scholarly journals Association between echocardiographic manifestations and bacterial infections in patients with infective endocarditis: a cohort study

2019 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling ◽  
Eva Maret ◽  
Cecilia Stålsby Lundborg ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Bacterial Infections ◽  
National Registry ◽  
University Hospital ◽  
Categorical Variables ◽  
Group B Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Manifestations

Abstract Abstract Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for direct visualization of IE-induced cardiac manifestations. We investigated correlations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite or possible IE admitted at the Karolinska University Hospital between 2008-2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR were excluded. IE manifestations diagnosed by ECHO and risk factors were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s ttest was used for continuous numerical variables; two-sided and skewed variables were log-transformed before these analyses. Multivariable analyses were performed using logistic regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P< 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus(n= 268, 47%) and viridans group streptococci (n= 127, 22%). The most common manifestations were vegetation in the mitral (n = 222, 36%), aortic (n = 214, 34%), and tricuspid valves (n = 117, 19%). Correlations were seen between aortic valve vegetation and coagulase-negative staphylococci (CoNS) and Enterococcus faecalis, between mitral valve vegetation and group B streptococci, tricuspid valve vegetation, andS.aureus, and between perivalvular abscesses and CoNS (all P< 0.05). Conclusions Correlations were found between certain bacteria and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

scholarly journals Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

2019 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling ◽  
Eva Maret ◽  
Cecilia Stålsby Lundborg ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Bacterial Infections ◽  
Electronic Device ◽  
Bacterial Species ◽  
University Hospital ◽  
Categorical Variables ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Manifestations

Abstract Abstract Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated correlations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Correlations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S. aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). Conclusions Correlations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

scholarly journals Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
A. Damlin ◽  
K. Westling ◽  
E. Maret ◽  
C. Stålsby Lundborg ◽  
K. Caidahl ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Bacterial Infections ◽  
Electronic Device ◽  
Bacterial Species ◽  
University Hospital ◽  
Categorical Variables ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Manifestations

Abstract Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated associations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Associations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S. aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). Conclusions Associations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

scholarly journals Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

2019 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling ◽  
Eva Maret ◽  
Cecilia Stålsby Lundborg ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Bacterial Infections ◽  
Electronic Device ◽  
Bacterial Species ◽  
University Hospital ◽  
Categorical Variables ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Manifestations

Abstract Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated associations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Associations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S. aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). Conclusions Associations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

scholarly journals Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

2019 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling ◽  
Eva Maret ◽  
Cecilia Stålsby Lundborg ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Bacterial Infections ◽  
Electronic Device ◽  
Bacterial Species ◽  
University Hospital ◽  
Categorical Variables ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Manifestations

Abstract Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated associations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Associations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S.aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). Conclusions Associations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

scholarly journals Blood Cultures for the Diagnosis of Infective Endocarditis: What Is the Benefit of Prolonged Incubation?

2021 ◽  
Vol 10 (24) ◽  
pp. 5824
Author(s):  
Vincent Fihman ◽  
Hélène Faury ◽  
Amina Moussafeur ◽  
Raphaelle Huguet ◽  
Adrien Galy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Retrospective Cohort ◽  
Blood Cultures ◽  
University Hospital ◽  
Infectious Endocarditis ◽  
Prolonged Incubation ◽  
Cutibacterium Acnes

To assess the need for prolonged incubation of blood culture bottles beyond five days for the diagnosis of infectious endocarditis (IE), we conducted a retrospective cohort study of 6109 sets of two blood culture bottles involving 1211 patients admitted to the Henri Mondor University Hospital for suspicion of IE between 1 January 2016 and 31 December 2019. Among the 322 patients with IE, 194 had positive blood cultures in our centre. Only one patient with a time-to-positivity blood culture of more than 120 h (5 days) was found. The main cause for the 22 patients with positive blood cultures after five days was contamination with Cutibacterium acnes. Our results do not support extending the duration of incubation of blood culture bottles beyond five days for the diagnosis of infectious endocarditis, with the exception of patients with risk factors for C. acnes infection.

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study

2021 ◽  
pp. 1-9
Author(s):  
Lorenzo Roberto Suardi ◽  
Arístides de Alarcón ◽  
María Victoria García ◽  
Antonio Plata Ciezar ◽  
Carmen Hidalgo Tenorio ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Culture Negative ◽  
Spanish Cohort

scholarly journals Blood culture time to positivity in non-β-hemolytic streptococcal bacteremia as a predictor of infective endocarditis—a retrospective cohort study

2021 ◽  
Author(s):  
David Krus ◽  
Fredrik Kahn ◽  
Bo Nilson ◽  
Torgny Sunnerhagen ◽  
Magnus Rasmussen
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Culture Time ◽  
Time To Positivity

AbstractNon-β-hemolytic streptococci (NBHS) cause infective endocarditis (IE) and a short blood culture time to positivity (TTP) is associated with risk of IE in bacteremia with other pathogens. In this retrospective population-based cohort study, we investigate if TTP is associated to IE or mortality. Of 263 episodes with NBHS bacteremia, 28 represented IE and the median TTP did not differ significantly between episodes with IE (15 h) and non-IE (15 h) (p=0.51). TTP was similar among those who survived and those who died within 30 days. However, TTP significantly differed when comparing the different streptococcal groups (p<0.001).

scholarly journals Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 566
Author(s):  
Nesterovics ◽  
Nesterovics ◽  
Stradins ◽  
Kalejs ◽  
Ansabergs ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Devices ◽  
Positive Culture ◽  
Major Complication ◽  
Heart Rhythm ◽  
University Hospital ◽  
Lead Extraction ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Implantable Electronic Devices ◽  
Common Location

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

scholarly journals Patients with infective endocarditis and history of injection drug use –a register-based study of a 10-year period

2020 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background: Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE), however data of these patients are scarce and need to be explored further. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE.Methods: Data of adults with IDU-IE and non-IDU-IE, treated between 2008-2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results: In total, 165 (32%) of the included patients had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years; non-IDU-IE: 64.3 years; P<0.01). No difference in distribution of genders was observed, 33% women in both groups. History of previous IE (n=49, 30%) and vascular phenomena (n=101, 61%), were more common among patients with IDU-IE while prosthetic heart valves (n=83, 23%) and known valvular disease (n=78, 22%) were more common among patients with non-IDU-IE (P<0.05). Aetiology of Staphylococcus aureus (n=121, 73%) and tricuspid (n=91, 55%) or pulmonary valve (n=7, 4%) vegetations were more common among IDU-IE (P<0.05). The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P<0.01). Conclusions: Patients with IDU-IE were younger, frequently presenting with right-sided vegetations and S. aureus aetiology, and were less frequently treated with surgery. Patients with IDU-IE had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

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