scholarly journals Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Valentina Scheggi ◽  
Stefano Del Pace ◽  
Nicole Ceschia ◽  
Francesco Vanni ◽  
Irene Merilli ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Multivariable Analysis ◽  
Surgical Indication ◽  
Intravenous Drug ◽  
Drug Abusers ◽  
Prognostic Impact ◽  
Benefit Ratio ◽  
Frequent Relapses ◽  
Multiple Relapses

Abstract Background Intravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE. Methods We retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020. Results Patients reporting IDA (N = 54; 12.2%) were significantly younger (p < 0.001) and presented fewer comorbidities (p < 0.001). IDA was associated with a higher proportion of relapses (27.8 vs. 3.3%, p < 0.001) and, at multivariable analysis, was an independent predictor of long-term mortality (HR 2.3, 95%CI 1.1–4.7, p = 0.015). We did not register multiple relapses in non-IDA patients. Among IDA patients, we observed 1 relapse after discharge in 9 patients, 2 relapses in 5 patients and 3 relapses in 1 patient. In IDA patients, neither clinical and laboratory variables nor the occurrence of even multiple relapses emerged as indicators of an adverse risk–benefit ratio of surgery in patients with surgical indication. Conclusions IE secondary to IDA affects younger patients than those with IE not associated with IDA. Probably due to this difference, IE secondary to IDA is not associated with significantly higher mortality, whereas the negative, long-term prognostic impact of IDA emerges in multivariate analysis. Considering the good prognosis of patients with uncomplicated IE treated medically, surgery should be reserved to patients with a strict- guidelines-based indication. However, since there are no clear predictors of an unfavourable risk–benefit ratio of surgery in patients with surgical indication, all patients with a complicated IE should be operated, irrespective of a history of IDA.

Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319661
Author(s):  
Pablo Elpidio Garcia Granja ◽  
Javier Lopez ◽  
Isidre Vilacosta ◽  
Carmen Saéz ◽  
Gonzalo Cabezón ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Infective Endocarditis ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Multivariable Analysis ◽  
Active Phase ◽  
Surgical Indication ◽  
Prognostic Impact ◽  
Urgent Surgery ◽  
Score Analysis

ObjectiveTo evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.Methods605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.ResultsSurgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).ConclusionsSurgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.

Infective endocarditis by coagulase-negative staphylococcus in intravenous drug abusers

1992 ◽  
Vol 93 (3) ◽  
pp. 354
Author(s):  
M. Torres-Tortosa ◽  
A. Vergara ◽  
E. Perez-Guzman ◽  
A. Sanchez-Porto ◽  
M. de Cueto
Keyword(s):  
Infective Endocarditis ◽  
Intravenous Drug ◽  
Coagulase Negative Staphylococcus ◽  
Drug Abusers ◽  
Intravenous Drug Abusers

scholarly journals Clinical characteristics and outcome of infective endocarditis among intravenous drug abusers in India

2020 ◽  
Vol 72 (6) ◽  
pp. 547-551
Author(s):  
Abhishek Goyal ◽  
Bishav Mohan ◽  
Pawan Kumar ◽  
Dinesh Gupta ◽  
Rohit Tandon ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Characteristics ◽  
Intravenous Drug ◽  
Drug Abusers ◽  
Intravenous Drug Abusers

Long-Term Outcome for the Surgical Treatment of Infective Endocarditis With a Focus on Intravenous Drug Users

2012 ◽  
Vol 93 (1) ◽  
pp. 51-57 ◽  
Author(s):  
David G. Rabkin ◽  
Nahush A. Mokadam ◽  
Donald W. Miller ◽  
Raymond R. Goetz ◽  
Edward D. Verrier ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Drug Users ◽  
Intravenous Drug ◽  
Intravenous Drug Users ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Intraveninių narkomanų triburio vožtuvo izoliuoto infekcinio endokardito chirurginio gydymo patirtis

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Gediminas Džiugas ◽  
Kęstutis Ručinskas ◽  
Palmyra Semėnienė ◽  
Karolina Džiugienė ◽  
Arimantas Grebelis ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Drug Users ◽  
Intravenous Drug ◽  
Drug Abusers ◽  
Tricuspid Valve Replacement ◽  
Valve Reconstruction ◽  
Intravenous Drug Abusers ◽  
Tricuspid Valve Reconstruction

Gediminas Džiugas1, Kęstutis Ručinskas1 , Palmyra Semėnienė1, Karolina Džiugienė2, ArimantasGrebelis1, Vytautas Sirvydis1 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Vilniaus universiteto Medicinos fakultetas Įvadas: Mažiausiai 5 % triburio vožtuvo (TV) infekcinio endokardito (IE) atvejų reikia gydyti chirurgiškai. Nėra daug studijų, analizuojančių intraveninių narkomanų izoliuoto triburio vožtuvo infekcinio endokardito chirurginio gydymo rezultatus. Duomenų apie tokių ligonių gydymą Lietuvoje nėra. Mes pateikiame pastarųjų 10-ies metų rezultatus, gydant intraveninius narkomanus, operuotus dėl triburio vožtuvo infekcinio endokardito. Įvertinome triburio vožtuvo protezavimo biologiniu vožtuvu ir plastikos ankstyvuosius bei vėlyvuosius rezultatus. Ligoniai ir metodai: Ši studija retrospektyvi. Atlikta 18 ligonių, operuotų Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centre dėl izoliuoto triburio vožtuvo infekcinio endokardito 2000–2010 m., duomenų analizė. Visi ligoniai vartojo intraveninius narkotikus. Rezultatai: Pooperaciniu laikotarpiu nemirė nė vienas ligonis, visi išrašyti iš stacionaro. Ankstyvųjų pooperacinių komplikacijų pasitaikė tik ligoniams, kuriems atliktas triburio vožtuvo protezavimas (4 iš 14 pacientų). Tačiau skirtumas, palyginti su triburio vožtuvo plastikos grupe, nereikšmingas (p=0,225). Ilgesnė hospitalizacijos trukmė buvo po TV protezavimo biologiniu protezu (27,7±14,5 d.) nei po TV plastikos (18,7±15,1 d.). Vėlyvosios komplikacijos išsivystė 8 ligoniams: septyniems buvo atliktas pirminis TV protezavimas biologiniu vožtuvu ir vienam – TV plastika. Keturiems ligoniams buvo infekcinio endokardito atkrytis. Vėlyvuoju pooperaciniu laikotarpiu mirė 4 (22 %) ligoniai. Išvados: Daliai intraveninių narkomanų triburio vožtuvo chirurginė korekcija yra vienintelis veiksmingas triburio vožtuvo infekcinio endokardito gydymo būdas. Po triburio vožtuvo protezavimo biologiniu protezu dažnai būna ankstyvųjų ir vėlyvųjų komplikacijų. Triburio vožtuvo plastika – saugesnis gydymo būdas ankstyvuoju pooperaciniu laikotarpiu. Reikšminiai žodžiai: triburis vožtuvas, intraveninių narkotikų vartojimas, infekcinis endokarditas, triburio vožtuvo plastika, triburio vožtuvo protezavimas, komplikacijos The experience of surgery for isolated tricuspid valve infective endocarditis in intravenous drug abusers Gediminas Džiugas1, Kęstutis Ručinskas1 , Palmyra Semėnienė1, Karolina Džiugienė2, ArimantasGrebelis1, Vytautas Sirvydis1 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Vilniaus universiteto Medicinos fakultetas Objective: Tricuspid valve infective endocarditis usually affects intravenous drug users. At least 5% of patients with tricuspid valve infective endocarditis have to be treated surgically. Few data exist on surgery for the isolated tricuspid valve infective endocarditis in intravenous drug abusers, and there is no such data in Lithuania. This study summarizes our experience in a surgical treatment of isolated tricuspid valve infective endocarditis in intravenous drug users. Patients and methods: This is a retrospective analysis of 18 patients operated on for isolated tricuspid valve infective endocarditis in our centre in 2000–2010. All the patients were intravenous drug abusers. Results: There were no perioperative deaths. Early complications were observed only in the tricuspid valve replacement group (4/14), but there was no significant difference (p = 0.225) was compared to the reconstruction group. There was a longer hospitalization period (27.7 ± 14.5 d) for tricuspid valve replacement than for tricuspid valve reconstruction (18.7 ± 15.1 d.). Eight patients had late complications, of them seven had undergone initial tricuspid valve replacement and one – reconstruction. Four patients had recurrent endocarditis. Late mortality was in 4 (22 %) patients. Conclusion: For some intravenous drug abusers, tricuspid valve surgery for tricuspid valve infective endocarditis is the only effective treatment. Tricuspid valve replacement with biological prosthesis for intravenous drug abusers is associated with numerous early and late postoperative complications. Tricuspid valve reconstruction is a safe method of treatment in the early postoperative period. Key words: tricuspid valve, intravenous drug abusers, infective endocarditis, tricuspid valve reconstruction, tricuspid valve replacement, complications.

High Expression of the ETS Transcription Factor ERG Predicts Adverse Outcome in Acute T-Lymphoblastic Leukemia in Adults

2006 ◽  
Vol 24 (29) ◽  
pp. 4714-4720 ◽  
Author(s):  
Claudia D. Baldus ◽  
Thomas Burmeister ◽  
Peter Martus ◽  
Stefan Schwartz ◽  
Nicola Gökbuget ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Real Time ◽  
Lymphoblastic Leukemia ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
High Expression ◽  
Prognostic Impact ◽  
Free Survival ◽  
Molecular Aberrations

Purpose In adult T-lymphoblastic leukemia (T-ALL) disease-free survival remains limited to 32% to 46%. The adverse prognosis in T-ALL has not been attributed to cytogenetic or molecular aberrations. We have determined the prognostic impact of the oncogenic transcription factor ERG in T-ALL. Patients and Methods ERG expression was analyzed by real-time polymerase chain reaction (PCR) in 105 adults with newly diagnosed T-ALL treated on the German ALL protocols. Patients were dichotomized at ERG′s median expression into low (n = 52) and high (n = 53) expressers. Homeobox (HOX) 11 and HOX11L2 expression was determined by real-time PCR. Results High ERG expressers compared with low ERG expressers had an inferior overall survival (OS, P = .02; 5-year OS: high ERG 26% v low ERG 58%) and relapse-free survival (RFS, P = .003; 5-year RFS: high ERG 34% v low ERG 72%). On multivariable analysis high ERG expression (P = .005), immunophenotypic subgroups (early v mature v thymic T-ALL; overall P = .04), HOX11L2 positivity (P = .055), and absence of HOX11 (P = .017) were independent adverse risk factors predicting RFS. Patients with high ERG expression had a hazard ratio (HR) for relapse of 3.2. Within the good prognostic subgroup of thymic T-ALL (n = 57), high ERG (HR, 4.1; P = .02) and presence of HOX11L2 (HR, 6.6; P = .008) were independent adverse factors for RFS. Conclusion High expression of ERG is an adverse risk factor in adult T-ALL. Within thymic T-ALL, otherwise classified as standard-risk, high ERG expression-identified patients that were four times more likely to fail long-term RFS. The prognostic impact of ERG may assist treatment stratification and suggest the need of alternative regimens.

scholarly journals Injection drug use infective endocarditis: clinical features and therapeutic challanges

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Scheggi ◽  
N Ceschia ◽  
F Vanni ◽  
I Merilli ◽  
E Sottili ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Injection Drug ◽  
Considerable Proportion ◽  
Prognostic Impact

Abstract Introduction Injection drug use (IDU) is a known risk factor for infective endocarditis (IE) and is associated with frequent recurrences, but its prognostic impact is still debated. Moreover, the potential futility of surgery in this population is an unsolved matter. Purpose We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of injection drug use IE (IDUIE). Method We retrospectively included in the analysis 454 consecutive episodes of definite active IE admitted in a single surgical centre from January 2012 to December 2020; 14 out of them where a subsequent infective episode of the same patient. Results IDUIE cases were 63 (13.8%), without significant proportional differences over time. IDUIE patients were significantly younger (43.95±10.12 vs 67.84±13.33, p 0.00) and presented fewer comorbidities (p&lt;0.001). They were admitted with a first episode of IE only in 60.3% of cases vs 92.8% of non-IDU (p&lt;0.001). Embolism was present at admission in a higher percentage (60.3 vs 38.4%, p&lt;0.001). IDUIE was more frequently associated with spondylodiscitis (15.9 vs 7.4%, p=0.026). The infection was less frequently left-sided than in non-IDU patients (57.1 vs 97.2%, p&lt;0.001) and was more often polimicrobic (12.7 vs 4.9%, p=0.015). Most patients were positive for Staphylococcus aureus (54.0 vs 12.8%, p&lt;0.001), while Streptococci were significantly less frequent in patients with IDUIE (11 vs 25%, p=0.015). The proportion of patients undergoing surgery was similar among the two groups (85.5 vs 78.8%, NS). IDUIE patients treated medically for absence of surgical indication had a better survival than patients undergoing surgery for complicated IE (p&lt;0.001). IDUIE was associated with a higher proportion of relapse during follow-up (28.3 vs 3.3%, p&lt;0.001). It was not associated with higher mortality (Figure 1) but was an independent predictor of mortality in multivariable analysis including age (HR per unit 1.048, 95% CI 1.038–1.063, p=0.00) and drug abuse (HR 3.2, 95% CI 1.8–5.6, p=0.00; Figure 2). Among IDUIE patients, we did not find predictors of futility of surgery, not even multiple relapses. Conclusions IDUIE represents a considerable proportion of overall cases of IE, mainly affecting young people. Staphylococcus aureus is the most common microbiologic agent. IDUIE is not associated with higher mortality but drug abuse is an independent predictor of mortality. Considering that patient with uncomplicated IE treated medically have a better prognosis, we should reserve surgery to patients with a strict indication for it. On the other hand, since there are no predictors of futility of surgery, all patients with a complicated IE should undergo surgery without delay. The main determinant of prognosis in these patients is not IE but drug abuse itself. For this reason, increased focus on addiction treatment following hospital discharge is mandatory to improve long term prognosis. FUNDunding Acknowledgement Type of funding sources: None.

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