19 cases have been described, including this current report. We report the case of community-acquired native valve endocarditis caused by A. xylosoxidans in an elderly patient without a concomitant diagnosis of a malignancy or any known immunodeficiency. The patient presented with a 2-month history of fever, weight loss, and progressive dyspnea. On physical examination, mitral and aortic murmurs were present, along with Janeway's lesions, and a positive blood culture for A. xylosoxidans. The transesophageal echocardiogram showed vegetation in the aortic valve, which was consistent with the diagnosis of infective endocarditis.
Collapse
Affiliation(s)
- Caio Godoy Rodrigues
- University of São Paulo (USP), School of Medicine, Internal Medicine Department. São Paulo, SP, Brazil
| | - Jairo Rays
- University of São Paulo (USP), Hospital Universitário, Internal Medicine Division. São Paulo, SP, Brazil
| | - Marcia Yoshie Kanegae
- University of São Paulo (USP), Hospital Universitário, Internal Medicine Division. São Paulo, SP, Brazil
| |
Collapse
|
19
|
Boukobza M, Smaali I, Duval X, Laissy JP. Convexity Subarachnoid Hemorrhage, Pseudomonas Aeruginosa (PA) Infective Endocarditis and Left Atrial Appendage Occluder (LAAO) Device Infection. A Case Report. Open Neuroimag J 2017; 11:26-31. [PMID: 28660006 PMCID: PMC5470070 DOI: 10.2174/1874440001711010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/18/2017] [Revised: 03/07/2017] [Accepted: 04/20/2017] [Indexed: 12/20/2022] Open
Abstract
An 83 year-old-man with left atrial appendage occluder (LAAO) developed Pseudomonas Aeruginosa (PA) infective endocarditis. MRI at day 3 of onset showed distal small infarcts in both middle cerebral arteries and left postero-inferior cerebellar artery territories. MRI at day 6 revealed two sites of convexity subarachnoid hemorrhage (cSAH). MRA and CTA failed to reveal a Mycotic aneurysm. The radiologic findings favor the assumption of necrosis of distal branches of mca or of pial arteries wall. This case present three unusual features: the presence of localized cSAH after initiation of antibiotherapy without mycotic aneurysm being individualized; the late occurrence of infective endocarditis after LAAO implantation; the very rare occurrence of PA in prosthetic infections.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Ibtissem Smaali
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM Clinical Investigation Center 007, (S.T., X.D.) and INSERM U738, (C.L., X.D.) Université Paris Diderot, Sorbonne Paris Cité, France
| | - Jean-Pierre Laissy
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France
| |
Collapse
|
20
|
San-Juan R, Pérez-Montarelo D, Viedma E, Lalueza A, Fortún J, Loza E, Pujol M, Ardanuy C, Morales I, de Cueto M, Resino-Foz E, Morales-Cartagena MA, Fernández-Ruiz M, Rico A, Romero MP, Fernández de Mera M, López-Medrano F, Orellana MÁ, Aguado JM, Chaves F. Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study. Eur J Clin Microbiol Infect Dis 2017; 36:1757-1765. [PMID: 28477236 DOI: 10.1007/s10096-017-2989-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 11/24/2022]
Abstract
Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14-7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.
Collapse
Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain.
| | - D Pérez-Montarelo
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - E Viedma
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - A Lalueza
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Madrid, Spain
| | - E Loza
- Department of Microbiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - M Pujol
- Department of Infectious Diseases, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain
| | - C Ardanuy
- Department of Microbiology, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain
| | - I Morales
- Department of Infectious Diseases, University Hospital Virgen de la Macarena, Seville, Spain
| | - M de Cueto
- Department of Microbiology, University Hospital Virgen de la Macarena, Seville, Spain
| | - E Resino-Foz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M A Morales-Cartagena
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - A Rico
- Unit of Infectious Diseases, University Hospital La Paz, Madrid, Spain
| | - M P Romero
- Department of Microbiology, University Hospital La Paz, Madrid, Spain
| | - M Fernández de Mera
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M Á Orellana
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - F Chaves
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| |
Collapse
|
21
|
Bhatia N, Agrawal S, Garg A, Mohananey D, Sharma A, Agarwal M, Garg L, Agrawal N, Singh A, Nanda S, Shirani J. Trends and outcomes of infective endocarditis in patients on dialysis. Clin Cardiol 2017; 40:423-429. [PMID: 28300288 DOI: 10.1002/clc.22688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/20/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 ± 15 years vs 62 ± 18 years) and more likely to be female (47% vs 40%) and African-American (47% vs 40%; all P < 0.001). Hospitalizations for IE in the dialysis group increased from 175 to 222 per 10 000 patients (P trend = 0.04). Staphylococcus aureus was the most common microorganism isolated in both dialysis (61%) and nondialysis (45%) groups. IE due to S aureus (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.73-1.84), non-aureus staphylococcus (aOR: 1.72, 95% CI: 1.64-1.80), and fungi (aOR: 1.4, 95% CI: 1.12-1.78) were more likely in the dialysis group, whereas infection due to gram-negative bacteria (aOR: 0.85, 95% CI: 0.81-0.89), streptococci (aOR: 0.38, 95% CI: 0.36-0.39), and enterococci (aOR: 0.78, 95% CI: 0.74-0.82) were less likely (all P < 0.001). Dialysis patients had higher in-hospital mortality (aOR: 2.13, 95% CI: 2.04-2.21), lower likelihood of valve-replacement surgery (aOR: 0.82, 95% CI: 0.76-0.86), and higher incidence of stroke (aOR: 1.08, 95% CI: 1.03-1.12; all P < 0.001). We demonstrate rising incidence of IE-related hospitalizations in dialysis patients, highlight significant differences in baseline comorbidities and microbiology of IE compared with the general population, and validate the association of long-term dialysis with worse in-hospital outcomes.
Collapse
Affiliation(s)
- Nirmanmoh Bhatia
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sahil Agrawal
- Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Aakash Garg
- Department of Internal Medicine, St. Peter's University Hospital, New Brunswick, New Jersey
| | | | - Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Manyoo Agarwal
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Lohit Garg
- Division of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Amitoj Singh
- Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Sudip Nanda
- Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jamshid Shirani
- Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania
| |
Collapse
|
22
|
Hosseini SMJ, Bakhshian R, Moshkani Farahani M, Abdar Esfahani M, Bahrami A, Sate A. An observational study on infective endocarditis: a single center experience. Res Cardiovasc Med 2015; 3:e18423. [PMID: 25785248 PMCID: PMC4347754 DOI: 10.5812/cardiovascmed.18423] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/20/2014] [Accepted: 10/05/2014] [Indexed: 11/21/2022] Open
Abstract
Background: Cloning of microorganisms on heart endothelium can lead to infective endocarditis (IE). The prototypic lesion of infective endocarditis, the vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Objectives: The aim of this study was to evaluate patients with IE and also focusing on echocardiographic data and comparison between TTE (transthoracic echocardiography) and TEE (transesophageal echocardiography) of native and prosthetic valve endocarditis and the final impact of IE (infective endocarditis) in these patients with endocarditis. Patients and Methods: All patients with IE admitted to our center between 2007 and 2010 were studied. All echocardiographies were performed by the same echocardiographer. Echocardiography and lab tests were performed for all patients. We used SPSS 16 for data analysis. Results: We studied 35 patients, 45% male and 55% female with a mean age of 56.36 ± 12.44 years. Fever (80%) and chills (65.7%) were the most common symptoms. There was only a positive blood culture and enterococci sensitive to vancomycin and amoxicillin. The most involved valve was mitral (54.2%) and then aortic valve (48.5%) (two patients had vegetation on both aortic and mitral valves). In this study, specificity and sensitivity of TEE were 100% and 88.6%. Six patients (17.1%) died and six patients needed surgery. Conclusions: Endocarditis is an important disease with a high mortality rate if not treated appropriately. Therefore, these patients need more attention. In echocardiography, vegetation and complications of IE such as abscess and paravalvular leakage can be detected.
Collapse
Affiliation(s)
| | - Ramezan Bakhshian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Maryam Moshkani Farahani
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Maryam Moshkani Farahani, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125162330, Fax: +98-2181263420, E-mail:
| | | | - Amir Bahrami
- Occupational Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Ali Sate
- Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
23
|
Rhodes DV, Crump KE, Makhlynets O, Snyder M, Ge X, Xu P, Stubbe J, Kitten T. Genetic characterization and role in virulence of the ribonucleotide reductases of Streptococcus sanguinis. J Biol Chem 2013; 289:6273-87. [PMID: 24381171 DOI: 10.1074/jbc.m113.533620] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Streptococcus sanguinis is a cause of infective endocarditis and has been shown to require a manganese transporter called SsaB for virulence and O2 tolerance. Like certain other pathogens, S. sanguinis possesses aerobic class Ib (NrdEF) and anaerobic class III (NrdDG) ribonucleotide reductases (RNRs) that perform the essential function of reducing ribonucleotides to deoxyribonucleotides. The accompanying paper (Makhlynets, O., Boal, A. K., Rhodes, D. V., Kitten, T., Rosenzweig, A. C., and Stubbe, J. (2014) J. Biol. Chem. 289, 6259-6272) indicates that in the presence of O2, the S. sanguinis class Ib RNR self-assembles an essential diferric-tyrosyl radical (Fe(III)2-Y(•)) in vitro, whereas assembly of a dimanganese-tyrosyl radical (Mn(III)2-Y(•)) cofactor requires NrdI, and Mn(III)2-Y(•) is more active than Fe(III)2-Y(•) with the endogenous reducing system of NrdH and thioredoxin reductase (TrxR1). In this study, we have shown that deletion of either nrdHEKF or nrdI completely abolishes virulence in an animal model of endocarditis, whereas nrdD mutation has no effect. The nrdHEKF, nrdI, and trxR1 mutants fail to grow aerobically, whereas anaerobic growth requires nrdD. The nrdJ gene encoding an O2-independent adenosylcobalamin-cofactored RNR was introduced into the nrdHEKF, nrdI, and trxR1 mutants. Growth of the nrdHEKF and nrdI mutants in the presence of O2 was partially restored. The combined results suggest that Mn(III)2-Y(•)-cofactored NrdF is required for growth under aerobic conditions and in animals. This could explain in part why manganese is necessary for virulence and O2 tolerance in many bacterial pathogens possessing a class Ib RNR and suggests NrdF and NrdI may serve as promising new antimicrobial targets.
Collapse
Affiliation(s)
- DeLacy V Rhodes
- From the Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, Virginia 23298 and
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Hajihossainlou B, Heidarnia MA, Sharif Kashani B. Changing pattern of infective endocarditis in Iran: A 16 years survey. Pak J Med Sci 2013; 29:85-90. [PMID: 24353514 PMCID: PMC3809170 DOI: 10.12669/pjms.291.2682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the changes in characteristics of patients with infective endocarditis in Iran and comparing the results with the changing profiles of Infection Endocarditis (IE) in other countries. METHODOLOGY We studied all patients with definite or possible IE seen at four referral teaching hospitals in Iran from Jan. 1995 to Dec. 2010. The data was analyzed both collectively and separately in two consecutive eight-year periods, i.e. 1995-2003 and 2004-2010. RESULTS A total of 286 episodes of IE, 172 males and 114 females, were reviewed from which 162 ones were in the first eight-year time period and 124 episodes in the second one. Mean age of the patients was significantly increased in the second eight-year period (24.2±11 vs 39.4±15 years old, p value = 0.01). Increase in the episodes caused by Staphylococcus aureus was significant (40.7% vs 22.8%, p value = 0.01). The mean size of the vegetation was noticeably higher among IDUs than non-IDUs (1.53±0.1cm vs 0.76±0.2cm, p value < 0.001). As well as extra cardiac complications, mortality rate was noticeably higher among the patients with vegetation size ≥ 1cm (34.4% vs 16.3%, p value = 0.003). There was not a significant difference regarding the mortality rate between the conservatively and surgically treated patients (20.7% vs 22.9%, p value = 0.07). CONCLUSION The most important changing characteristic of IE which influences the outcome of the disease seems to be vegetation size which can account for as the outcome predictor.
Collapse
Affiliation(s)
- Behnam Hajihossainlou
- Behnam Hajihossainlou, MD, Graduate Student in Clinical Research Program, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Ali Heidarnia
- Mohammad-Ali Heidarnia, MD, Assistant Professor, Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- Dr. Babak Sharif Kashani, MD, Assistant Professor, Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
Meidani M, Taghavi M, Abdar Esfahani M. Aortic valve streptococcus group B endocarditis post-extracorporeal shock wave lithotripsy. ARYA Atheroscler 2013; 9:300-2. [PMID: 24302939 PMCID: PMC3845697] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/08/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sub-acute left-sided bacterial endocarditis is a serious condition that may present with variable clinical manifestations. Its symptoms include both sterile and infected emboli, and various immunological phenomena. CASE REPORT This report presents a 55 year old man with frequency and dysuria after a lithotripsy and several admissions with urosepsis. Due to the suspicion of infective endocarditis echocardiography was done which confirmed streptococcus group B endocarditis. CONCLUSION Streptococci group B is one of the rare causes of infective endocarditis, but it was observed after various producers such as lithotripsy.
Collapse
Affiliation(s)
- Mohsen Meidani
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Taghavi
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Abdar Esfahani
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Morteza Abdar Esfahani,
| |
Collapse
|
26
|
Kang G, Yang TK, Choi JH, Heo ST. Effectiveness of mechanical embolectomy for septic embolus in the cerebral artery complicated with infective endocarditis. J Korean Med Sci 2013; 28:1244-7. [PMID: 23960455 PMCID: PMC3744716 DOI: 10.3346/jkms.2013.28.8.1244] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Received: 11/30/2012] [Accepted: 04/10/2013] [Indexed: 12/03/2022] Open
Abstract
There has been a controversy over data of thrombolytic and endovascular surgical treatment about cerebral infarction secondary to infective endocarditis. We report a woman who received early mechanical embolectomy as a treatment of acute stroke with infective endocarditis. A 35-yr-old woman was hospitalized due to right hemiparesis. Brain image showed cerebral infarction at the middle cerebral artery and echocardiography demonstrated vegetation at the mitral valve. She was successfully treated with embolectomy and parenteral antibiotics without any neurologic sequelae. This report shows that the early retrieve of septic cerebral emboli can be a helpful treatment of acute stroke associated with endocarditis.
Collapse
Affiliation(s)
- Gimoon Kang
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Tae Ki Yang
- Department of Neurosurgery, Jeju National University School of Medicine, Jeju, Korea
| | - Joon Hyouk Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
27
|
Abstract
Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.
Collapse
Affiliation(s)
- Min Hee Lim
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Sun Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| |
Collapse
|
28
|
Kobayashi D, Delius RE, Aggarwal S. Successful replacement of common atrioventricular valve with a single mechanical prosthetic valve in an infant with repaired complete atrioventricular septal defect and methicillin-resistant Staphylococcus aureus endocarditis. CONGENIT HEART DIS 2012; 8:E134-8. [PMID: 22883625 DOI: 10.1111/j.1747-0803.2012.00698.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2012] [Indexed: 11/26/2022]
Abstract
A 4-month-old infant with trisomy 21 and repaired complete atrioventricular septal defect developed endocarditis with methicillin-resistant Staphylococcus aureus in the early postoperative period. We report the successful replacement of the common atrioventricular valve with a single St. Jude mechanical prosthetic valve, along with an intraluminal pulmonary artery banding to restrict pulmonary flow.
Collapse
Affiliation(s)
- Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Mich, USA
| | | | | |
Collapse
|