Infective Endocarditis: Diagnosis and Treatment

2012 ◽  
Author(s):  
John W. Wilson ◽  
Lynn L. Estes
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Involvement ◽  
Early Postoperative Period ◽  
Causative Organism ◽  
Viridans Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Therapeutic Decisions ◽  
Persistent Bacteremia ◽  
Microbiologic Diagnosis

• Viridans streptococci•Staphylococcus aureus• Enterococci• HACEK organisms• Same as native valves, plus• Coagulase-negative staphylococci• Fungi• Gram-negative rods (early postoperative period)The diagnosis of infective endocarditis (IE) rests on demonstrated evidence of cardiac involvement and persistent bacteremia due to microorganisms that typically cause endocarditis. Establishing a microbiologic diagnosis is critical to therapeutic decisions. Every effort should be made to identify the causative organism....

scholarly journals National Temporal Trend Analysis of Infective Endocarditis among Patients Infected with HIV in Spain (1997–2014): A Retrospective Study

2019 ◽  
Vol 8 (8) ◽  
pp. 1167 ◽  
Author(s):  
Maria Fe Muñoz-Moreno ◽  
Pablo Ryan ◽  
Alejandro Alvaro-Meca ◽  
Jorge Valencia ◽  
Eduardo Tamayo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Infective Endocarditis ◽  
Hospital Admissions ◽  
Downward Trend ◽  
Coagulase Negative Staphylococci ◽  
Data Set ◽  
Gram Negative ◽  
Epidemiological Trend ◽  
Incidence And Mortality ◽  
Significant Downward Trend

Background: People living with human immunodeficiency virus (HIV) (PLWH) form a vulnerable population for the onset of infective endocarditis (IE). We aimed to analyze the epidemiological trend of IE, as well as its microbiological characteristics, in PLWH during the combined antiretroviral therapy era in Spain. Methods: We performed a retrospective study (1997–2014) in PLWH with data obtained from the Spanish Minimum Basic Data Set. We selected 1800 hospital admissions with an IE diagnosis, which corresponded to 1439 patients. Results: We found significant downward trends in the periods 1997–1999 and 2008–2014 in the rate of hospital admissions with an IE diagnosis (from 21.8 to 3.8 events per 10,000 patients/year; p < 0.001), IE incidence (from 18.2 to 2.9 events per 10,000 patients/year; p < 0.001), and IE mortality (from 23.9 to 5.5 deaths per 100,000 patient-years; p < 0.001). The most frequent microorganisms involved were staphylococci (50%; 42.7% Staphylococcus aureus and 7.3% coagulase-negative staphylococci (CoNS)), followed by streptococci (9.3%), Gram-negative bacilli (8.3%), enterococci (3%), and fungus (1.4%). During the study period, we found a downward trend in the rates of CoNS (p < 0.001) and an upward trends in streptococci (p = 0.001), Gram-negative bacilli (p < 0.001), enterococci (p = 0.003), and fungus (p < 0.001) related to IE, mainly in 2008–2014. The rate of community-acquired IE showed a significant upward trend (p = 0.001), while the rate of health care-associated IE showed a significant downward trend (p < 0.001). Conclusions: The rates of hospital admissions, incidence, and mortality related to IE diagnosis in PLWH in Spain decreased from 1997 to 2014, while other changes in clinical characteristics, mode of acquisition, and pathogens occurred over this time.

Point: Fluoroquinolone-Based Antibacterial Chemoprophylaxis in Neutropenic Cancer Patients Works for Defined Outcomes in Defined Populations, but Must Be Used Wisely

2004 ◽  
Vol 2 (5) ◽  
pp. 433-444 ◽  
Author(s):  
Eric J. Bow
Keyword(s):  
Viridans Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Prescribing Behavior ◽  
Phase Ii Clinical Trials ◽  
Empirical Antibacterial Therapy ◽  
Invasive Infections ◽  
Neutropenic Patients ◽  
Related Mortality

Fluoroquinolone-based antibacterial chemoprophylaxis administered in situations in which the prevalence of fluoroquinolone-resistant Escherichia coli is low (<3% to 5%) can reliably reduce the risk for invasive gram-negative bacillary infection, and, if supplemented by gram-positive agents such as rifampin, penicillin, or macrolides, can reduce the risk of developing invasive infections caused by gram-positive microorganisms, including Viridans streptococci and coagulase-negative staphylococci. In the published literature, fluoroquinolone-based chemoprophylaxis does not reliably reduce the incidence of febrile neutropenic episodes, neutropenic episode-related mortality, or physician-initiated systemic antimicrobial prescribing behavior. Prophylaxis should only be prescribed in defined patient populations from the first day of cytotoxic therapy until neutrophil regeneration in environments in which the prevalence of gram-negative bacillary resistance to the prophylaxis strategy is low. Small phase II clinical trials suggest that empirical antibacterial therapy of unexplained fevers in neutropenic patients receiving effective fluoroquinolone-based prophylaxis under defined epidemiologic circumstances may be safely discontinued early. Better discriminators of infection in febrile neutropenic patients are needed.

scholarly journals Disseminated melioidosis with native valve endocarditis: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Hariharan Subramony ◽  
Sengottuvelu Gunasekaran ◽  
Vinodh Kumar Paul Pandi
Keyword(s):  
Infective Endocarditis ◽  
Burkholderia Pseudomallei ◽  
Cardiac Involvement ◽  
Clinical Presentation ◽  
South East Asia ◽  
Northern Australia ◽  
Native Valve ◽  
Gram Negative ◽  
Native Valve Endocarditis ◽  
Case Summary

Abstract Background  Burkholderia pseudomallei is a Gram negative, soil-water saprophytic bacterium endemic in South-East Asia and Northern Australia. Melioidosis is being increasingly diagnosed in other regions like India, China, and Sri Lanka during recent years. The clinical presentation of melioidosis is extremely variable. Case summary  We present a case of melioidosis presenting as native valve infective endocarditis with concomitant hepatic and splenic abscesses. This is the second case of melioidosis with infective endocarditis reported from India. Discussion  Melioidosis can present with pneumonia, pleural effusion, subcutaneous abscesses, visceral abscesses, osteomyelitis, and septicaemia, but cardiac involvement is rare. Endocarditis due to melioidosis is rare (∼1%) and is rarely reported in literature. This case highlights the unusual presentation of this emerging disease.

COMMON INFECTIONS IN PAEDIATRIC BURN INJURY WOUND

2021 ◽  
pp. 3-4
Author(s):  
Satish Gadade ◽  
Monali Sonawane
Keyword(s):  
Burn Injury ◽  
Complete Blood Count ◽  
Hospital Environment ◽  
Causative Organism ◽  
Klebsiella Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
The Common ◽  
Common Infections ◽  
Burn Patient

Introduction: The incidence of burns, their treatment and rehabilitation process have a considerably marked effect on children in both physical and psychological terms. Disruption of homeostatic and barrier functions leaves the underlying tissues highly susceptible to infection. Such local infections, when left unchecked, can quickly result in systemic infection. In the present study discussion on the common infections and the causative organism and its effect on the outcome of the burn patient studied. Aim and Objectives: The aim of the study to nd out the common infection in burn injury wound and study the common factors precipitating complications in burn injury. Materials and Methods: The Data was collected from 86 paediatric patients less than 15 years admitted in GMC, Miraj, Maharashtra during the period from September 2014 to September 2016. The lab investigations were done periodically and as and when required, time to time including Hemoglobin, complete blood count, blood sugar level, blood urea level, serum creatinine, HIV Status, hepatitis B status and weakly wound swab culture were done. Observations and Results: In our study a total of 83 patients, almost 32(38.5%) of admitted patients had developed infections and the most common developed infection in the burning patient was wound infection. The most common organism isolated was Coagulase negative staphylococci 18 cases (21.7%) followed by klebsiella Pneumonia in 6 cases. No organisms seen in 51 cases. The coagulase negative staph sensitive to cefoxitin and klebsiella Pneumonia sensitive to imipanum. Conclusion: Gram-negative bacteria were the commonest pathogens followed by gram-positives and then fungi. In additional, MRSA was the commonest frequent gram-positive bacteria detected and it is the major cause for infection. Fungal and Gram-negative colonization more associated with higher TBSA burnt and prolonged hospitalization. We recommended that regular microbial surveillance of burn patient and hospital Environment microbiological surveillance of potential nosocomial pathogens indicated inanimate environment of patients should be done to nd out the presences of our pathogens which are contaminated

scholarly journals A Rare Culprit of Infective Endocarditis in an IV Drug User: Burkholderia cepacia

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher Nnaoma ◽  
Ogechukwu Chika-Nwosuh ◽  
Christoph Sossou
Keyword(s):  
Staphylococcus Aureus ◽  
Heart Disease ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Burkholderia Cepacia ◽  
Mechanical Valve ◽  
Prosthetic Heart Valves ◽  
Viridans Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Iv Drug Abuse

Infective endocarditis (IE) is an infection of the cardiac native or prosthetic valves typically caused by Staphylococcus aureus, viridans streptococci group, and coagulase-negative staphylococci. Risk factors include congenital heart disease, structural and valvular heart disease, implantation of prosthetic heart valves, and intravenous (IV) drug abuse. IE caused by organisms such as Burkholderia cepacia is rarely seen. We herein present a case of a patient with a history of IV drug abuse previously treated for Staphylococcus aureus IE with newly diagnosed IE secondary to B. cepacia. He was taken to the operating room for mitral valve replacement after an echocardiogram revealed severe mitral regurgitation. He was successfully treated with antibiotics. After 2 months, at follow-up, the patient remained free from mechanical valve-related events, had no new occurrences of fever, and had no other symptoms of infection. He reported good exercise tolerance.

The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

2020 ◽  
Vol 21 (12) ◽  
pp. 1140-1153 ◽  
Author(s):  
Mohammad A. Noshak ◽  
Mohammad A. Rezaee ◽  
Alka Hasani ◽  
Mehdi Mirzaii
Keyword(s):  
Foreign Body ◽  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Human Life ◽  
Prosthetic Valve Endocarditis ◽  
Surgical Site Infections ◽  
Coagulase Negative Staphylococci ◽  
Native Valve ◽  
Native Valve Endocarditis

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

scholarly journals Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland

2021 ◽  
Vol 18 (5) ◽  
pp. 2785
Author(s):  
Agnieszka Chmielarczyk ◽  
Monika Pomorska-Wesołowska ◽  
Dorota Romaniszyn ◽  
Jadwiga Wójkowska-Mach
Keyword(s):  
Bloodstream Infections ◽  
Diagnostic Techniques ◽  
Resistance Mechanisms ◽  
Infection Prevention And Control ◽  
The South ◽  
Coagulase Negative Staphylococci ◽  
Aminoglycoside Resistance ◽  
Gram Negative ◽  
Maldi Tof ◽  
Carbapenem Resistant

Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. Patients and methods: Data on 4218 LC-BSIs were collected between 2016–2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. Results: Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. Conclusions: The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.

Atypical Pharyngitis In Suppurative Otitis Media Cases

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P98-P99
Author(s):  
Alaa A Abou-Bieh ◽  
Mona F Salama
Keyword(s):  
Middle Ear ◽  
Causative Organism ◽  
Isolation And Identification ◽  
Middle Ear Mucosa ◽  
Suppurative Otitis Media ◽  
Gram Negative ◽  
Middle Ear Infection ◽  
Gram Negative Organisms ◽  
Micro Organisms ◽  
Middle Ear Cleft

Problem Unexplained persistent or recurrent bacterial pharyngitis in some patients who suffer from infected middle ear cleft. Methods Bacteriological swabs were obtained from both the ears and the pharynx of 37 cases with chronic otorrhea and perforation, whom complain of recurrent or persistent sore-throat. Then isolation and identification of the micro-organisms were done. This included examination of direct Gram stained films and cultures. Isolated Gram negative bacilli were subjected to further identification by the biochemical reactions and antibiotyping. Identical isolates from the same patient (ear and pharyngeal swabs) were subjected to further identification by genotyping using the pulsed field gel electrophoresis technique. Results 6 cases (16%) showed identity in phenotypes and genotypes for ear and pharyngeal samples from the same patient. All pharyngeal isolates were Gram negative organisms. 4 of them were Pseudomonas aeruginosa, 1 was Proteus sp., and 1 was Escherichia coli. All of these 3 species are not known to be among the primary organisms which may cause pharyngitis. Conclusion Bacterial pharyngitis in patients with chronically infected middle ear cleft may be attributed to the same organism invaded the middle ear mucosa. Also this study highlights some organisms as a pharyngeal invaders although they are not among the previously documented causatives of bacterial pharyngitis. But the study do not confirm the method of spread of these organisms and whether this was directly via the eustachian tube. Significance The study correlates the causative organism of the middle ear infection and that infected the pharyngeal mucosa utilizing the advanced bacteriological identification and genotyping techniques.

scholarly journals 695. Infective endocarditis in people who inject drugs (PWID) at UK Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S399-S400
Author(s):  
Evelyn Villacorta Cari ◽  
John T Henderson ◽  
Donna R Burgess ◽  
J Zachary Porterfield ◽  
Nicole Leedy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Bacterial Infections ◽  
Medical Center ◽  
Cross Sectional Study ◽  
Addiction Medicine ◽  
University Of Kentucky ◽  
Cross Sectional ◽  
Health Crisis ◽  
Gram Negative

Abstract Background The Intravenous Drug Use (IVDU) epidemic has been developing into a public health crisis in the last twenty years. As a result, the incidence of severe bacterial infections such as infective endocarditis (IE) has been rising dramatically. Methods Cross-sectional study, we reviewed records of all admissions to University of Kentucky hospitals with IVDU associated ICD9/10 codes who received an Infectious Diseases consult during 2018 and focused on the cases with a diagnosis of IE. We describe associated epidemiologic, clinical, and microbiological features Results We include 391 patients in this cohort, among those 157 patients were for IE. Patients had a median age of 34 years old (range: 20 - 62); 81 (51.5%) were female, and five (6.1%) were pregnant and 153 (97.4%) identified as white. A previous episode of infective endocarditis was reported in 55 (35%) cases. The most common illicit substances used were heroin 68 (43.3%) and methamphetamine 65 (41.45%). Tobacco abuse was reported in 134 (86.4%) cases. Fever reported in 93 (59.8%) cases, shortness of air in 43 (28.0%) cases, and chest pain in 44 (28.6%) cases were the most common symptoms. Hepatitis C antibody was positive in 115/149 (73.2%) and 3/143 (1.9%) were HIV positive. Right-sided IE was more frequent, the tricuspid valve was involved in 94 (59.8%) patients. Gram-positive pathogens were isolated in 139 (88.5%) patients, Staphylococcus aureus was isolated in 102 (64.9%) patients, of which 67 (65.7%) were methicillin resistant. Gram-negative pathogens were isolated in 18 (11.2%) patients. Eighty-eight (56.4%) patients had an addiction medicine consult during their admission, (22.9%) patients left against medical advice and 20 (12.7%) patients needed to be readmitted within 30 days after discharge. Overall mortality was 12.7% and was significantly associated with infection by gram-negative pathogens (RR: 2.5; CI 95% 1.05 – 6.25, p=0.037). Conclusion Infectious endocarditis is a frequent complication in PWID which carries a high risk of mortality and often involves the tricuspid valve. The most common pathogen isolated was S. aureus, isolation of gram-negative pathogens was associated with increased mortality. Disclosures All Authors: No reported disclosures

scholarly journals Multidrug-resistant bacteria isolated from surgical site of dogs, surgeon's hands and operating room in a veterinary teaching hospital in Brazil

2021 ◽  
Author(s):  
Mareliza Possa de Menezes ◽  
Mariana Borzi ◽  
Mayara Ruaro ◽  
Marita Cardozo ◽  
Fernando Ávila ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
High Rate ◽  
Resistant Bacteria ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Source Of Infection ◽  
The One ◽  
Clean Contaminated ◽  
In The Beginning ◽  
Coagulase Positive Staphylococci

Abstract The aim of this study was to evaluate the prevalence and antimicrobial resistance profile of Gram-positive cocci and Gram-negative bacilli isolated from the surgical environment. All samples were collected during the intraoperative period of clean/clean-contaminated (G1) and contaminated (G2) surgery. A total of 150 samples were collected from the surgical wound in the beginning (n = 30) and end (n = 30) of the procedure, surgeon’s hands before (n = 30) and after (n = 30) antisepsis and the surgical environment (n = 30). Forty-three isolates with morphological and biochemical characteristics of Staphylococcus spp. and 13 of Gram-negative bacilli were obtained. Coagulase-negative staphylococci (85.71% [18/21]), coagulase-positive staphylococci (9.52% [2/21]) and Pseudomonas spp. (47.52% [1/21]) in G1, and coagulase-negative staphylococci (40% [14/35]), coagulase-positive staphylococci (20% [7/35]), Proteus spp. (17.14% [6/35]), E. coli (8.57% [3/35]), Pseudomonas spp. (2.86% [1/35]) and Salmonella spp. (2.86 [1/35]) in G2 were more frequently isolated, and a high incidence of multidrug resistance was observed in coagulase-negative staphylococci (87.5% [28/32]), coagulase-positive staphylococci (100% [11/11]) and Gram-negative bacilli (76.92% [10/13]). Methicillin-resistant Staphylococcus spp. accounted for 83.72% (36/43) of the Staphylococcus strains. Gram-negative bacilli cefotaxime-resistance constituted 81.82% (9/11) and imipenem resistance constituted 53.85% (7/13). The high rate of resistance of commensal bacteria found in our study is worrying. Coagulase-negative staphylococci are community pathogens related to nosocomial infections in human and veterinary hospitals, their presence in healthy patients and in veterinary professionals represent an important source of infection in the one health context. Continuous surveillance and application of antimicrobial stewardship programs are essential in the fight against this threat.

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