The 3 noes right-sided infective endocarditis: a unrecognized type of right-sided endocarditis

Abstract Introduction The “3 noes right-sided infective endocarditis” (3no-RSIE: no left-sided, no drug users, no cardiac devices) was depicted for the first time more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Methods Eight tertiary centers with surgical facilities participated in this study. Patients with right-sided endocarditis without left involvement, absence of antecedents of drug use and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analysed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. Results A total of 100 patients (mean age 54.1±20 years, 65% male) with definite 3no-RSIE were included (16.7% of all the right-sided endocarditis of the series). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent, fever was the main manifestation at admission (85%). The microbiological profile is led by Staphylococci spp. Vegetations were detected in 92% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, p<0.001). Non community-acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. Conclusions The clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery plays an important role in improving outcome. Funding Acknowledgement Type of funding source: None

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Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa120 ◽

2020 ◽

Vol 7 (5) ◽

Author(s):

Núria Fernández Hidalgo ◽

Amal A Gharamti ◽

María Luisa Aznar ◽

Benito Almirante ◽

Mohamad Yasmin ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Univariate Analysis ◽

Case Report Form ◽

Predisposing Factor ◽

Cardiac Device ◽

Native Valve ◽

Data Set ◽

Standard Case ◽

Cardiac Devices

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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A changing profile of infective endocarditis at a tertiary hospital in China: A retrospective study from 2001 to 2018

10.21203/rs.2.10674/v2 ◽

2019 ◽

Author(s):

Zuning Ren ◽

Xichao Mo ◽

Hongjie Chen ◽

Jie Peng

Keyword(s):

Infective Endocarditis ◽

Medical Records ◽

Drug Users ◽

Southern China ◽

Age At Onset ◽

Early Period ◽

Tertiary Hospital ◽

Intravenous Drug ◽

Intravenous Drug Users ◽

The Right

Abstract Background: Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in southern China over a period of nearly eighteen years. Methods: Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018. Results: A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDU), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher rate of whole-blood culture positive compared with the early-period group. The in-hospital mortality rate remained about the same between the two periods. Conclusions: Our study demonstrated a dramatic change in the profile and characteristics of IE over a period of eighteen years at a tertiary hospital in southern China, especially the decrease in intravenous drug users (IVDU), which might be responsible for many other changes.

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Isolated Native Tricuspid Valve Endocarditis in a Nonintravenous Drug User

Case Reports in Cardiology ◽

10.1155/2020/8812597 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Habtewold Shibru ◽

Ermias shenkutie Greffie ◽

Zenahbezu Abay ◽

Oumer Abdu Muhie

Keyword(s):

Infective Endocarditis ◽

Tricuspid Valve ◽

Drug Users ◽

High Morbidity ◽

Central Venous ◽

Cardiac Device ◽

Rural Ethiopia ◽

Cardiac Devices ◽

Underlying Risk ◽

Tricuspid Valve Endocarditis

Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.

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Postpartum-Isolated Native Pulmonic Valve Methicillin-Resistant Staphylococcus aureus Infective Endocarditis Complicated by Pelvic Abscess, Clavicle Osteomyelitis, and Polyarticular Septic Arthritis

Case Reports in Infectious Diseases ◽

10.1155/2020/8850340 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Daniela Navarrete ◽

David Hannibal ◽

Sachin M. Patil ◽

Tarang Pankaj Patel ◽

William Roland

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Septic Arthritis ◽

Drug Users ◽

Methicillin Resistant Staphylococcus Aureus ◽

Pelvic Abscess ◽

Injection Drug ◽

Pulmonic Valve ◽

Methicillin Resistant ◽

Cardiac Devices

Isolated native pulmonic valve infective endocarditis (IE) is a rare occurrence. The most commonly involved valves in injection drug users are the tricuspid valve followed by mitral and then aortic valves. Most reported cases of methicillin-resistant Staphylococcus aureus (MRSA) IE involve multiple valves. Isolated involvement of the pulmonic valve in IE is infrequent, especially in intravenous drug users or patients with indwelling catheters, prosthetic valves, or implantable cardiac devices. Here, we report a young postpartum female patient with isolated native pulmonic valve MRSA IE with MRSA bacteremia and history of active injection drug use. A PubMed literature review revealed a single described prior case report in a postpartum female. The patient’s clinical course was complicated by a large native pulmonic valve vegetation, septic pulmonary emboli, pelvic abscess, polyarticular septic arthritis, and clavicular osteomyelitis. The patient underwent bioprosthetic pulmonic valve replacement and finished six weeks of intravenous vancomycin for complete recovery.

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P3661Two-fold increase in incidence of infective endocarditis in the period 1997–2016: a Danish nationwide study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0516 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Dalsgaard Jensen ◽

L Ostergaard ◽

N Eske Bruun ◽

M Voldstedlund ◽

C Torp-Pedersen ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Incidence Rate ◽

Temporal Trends ◽

Fold Increase ◽

Patient Characteristics ◽

Incidence Rates ◽

Study Cohort ◽

Incidence And Mortality ◽

First Time

Abstract Background Infective Endocarditis (IE) is a disease with high mortality. Previous studies have shown considerable differences and contradicting trends in overall incidence and mortality why data from an unselected nationwide cohort is needed. Purpose We investigated temporal trends in the incidence rate and in-hospital mortality of IE in Denmark in the period of 1997–2016. Methods We included cases of first-time IE (1997–2016) using Danish nationwide registries. Crude incidence rates were given for each calendar year. Further, incidence rates were reported for subgroups of age and sex. For the analysis of patient characteristics and in-hospital mortality, the study cohort was grouped into four 5-year intervals (1997–2001, 2002–2006, 2007–2011, 2012–2016). Multivariable adjusted Cox proportional hazard model was used to compare in-hospital mortality between groups. Results A total of 8,147 patients with IE were identified in the period of 1997–2016. The median age and proportion of males increased from 64.3 years (P25-P75: 48–75.5) and 59.1% to 71.8 years (P25-P75: 62.1–79.9) and 67.1% in 1997–2001 and 2012–2016, respectively. The overall incidence rate (Figure 1) increased from 4.68/100.000-person-years (PY) (CI95: 4.17–5.26) to 8.23/100.000 PY (CI95: 7.53–8.99) in 1997 and 2016, respectively. Male incidence increased from 5.35/100.000 PY (CI95: 4.59–6.23) to 11.03/100.000 PY (CI95: 9.9–12.29) and female incidence increased from 4.03/100.000 PY (CI95: 3.38–4.8) to 5.44/100.000 PY (CI95: 4.67–6.35) in 1997 and 2016 respectively. Incidence rates increased more than seven-fold for the oldest age group (≥80 years) from 1997 to 2016 (6.95/100.000 PY [CI95: 5.32–9.08] to 51.19/100.000 PY [CI95: 43.41–60.38], respectively). In-hospital mortality was significantly lower for patients with IE in the period of 2011–2016 compared with 1997–2001 HR: 0.8 (CI95: 0.69–0.92). Figure 1 Conclusion Infective endocarditis incidences are increasing mostly among men and elderly patients. In order to prevent this disease as best as possible, we need more knowledge on causes for this increasing incidence.

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The impact of establishing a regional infective endocarditis (IE) network on pre-operative IE-related complications and on post-operative outcome

European Heart Journal ◽

10.1093/eurheartj/ehab724.1721 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Diab ◽

M Franz ◽

S Hagel ◽

A Guenther ◽

A Struve ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Independent Predictor ◽

Univariate Analysis ◽

Chi Square ◽

Exact Test ◽

Logistic Regression Models ◽

European Guidelines ◽

Management Recommendations ◽

The Impact

Abstract Background Infective endocarditis (IE) requires a high degree of suspicion and advanced level of multidisciplinary management. In 2015, the European guidelines recommended the formation of an endocarditis-team (ET) for optimal treatment of IE. In 2011, we already established an ET within the hospital that was only consulted on demand for certain patients. Since 2015, ET has been increasingly involved in the management of almost all patients with IE. In addition, we established in 2015 a statewide endocarditis- (E) network for the referring hospitals. Purpose We investigated the effect of E-network on reducing referral latency and pre-operative IE-related complications. We also investigated the adherence to the ET management recommendations in our hospital and its impact on post-operative stroke and mortality. Methods We retrospectively analyzed data from patients operated for IE in our center between 01/2007 and 03/2018. We conducted univariate analysis using Chi-square or Fisher's exact test, Multivariate logistic regression models for in-hospital mortality and post-operative stroke, and Kaplan-Meier estimate of 5-years survival. Results Among 630 patients operated for IE in our center, 409 (65%) underwent surgery in the 1st era before 12/2014. S. aureus IE was more frequent in the second era (34% vs 25%, p<0.001). The median time from the onset of symptoms to referral in the 2nd era was halved compared to the first one [7 days (IQR 2–19) vs 15 days (IQR 6–35)]. Patients in the 2nd era were admitted with less IE-related complications, i.e. less preoperative stroke (14% vs 27%, p<0.001), less heart failure (45% vs 69%, p<0.001) less cardiac abscesses (24% vs 34%, p=0.018), less acute renal insufficiency requiring hemodialysis (8% vs 14%, p=0.026). The lack of ET management recommendations was an independent predictor for in-hospital mortality (adjusted OR: 2.13, 95% CI: 1.27–3.53, p=0.004) and post-operative stroke (adjusted OR: 2.23, 95% CI: 1.12–4.39, p=0.02), and was associated with worse 5-years survival (59% compared to 40%, log rank<0.001). Conclusion Endocarditis-network led to earlier referral of patients, which resulted in less IE-related complications on admission. Lack of ET management recommendations was an independent predictor for post-operative stroke, in-hospital mortality and was associated with worse 5-years survival. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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A changing profile of infective endocarditis at a tertiary hospital in China: A retrospective study from 2001 to 2018

10.21203/rs.2.10674/v3 ◽

2019 ◽

Author(s):

Zuning Ren ◽

Xichao Mo ◽

Hongjie Chen ◽

Jie Peng

Keyword(s):

Infective Endocarditis ◽

Medical Records ◽

Drug Users ◽

Southern China ◽

Age At Onset ◽

Early Period ◽

Tertiary Hospital ◽

Intravenous Drug ◽

Intravenous Drug Users ◽

The Right

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A changing profile of infective endocarditis at a tertiary hospital in China: A retrospective study from 2001 to 2018

10.21203/rs.2.10674/v1 ◽

2019 ◽

Author(s):

Zuning Ren ◽

Xichao Mo ◽

Hongjie Chen ◽

Jie Peng

Keyword(s):

Infective Endocarditis ◽

Medical Records ◽

Drug Users ◽

Southern China ◽

Age At Onset ◽

Early Period ◽

Tertiary Hospital ◽

Intravenous Drug ◽

Intravenous Drug Users ◽

The Right

Abstract Background: Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE in southern China over a period of nearly eighteen years. Methods: Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital at Southern Medical University. Data were divided by admission time into two groups: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018. Results: A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDU), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher rate of whole-blood culture positive compared with the early-period group. The in-hospital mortality rate remained about the same between the two periods. Conclusions: Our study demonstrated a dramatic change in the profile and characteristics of IE over a period of eighteen years in southern China, especially the decrease in intravenous drug users (IVDU), which might be responsible for many other changes.

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P2763Clinical prognosis of pure right-sided infective endocarditis without association to cardiac devices or intravenous drug abuse

European Heart Journal ◽

10.1093/eurheartj/ehz748.1080 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Vilardell ◽

S Moral ◽

D Bosch ◽

M Morales ◽

J M Frigola ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Event Rate ◽

Heart Diseases ◽

Meta Analysis ◽

Predisposing Factors ◽

Intravenous Drug ◽

Related Event ◽

Clinical Prognosis ◽

Cardiac Devices

Abstract Background Pure right-sided infective endocarditis (RSIE) without association with cardiac devices or intravenous drug users (IVDUs) is an entity with unclear predisposing factors and prognosis. Purpose To evaluate predisposing factors and prognosis of pure RSIE compared tothose associated to cardiac devices or IVDUs. Methods 280 consecutive patients with endocarditis were included retrospectively in a protocol of clinical and imaging follow-up. Endocarditis-related event was defined as endocarditis mortality or open-surgery requirement. Besides, a review and meta-analysis of the literature between january 2000 and december 2018 were performed. Results Fifty-two (19%) patients presented RSIE: 20 of them (39%) were pure RSIE. Intravascular catheters carriers (25% vs 3%; p=0.026) and congenital heart diseases (20% vs 0%; p=0.018) were associated to pure RSIE. These patients demonstrated the worst clinical prognosis, with the highest in-hospital mortality (25% vs 3%; p=0.026) and endocarditis-related event rate (45% vs 6%; p=0.001), being pure RSIE independently associated with in-hospital endocarditis-related events (OR=8.40; 95% CI, 1.13–62.68; p=0.038). Four studies, including ours, with 315 participants diagnosed of RSIE were evaluated in meta-analysis: 94 individuals (30%) presented pure RSIE.This group demonstrated a higher in-hospital mortality than those with cardiac devices or IVDUs (RR=2.854; 95% CI, 1.640–4.965; P<0.001; I2=0.0%; Figure 1). Figure 1. RSIE and in-hospital mortality based on groups: cases with pure RSIE versus those with cardiac devices or IVDUs. Conclusions Pure RSIE is the worst prognosis group among RSIE with the highest endocarditis-related event rate and in-hospital mortality. This growing group should stake out the benign impression and recommendations given to RSIE among IE patients.

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Infective Endocarditis, Predictors of Mortality and Morbidity

10.21203/rs.3.rs-601096/v1 ◽

2021 ◽

Author(s):

Aditya Eranki ◽

Akshat Saxena ◽

Umar Ali ◽

Eric Slimani

Keyword(s):

Multivariate Analysis ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Heart Block ◽

Complete Heart Block ◽

Univariate Analysis ◽

Secondary Outcome ◽

Mortality And Morbidity ◽

Factors Associated ◽

Valvular Surgery

Abstract Objectives: Infective endocarditis is a disease with high mortality and morbidity. The primary outcome of this study is to assess factors associated with in-hospital mortality in patients undergoing valvular surgery for infective endocarditis. The secondary outcome of this study is to assess the incidence and factors associated with post-operative morbidity; namely post-operative stroke, renal failure and dialysis, complete heart block and return to theatre for bleeding or tamponade. Methods Between the years of 2015 to 2019, a total of 89 patients underwent surgery for infective endocarditis at Fiona Stanley Hospital. Data was collected from the Australia and New Zealand Cardiac Surgery Database from 2015 to 2019 as well as patients electronic medical record (EMR). A number of preoperative and perioperative factors were assessed in relation to patient mortality and morbidity. Univariate and multivariate logistical regression analysis was done to assess for the association between factors and in-hospital mortality and morbidity Results: A total of 89 patients underwent surgery for infective endocarditis, affecting 101 valves. The mean age of patients was 53.7. A total of 79 patients had a positive blood culture pre-operatively, with Staphylococcus Aureus being the most frequently cultured organism (39%). Fourteen patients (16%) were deemed emergent and underwent surgery within 24 hours of review. A total of five patients died within their hospital stay postoperatively. Variables significantly associated with mortality on univariate analysis were intravenous drug use, emergent surgery, perioperative dialysis, perioperative inotropes, cardiopulmonary bypass (CPB) time and cross clamp time (CCT). Only CBP time was significantly associated with mortality on multivariate analysis. A total of 19 patients (21%) required hemodialysis after surgery, 10 patients sustained a postoperative stroke (11%), 15 patients required to return to theatre (17%) and 11 patients developed a complete heart block post operatively (12%). Conclusion There are a number of factors associated with mortality and morbidity in patients undergoing surgery with infective endocarditis. Our study demonstrates a lower mortality rate in these patients than previously quoted in literature. Exposure of prolonged CBP times was the only factor significantly associated with increased mortality on multivariate analysis, although a critical perioperative state was highly significant on univariate analysis.

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