scholarly journals 155. A Case Series of Patients with Gemella Endocarditis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S103-S104
Author(s):  
Abarna Ramanathan ◽  
Steven M Gordon ◽  
Nabin K Shrestha
Keyword(s):  
Heart Valves ◽  
Cleveland Clinic ◽  
Case Series ◽  
Prosthetic Valve Endocarditis ◽  
Blood Cultures ◽  
Valvular Regurgitation ◽  
Native Valve ◽  
Duke Criteria ◽  
Metastatic Infection ◽  
16S Rna

Abstract Background Gemella is a genus of gram-positive bacteria that thrives best at a high partial pressure of CO2 and is an unusual cause of infective endocarditis (IE). Methods We identified cases of Gemella IE in patients aged >18 years old, hospitalized at Cleveland Clinic between July 1, 2007 and January 1, 2017, by screening the Cleveland Clinic IE Registry. Gemella IE was defined as meeting modified Duke Criteria and having Gemella identified as the pathogen (by culture and/or 16S RNA sequencing from explanted valve tissue). Clinical features were obtained by manual chart review. Results A total of 13 cases of Gemella IE (G. haemolysans [6], G. morbillorum [3], G. sanguinis [2], and 2 undifferentiated species) were identified within the study period and accounted for <1% of all cases of IE. 9 were native valve IE and 4 were prosthetic valve endocarditis. Age varied from 20 to 86 years and 77% were male. The most common predisposing factors were pre-existing valvular disease (54%) and congenital heart disease (46%). 3 cases had dental manipulation within the prior 3 months, 3 had bioprosthetic valves, 2 had mechanical heart valves, and 2 were actively using intravenous recreational drugs. All cases were left-sided: 38% involved the aortic valve, 23% the mitral valve and 38% involved both. 69% had positive blood cultures, 38% had positive blood cultures and positive valve PCR, and 31% were identified based on positive valve PCR results only. Not one patient had positive valve cultures. 85% had significant valvular regurgitation and locally invasive disease occurred in 4 patients. Central nervous system emboli occurred in 3 cases and metastatic infection, in the form of lumbar diskitis, in one. All patients were treated surgically and the most commonly used anti-microbials were parenteral ceftriaxone and vancomycin, administered for a median duration of 42 days. All cases survived to hospital discharge and none relapsed over a median follow-up of 2.2 years. Conclusion Gemella species account for less than 1% of cases of IE, with G. haemolysans being the most common species. In a third of cases valve PCR provided the only means of diagnosis. It is effectively treated with surgery and antibiotics. Disclosures All authors: No reported disclosures.

Prosthetic valve endocarditis

ESC CardioMed ◽  
2018 ◽  
pp. 1720-1723
Author(s):  
José A. San Román ◽  
Javier López
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Antibiotic Treatment ◽  
Prosthetic Valve ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Prosthetic Valve Endocarditis ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

scholarly journals Modified Commando Procedure in Complicated Infective Endocarditis - A Case Series.

2020 ◽  
Author(s):  
Po Sung Chen ◽  
Chungyi Chang ◽  
Yicheng Chuang ◽  
Ichen Chen ◽  
Tingchao Lin
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Case Series ◽  
Prosthetic Valve Endocarditis ◽  
Surgical Mortality ◽  
Native Valve ◽  
Case Presentation ◽  
Native Valve Endocarditis ◽  
Fibrous Body ◽  
Urgent Surgery

Abstract Background: Complicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly. Case presentation: We presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding. Conclusions: We suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

scholarly journals Modified commando procedure in complicated infective endocarditis ─ a case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Posung Chen ◽  
Chungyi Chang ◽  
Yicheng Chuang ◽  
Ichen Chen ◽  
Tingchao Lin
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Case Series ◽  
Prosthetic Valve Endocarditis ◽  
Surgical Mortality ◽  
Native Valve ◽  
Case Presentation ◽  
Native Valve Endocarditis ◽  
Fibrous Body ◽  
Urgent Surgery

Abstract Background Complicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly. Case presentation We presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding. Conclusions We suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

Infective Endocarditis

2011 ◽  
Author(s):  
Patrick T. O'Gara
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve Endocarditis ◽  
Bacterial Endocarditis ◽  
Cardiac Complications ◽  
Microbial Infection ◽  
Native Valve ◽  
Duke Criteria ◽  
Clinical Presentations ◽  
Parenteral Drug Abuse ◽  
Criteria For Diagnosis

Infective endocarditis is a microbial infection of a cardiac valve or the mural endocardium caused by bacteria or fungi. Forms of this infection include subacute bacterial endocarditis (SBE) and acute bacterial endocarditis (ABE). Etiology and epidemiology are discussed. There is a section on pathogenesis followed by specific clinical presentations, including endocarditis associated with parenteral drug abuse as well as prosthetic valve endocarditis (PVE). Diagnosis and cardiac complications of endocarditis, treatment, recommendations for prophylaxis, and prognosis are addressed. There are several figures showing manifestations and anatomic relations from the infection. Tables describe microorganisms that cause native valve endocarditis, the etiology of PVE, the Duke criteria for diagnosis of infective endocarditis, antimicrobial therapy for endocarditis in adults, guidelines to prevent endocarditis, and recommendations and regimens for endocarditis prophylaxis. This chapter contains 99 references.

Infective Endocarditis

2011 ◽  
Author(s):  
Patrick T. O'Gara
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve Endocarditis ◽  
Bacterial Endocarditis ◽  
Cardiac Complications ◽  
Microbial Infection ◽  
Native Valve ◽  
Duke Criteria ◽  
Clinical Presentations ◽  
Parenteral Drug Abuse ◽  
Criteria For Diagnosis

Infective endocarditis is a microbial infection of a cardiac valve or the mural endocardium caused by bacteria or fungi. Forms of this infection include subacute bacterial endocarditis (SBE) and acute bacterial endocarditis (ABE). Etiology and epidemiology are discussed. There is a section on pathogenesis followed by specific clinical presentations, including endocarditis associated with parenteral drug abuse as well as prosthetic valve endocarditis (PVE). Diagnosis and cardiac complications of endocarditis, treatment, recommendations for prophylaxis, and prognosis are addressed. There are several figures showing manifestations and anatomic relations from the infection. Tables describe microorganisms that cause native valve endocarditis, the etiology of PVE, the Duke criteria for diagnosis of infective endocarditis, antimicrobial therapy for endocarditis in adults, guidelines to prevent endocarditis, and recommendations and regimens for endocarditis prophylaxis. This chapter contains 99 references.

Infective Endocarditis

2011 ◽  
Author(s):  
Patrick T. O'Gara
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve Endocarditis ◽  
Bacterial Endocarditis ◽  
Cardiac Complications ◽  
Microbial Infection ◽  
Native Valve ◽  
Duke Criteria ◽  
Clinical Presentations ◽  
Parenteral Drug Abuse ◽  
Criteria For Diagnosis

Infective endocarditis is a microbial infection of a cardiac valve or the mural endocardium caused by bacteria or fungi. Forms of this infection include subacute bacterial endocarditis (SBE) and acute bacterial endocarditis (ABE). Etiology and epidemiology are discussed. There is a section on pathogenesis followed by specific clinical presentations, including endocarditis associated with parenteral drug abuse as well as prosthetic valve endocarditis (PVE). Diagnosis and cardiac complications of endocarditis, treatment, recommendations for prophylaxis, and prognosis are addressed. There are several figures showing manifestations and anatomic relations from the infection. Tables describe microorganisms that cause native valve endocarditis, the etiology of PVE, the Duke criteria for diagnosis of infective endocarditis, antimicrobial therapy for endocarditis in adults, guidelines to prevent endocarditis, and recommendations and regimens for endocarditis prophylaxis. This chapter contains 99 references.

scholarly journals Analysis of the Genotype and Virulence of Staphylococcus epidermidis Isolates from Patients with Infective Endocarditis

2008 ◽  
Vol 76 (11) ◽  
pp. 5127-5132 ◽  
Author(s):  
Alastair B. Monk ◽  
Sam Boundy ◽  
Vivian H. Chu ◽  
Jill C. Bettinger ◽  
Jaime R. Robles ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Heart Valves ◽  
Prosthetic Valve Endocarditis ◽  
Bloodstream Infections ◽  
Prosthetic Heart Valves ◽  
Native Valve ◽  
Prosthetic Devices ◽  
C Elegans ◽  
Prosthetic Valves ◽  
Kaplan Meier

ABSTRACT Staphylococcus epidermidis is one of the most common causes of infections of prosthetic heart valves (prosthetic valve endocarditis [PVE]) and an increasingly common cause of infections of native heart valves (native valve endocarditis [NVE]). While S. epidermidis typically causes indolent infections of prosthetic devices, including prosthetic valves and intravascular catheters, S. epidermidis NVE is a virulent infection associated with valve destruction and high mortality. In order to see if the differences in the course of infection were due to characteristics of the infecting organisms, we examined 31 S. epidermidis NVE and 65 PVE isolates, as well as 21 isolates from blood cultures (representing bloodstream infections [BSI]) and 28 isolates from nasal specimens or cultures considered to indicate skin carriage. Multilocus sequence typing showed both NVE and PVE isolates to have more unique sequence types (types not shared by the other groups; 74 and 71%, respectively) than either BSI isolates (10%) or skin isolates (42%). Thirty NVE, 16 PVE, and a total of 9 of the nasal, skin, and BSI isolates were tested for virulence in Caenorhabditis elegans. Twenty-one (70%) of the 30 NVE isolates killed at least 50% of the worms by day 5, compared to 1 (6%) of 16 PVE isolates and 1 (11%) of 9 nasal, skin, or BSI isolates. In addition, the C. elegans survival rate as assessed by log rank analyses of Kaplan-Meier survival curves was significantly lower for NVE isolates than for each other group of isolates (P < 0.0001). There was no correlation between the production of poly-β(1-6)-N-acetylglucosamine exopolysaccharide and virulence in worms. This study is the first analysis suggesting that S. epidermidis isolates from patients with NVE constitute a more virulent subset within this species.

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 Corynebacterium jeikeium native valve infective endocarditis case report: a confirmed microbiological and pathological diagnosis from heart valvular tissue

2020 ◽  
Author(s):  
Wentzel Bruce Dowling ◽  
Johan Koen
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Penicillin G ◽  
Peripheral Vascular ◽  
Native Valve ◽  
Valve Tissue ◽  
Case Summary ◽  
Duke Criteria ◽  
G Prior ◽  
Initial Blood

Abstract Background The Modified Duke criteria is an important structured schematic for the diagnosis of infective endocarditis (IE). Corynebacterium jeikeium is a rare cause of IE that is often resistant to standard IE anti-microbials. We present a case of C. jeikeium IE, fulfilling the Modified Duke pathological criteria. Case summary A 50-year-old male presented with left leg peripheral vascular disease with septic changes requiring amputation. Routine echocardiography post-amputation demonstrated severe aortic valve regurgitation with vegetations that required valve replacement. Two initial blood cultures from a single venepuncture showed Streptococcus mitis which was treated with penicillin G prior to surgery. Subsequent aortic valve tissue cultured C. jeikeium with suggestive IE histological valvular changes and was successfully treated on a prolonged course of vancomycin. Discussion This is the first C. jeikeium IE case diagnosed on heart valvular tissue culture and highlights the importance for the fulfilment of the Modified Duke criteria in diagnosing left-sided IE. Mixed infection IE is rare, and this case possibly represents an unmasking of resistant C. jeikeium IE following initial treatment of penicillin G.

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