Infective Endocarditis Related to Unusual Microorganisms: A Prospective Population-Based Study

Abstract Background Increased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms. Methods We performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci. Results Of 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in >1 case: Candida albicans (n = 4), Cutibacterium acnes (n = 4), Pseudomonas aeruginosa (n = 3), Cardiobacterium hominis (n = 3), and Coxiella burnetii (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; P = .002), prosthetic valve (40.5% vs 18.1%; P = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; P = .003), and who were more often nosocomial (38.1% vs 20.2%; P = .02). Conclusions In this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition. Trial registration ORCID 0000-0003-3617-5411

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CUMULATIVE RISK OF INFECTIVE ENDOCARDITIS IN CHILDREN WITH CONGENITAL HEART DISEASE – A POPULATION-BASED STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)60820-1 ◽

2012 ◽

Vol 59 (13) ◽

pp. E819

Author(s):

Dinela Rushani ◽

Jay S. Kaufman ◽

Raluca lonescu-lttu ◽

Andrew Mackie ◽

Louise Pilote ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Infective Endocarditis ◽

Congenital Heart ◽

Cumulative Risk ◽

Population Based ◽

Population Based Study

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Three Separate Clinical Entities of Infective Endocarditis—A Population-Based Study From Southern Finland 2013–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa334 ◽

2020 ◽

Vol 7 (9) ◽

Author(s):

Mika Halavaara ◽

Timi Martelius ◽

Veli-Jukka Anttila ◽

Asko Järvinen

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Prosthetic Valve ◽

Risk Group ◽

Case Fatality ◽

Risk Groups ◽

Population Based ◽

Intravenous Drug Use ◽

Population Based Study ◽

Population Based Survey

Abstract Background Health care–associated infective endocarditis (HAIE) and intravenous drug use–related IE (IDUIE) have emerged as major groups in infective endocarditis (IE). We studied their role and clinical picture in a population-based survey. Methods A population-based retrospective study including all adult patients diagnosed with definite or possible IE in Southern Finland in 2013–2017. IE episodes were classified according to the mode of acquisition into 3 groups: community-acquired IE (CAIE), HAIE, and IDUIE. Results Total of 313 episodes arising from 291 patients were included. Incidence of IE was 6.48/100 000 person-years. CAIE accounted for 38%, HAIE 31%, and IDUIE 31% of IE episodes. Patients in the IDUIE group were younger, and they more frequently had right-sided IE (56.7% vs 5.0%; P < .001) and S. aureus as etiology (74.2% vs 17.6%; P < .001) compared with the CAIE group. In-hospital (15.1% vs 9.3%; P = .200) and cumulative 1-year case fatality rates (18.5% vs 17.5%; P = .855) were similar in CAIE and IDUIE. Patients with HAIE had more comorbidities, prosthetic valve involvement (29.9% vs 10.9%; P = .001), enterococcal etiology (20.6% vs 5.9%; P = .002), and higher in-hospital (27.8% vs 15.1%; P = .024) and cumulative 1-year case fatality rates (43.3% vs 18.5%; P < .001) than patients with CAIE. Staphylococcus aureus caused one-fifth of IE episodes in both groups. Conclusions Our study indicates that in areas where injection drug use is common IDUIE should be regarded as a major risk group for IE, along with HAIE, and not seen as part of CAIE. Three different risk groups, CAIE, HAIE, and IDUIE, with variable characteristics and outcome should be recognized in IE.

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Bacteriological Profile of Heart Valves Resected from Infective Endocarditis Patients

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v7i2.3017 ◽

1970 ◽

Vol 7 (2) ◽

pp. 108-111

Author(s):

S Manandhar ◽

S Basnyat ◽

J Sharma ◽

BM Pokhrel ◽

B Koirala

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Heart Valve ◽

Prosthetic Valve ◽

Heart Valves ◽

Significant Risk ◽

Prosthetic Heart Valve ◽

Prosthetic Valve Endocarditis ◽

Diffusion Method ◽

Post Surgery

Background: Early prosthetic valve endocarditis is a serious life threatening infection of newly implanted prosthetic heart valve. A positive post-surgery heart valve culture is a significant risk factor for development of early prosthetic valve endocarditis. Methods: A prospective bacteriological investigation was done in intraoperatively suspected and preoperatively diagnosed infective endocarditis patients undergoing heart valve replacement surgery. The valve samples were cultured after prior homogenization by sterile scalpel method. The bacterial isolates were identified by standard microbiological techniques and their antibiotic susceptibility profile was determined in vitro by Kirby Bauer disc diffusion method. Results: Of 31 heart valve samples cultured, 3 (9.67%) were culture positive which constituted 2 (13.33%) from preoperatively diagnosed infective endocarditis patients from which Staphylococcus aureus and Enterococcus faecalis were isolated and 1 (6.25%) from intraoperatively suspected infective endocarditis patient from which Staphylococcus aureus was isolated. All three isolates were sensitive to antibiotics Vancomycin and Ciprofloxacin and resistant to Penicillin and Amoxycillin. The isolates obtained from preoperatively diagnosed patients were more resistant to antibiotics tested than that from suspected patients. Conclusions: The bacteriological examination of heart valves resected from preoperatively diagnosed and intraoperatively suspected infective endocarditis patients revealed higher degree of culture positivity. Hence routine microbiological examination of all heart valves from diagnosed and suspected IE patients is required to rule out active endocardial infection to reduce the chance of early prosthetic valve endocarditis. Key words: bacteriology; heart valves; infective endocarditis DOI: 10.3126/jnhrc.v7i2.3017 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 108-111

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