scholarly journals Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species

Circulation ◽  
2020 ◽  
Vol 142 (8) ◽  
pp. 720-730 ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Anders Dahl ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Odds Ratio ◽  
Prosthetic Valve ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Species Level ◽  
Multivariable Logistic Regression Analysis ◽  
Cardiac Device ◽  
Native Valve ◽  
Streptococcal Species

Background: Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. We aimed to investigate the prevalence of IE at species level in patients with streptococcal BSIs. Methods: We investigated all patients with streptococcal BSIs, from 2008 to 2017, in the Capital Region of Denmark. Data were crosslinked with Danish nationwide registries for identification of concomitant hospitalization with IE. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species adjusted for age, sex, ≥3 positive blood culture bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results: Among 6506 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men) the IE prevalence was 7.1% (95% CI, 6.5–7.8). The lowest IE prevalence was found with Streptococcus pneumoniae ( S pneumoniae ) 1.2% (0.8–1.6) and Spyogenes 1.9% (0.9–3.3). An intermediary IE prevalence was found with Sanginosus 4.8% (3.0–7.3), Ssalivarius 5.8% (2.9–10.1), and Sagalactiae 9.1% (6.6–12.1). The highest IE prevalence was found with Smitis/oralis 19.4% (15.6–23.5), Sgallolyticus (formerly Sbovis ) 30.2% (24.3–36.7), Ssanguinis 34.6% (26.6–43.3), Sgordonii 44.2% (34.0–54.8), and Smutans 47.9% (33.3–62.8). In multivariable analysis using S pneumoniae as reference, all species except S pyogenes were associated with significantly higher IE risk, with the highest risk found with S gallolyticus odds ratio (OR) 31.0 (18.8–51.1), S mitis/oralis OR 31.6 (19.8–50.5), S sanguinis OR 59.1 (32.6–107), S gordonii OR 80.8 (43.9–149), and S mutans OR 81.3 (37.6–176). Conclusions: The prevalence of IE in streptococcal BSIs is species dependent with S mutans, S gordonii, S sanguinis, S gallolyticus , and S mitis/oralis having the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.

scholarly journals Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
L Oestergaard ◽  
M Arpi ◽  
E Fosboel ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Public Hospital ◽  
Bloodstream Infections ◽  
Population Based ◽  
University Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Funding Source ◽  
Cardiac Device ◽  
Native Valve ◽  
Streptococcal Species

Abstract Background Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. Purpose To investigate the prevalence of IE in BSIs with different streptococcal species. Methods We included all patients with streptococcal BSIs, from 2008 to 2017, in a population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main groups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, S. pneumoniae, and “other streptococci”. Using nationwide registries, we determined the prevalence of IE at streptococcal group level and at species level. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species with S. pneumoniae as reference and adjusted for age, sex, ≥3 positive blood culture (BC) bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results In 6,506 cases with streptococcal BSIs (mean age 68.1 years (SD 16.2), 52.8% men), the IE prevalence was 7.1% (95% CI: 6.5–7.8%). For the most common streptococcal species (>5% of BSIs), the IE prevalence was: S. pneumoniae 1.2% (95% CI: 0.8–1.6%), S. dysgalactiae 6.4% (95% CI: 4.9–8.2%), S. pyogenes 1.9% (95% CI: 0.9–3.3%), S. agalactiae 9.1% (95% CI: 6.6–12.1%), S. anginosus 4.8% (95% CI: 3.0–7.3%), and S. mitis/oralis 19.4% (95% CI: 15.6–23.5%) (Figure 1). For moderately common streptococcal species (1–5% of BSIs), the IE prevalence was: S. gallolyticus 30.2% (95% CI: 24.3–36.7%), S. salivarius 5.8% (95% CI: 2.9–10.1%), S. sanguinis 34.6% (95% CI: 26.6–43.3%), S. parasanguinis 10.3% (95% CI: 5.2–17.7), and S. gordonii 44.2% (95% CI: 34.0–54.8%). For uncommon streptococcal species (0.1–1% of BSIs), the highest IE prevalence was in S. mutans with 47.9% (95% CI: 33.3–62.8%). In a multivariable adjusted analysis using S. pneumoniae as a reference, we identified that all species except S. pyogenes were associated with a significantly higher IE risk (Figure 1). The highest associated IE risk was found in S. mutans (OR 81.3, 95% CI: 37.6–176), S. gordonii (OR 80.8, 95% CI: 43.9–149), S. sanguinis (OR 59.1, 95% CI: 32.6–107), S. gallolyticus (OR 31.0, 95% CI: 18.8–51.1), and S. mitis/oralis (OR 31.6, 95% CI: 19.8–50.5) (Figure 1). Conclusion The prevalence of IE in streptococcal BSIs is highly species dependent with the lowest IE prevalence observed in S. pneumoniae and S. pyogenes BSIs, whereas S. mutans, S. gordonii, S. sanguinis, S. gallolyticus and S. mitis/oralis had the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors. Figure 1. Risk of IE in streptococcal BSIs Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte University Hospital

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.

Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehmet A Topcuoglu ◽  
Oguzhan Kursun ◽  
Ferdinando S Buonanno ◽  
Aneesh B Singhal
Keyword(s):  
Infective Endocarditis ◽  
Mitral Regurgitation ◽  
Multivariable Analysis ◽  
Native Valve ◽  
Duke Criteria ◽  
Mycotic Aneurysms ◽  
Mean Size ◽  
Pre Treatment ◽  
Cardiac Valve Disease

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p<0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p<0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p<0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

scholarly journals 18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
D. ten Hove ◽  
R.H.J.A. Slart ◽  
B. Sinha ◽  
A.W.J.M. Glaudemans ◽  
R.P.J. Budde
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Prosthetic Valve Endocarditis ◽  
Cardiac Device ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Cardiac Devices ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Disseminated Disease

Abstract Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

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

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 &lt; .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P &lt; .005). Clinically, they were more likely to present acutely (P &lt; .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P &lt; .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.

scholarly journals Vaccination with FimA from Streptococcus parasanguis Protects Rats from Endocarditis Caused by Other Viridans Streptococci

2002 ◽  
Vol 70 (1) ◽  
pp. 422-425 ◽  
Author(s):  
Todd Kitten ◽  
Cindy L. Munro ◽  
Aijuan Wang ◽  
Francis L. Macrina
Keyword(s):  
Infective Endocarditis ◽  
Virulence Factor ◽  
Rat Model ◽  
Oral Streptococci ◽  
Bacterial Challenge ◽  
Viridans Streptococci ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Streptococcal Species

ABSTRACT The FimA protein of Streptococcus parasanguis is a virulence factor in the rat model of endocarditis, and immunization with FimA protects rats against homologous bacterial challenge. Because FimA-like proteins are widespread among the oral streptococci, the leading cause of native valve endocarditis, we evaluated the ability of this vaccinogen to protect rats when challenged by other streptococcal species. Here we report that FimA vaccination produced antibodies that cross-reacted with and protected against challenge by the oral streptococci S. mitis, S. mutans, and S. salivarius. FimA thus has promise as a vaccinogen to control infective endocarditis caused by oral streptococci.

scholarly journals 472 Epidemiology and temporal trends of cardiac device related infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Denes ◽  
A Bence ◽  
T Ferenci ◽  
S Borbas ◽  
Z Som ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Coagulase Negative Staphylococcus ◽  
Cardiac Device ◽  
Native Valve ◽  
Tertiary Referral Center ◽  
Device Implantation ◽  
Epidemiological Characteristics ◽  
Over Time

Abstract Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p &lt; 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p &lt; 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.

P2754Streptococcal infective endocarditis: distribution of species and their prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
C Hassager ◽  
M Arpi ◽  
L Oestergaard ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Device ◽  
Species Level ◽  
University Hospital ◽  
Heart Valve Disease ◽  
Significant Difference ◽  
Streptococcal Species ◽  
Species Groups ◽  
One Year ◽  
The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

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.

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