scholarly journals Clinical Features and Outcome of Infective Endocarditis in a University Hospital in Romania

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 158
Author(s):  
Emilia Elena Babeș ◽  
Diana Anca Lucuța ◽  
Codruța Diana Petcheși ◽  
Andreea Atena Zaha ◽  
Cristian Ilyes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
University Hospital ◽  
Hospital Death ◽  
Coagulase Negative Staphylococcus ◽  
Index Number ◽  
Duke Criteria

Background and Objectives: Characterization of patients with endocarditis regarding demographic, clinical, biological and imagistic data, blood culture results and possible correlation between different etiologic factors and host status characteristics. Material and methods: This is a retrospective observational descriptive study conducted on patients older than 18 years admitted in the past 10 years, in the Cardiology Clinic of the Clinical County Emergency Hospital Oradea Romania, with clinical suspicion of bacterial endocarditis. Demographic data, clinical, paraclinical investigations and outcome were registered and analyzed. Results: 92 patients with definite infective endocarditis (IE) according to modified Duke criteria were included. The mean age of patients was 63.80 ± 13.45 years. A percent of 32.6% had health care associated invasive procedure performed in the 6 months before diagnosis of endocarditis. Charlson’s comorbidity index number was 3.53 ± 2.029. Most common clinical symptoms and signs were: shortness of breath, cardiac murmur, fever. Sixty-six patients had native valve endocarditis, 26 patients had prosthetic valve endocarditis and one patient was with congenital heart disease. Blood cultures were positive in 61 patients. Among positive culture patient’s staphylococcus group was the most frequently involved: Staphylococcus aureus (19.6%) and coagulase negative Staphylococcus (18.5%). Most frequent complications were heart failure, acute renal failure and embolic events. Conclusions: Staphylococcus aureus IE was associated with the presence of large vegetations, prosthetic valve endocarditis and intracardiac abscess. Coagulase negative Staphylococcus (CoNS) infection was associated with prosthetic valve dysfunction. Streptococcus gallolyticus etiology correlated with ischemic embolic stroke and the presence of large vegetations. Cardiovascular surgery was recommended in 67.4% of patients but was performed only on half of them. In hospital death occurred in 33.7% of patients and independent predictors of mortality were congestive heart failure and septic shock.

scholarly journals Infective endocarditis caused by HACEK group bacteria—a registry-based comparative study

2021 ◽  
Author(s):  
Anna Bläckberg ◽  
Christian Morenius ◽  
Lars Olaison ◽  
Andreas Berge ◽  
Magnus Rasmussen
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Haemophilus Influenzae ◽  
Comparative Study ◽  
Clinical Characteristics ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Common Cause ◽  
Prosthetic Valves

AbstractInfective endocarditis (IE) caused by bacteria within Haemophilus (excluding Haemophilus influenzae), Aggregatibacter, Cardiobacterium, Eikenella and Kingella (HACEK) is rare. This study aimed to describe clinical features of IE caused by HACEK genera in comparison with IE due to other pathogens. Cases of IE due to HACEK were identified through the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of IE cases caused by HACEK were compared with cases of IE due to other pathogens reported to the same registry. Ninety-six patients with IE caused by HACEK were identified, and this corresponds to 1.8% of all IE cases. Eighty-three cases were definite endocarditis, and the mortality rate was 2%. The median age was 63 years, which was lower compared to patients with IE caused by other pathogens (66, 70 and 73 years respectively, p ≤ 0.01). Patients with IE caused by Haemophilus were younger compared to patients with IE due to Aggregatibacter (47 vs 67 years, p ≤ 0.001). Patients with IE due to HACEK exhibited longer duration from onset of symptoms to hospitalization and had more prosthetic valve endocarditis compared to patients with IE due to Staphylococcus aureus (10 vs 2 days, p ≤ 0.001, and 35 vs 14%, p ≤ 0.001). This is, to date, the largest study on IE due to HACEK. Aggregatibacter was the most common cause of IE within the group. The condition has a subacute onset and often strikes in patients with prosthetic valves, and the mortality rate is relatively low.

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.

Right-sided infective endocarditis

ESC CardioMed ◽  
2018 ◽  
pp. 1726-1728
Author(s):  
José A. San Román ◽  
Javier López
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Diagnostic Yield ◽  
Diuretic Therapy ◽  
Clinical Manifestations ◽  
Right Heart Failure ◽  
Right Heart ◽  
Duke Criteria ◽  
Initial Imaging

Right-sided infective endocarditis (RSIE) can be classified into three epidemiological groups: intravenous drug users (IDUs), intravascular device carriers, and the ‘three noes’ group (no left-sided, no device, no IDUs). RSIE represents 5–10% of all infective endocarditis episodes in adults. The most common clinical manifestations of RSIE are fever and respiratory symptoms. The microbiological profile is dominated by Staphylococcus species, especially methicillin-sensitive Staphylococcus aureus. The modified Duke criteria should be used for the diagnosis of this entity, although their sensitivity and specificity are lower than in left-sided infective endocarditis. Regarding imaging in RSIE, the diagnostic yield of transthoracic echocardiography (TTE) is comparable with transoesophageal echocardiography, so TTE should be the initial imaging technique when RSIE is clinically suspected. The empirical antibiotic treatment should include antibiotics against staphylococci, such as vancomycin or daptomycin in combination with gentamicin and then adapted to the antibiogram. In non-complicated episodes of isolated tricuspid endocarditis caused by methicillin-sensitive Staphylococcus aureus, a 2-week regimen with cloxacillin can be safely used. In other cases, a standard 4–6 weeks is mandatory. Careful selection of patients for surgery is needed and surgery is only indicated in cases of microorganisms difficult to eradicate, or bacteraemia for more than 7 days despite adequate antimicrobial therapy, persistent tricuspid valve vegetations larger than 20 mm after recurrent pulmonary emboli with or without concomitant right heart failure, or right heart failure secondary to severe tricuspid regurgitation with poor response to diuretic therapy. Mortality of RSIE in IDUs is about 7%.

scholarly journals 18F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve Infective Endocarditis over the modified Duke Criteria

2021 ◽  
Author(s):  
Christopher P. Primus ◽  
Thomas A Clay ◽  
Maria S. McCue ◽  
Kit Wong ◽  
Rakesh Uppal ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Prosthetic Valve ◽  
Standardized Uptake Value ◽  
Prosthetic Valve Endocarditis ◽  
Incremental Benefit ◽  
Duke Criteria ◽  
Diagnostic Certainty ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background International guidance recognizes the shortcomings of the modified Duke Criteria (mDC) in diagnosing infective endocarditis (IE) when transoesophageal echocardiography (TOE) is equivocal. 18F-FDG PET/CT (PET) has proven benefit in prosthetic valve endocarditis (PVE), but is restricted to extracardiac manifestations in native disease (NVE). We investigated the incremental benefit of PET over the mDC in NVE. Methods Dual-center retrospective study (2010-2018) of patients undergoing myocardial suppression PET for NVE and PVE. Cases were classified by mDC pre- and post-PET, and evaluated against discharge diagnosis. Receiver Operating Characteristic (ROC) analysis and net reclassification index (NRI) assessed diagnostic performance. Valve standardized uptake value (SUV) was recorded. Results 69/88 PET studies were evaluated across 668 patients. At discharge, 20/32 had confirmed NVE, 22/37 PVE, and 19/69 patients required surgery. PET accurately re-classified patients from possible, to definite or rejected (NRI: NVE 0.89; PVE 0.90), with significant incremental benefit in both NVE (AUC 0.883 vs 0.750) and PVE (0.877 vs 0.633). Sensitivity and specificity were 75% and 92% in NVE; 87% and 86% in PVE. Duration of antibiotics and C-reactive Protein level did not impact performance. No diagnostic SUV cut-off was identified. Conclusion PET improves diagnostic certainty when combined with mDC in NVE and PVE.

scholarly journals Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Maxwell D. Eder ◽  
Krishna Upadhyaya ◽  
Jakob Park ◽  
Matthew Ringer ◽  
Maricar Malinis ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Prosthetic Valve Endocarditis ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Duke Criteria ◽  
Positron Emission ◽  
Leukocyte Scintigraphy

Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.

scholarly journals A case of aggressive aortic prosthetic valve endocarditis aggressive caused by Staphylococcus lugdunensis

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Kazuhiro Yamazaki ◽  
Kenji Minakata ◽  
Kazuhisa Sakamoto ◽  
Jiro Sakai ◽  
Yujiro Ide ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Pathogenic Bacteria ◽  
Prosthetic Valve Endocarditis ◽  
Drug Susceptibility ◽  
Coagulase Negative Staphylococcus ◽  
Staphylococcus Lugdunensis

Abstract Background Staphylococcus lugdunensis is a coagulase-negative Staphylococcus species, which are weak pathogenic bacteria generally. However, the acute and severe pathogenicity of Staphylococcus lugdunensis infective endocarditis may be due to the rapid growth of large vegetation and consequent valve destruction. Case presentation The patient was an 81-year-old male who visited our hospital with chief complaints of low back pain and high fever. Four years before this visit, he had undergone aortic valve replacement for aortic regurgitation. He was found to be hypotensive. Although there is no heart murmur on auscultation and echocardiography revealed negative findings with aortic valve, a blood test showed increases in the white blood cell count and C-reactive protein concentration. On the next day, Gram-positive cocci were detected in a blood culture and echocardiography detected a large vegetation on the prosthetic valve with increased flow velocity. Therefore, he underwent redo aortic valve replacement emergently. Staphylococcus lugdunensis was identified in blood samples and vegetation culture. Consequently, the patient was treated with antibiotics for 5 weeks after the operation and discharged home. Conclusions We experienced rapidly progressive prosthetic valve endocarditis caused by Staphylococcus lugdunensis. Hence, Staphylococcus lugdunensis infective endocarditis requires aggressive treatment, and the pathogenicity of this coagulase-negative Staphylococcus with high drug susceptibility should not be underestimated.

scholarly journals 683. Epidemiology and Microbiology of Infective Endocarditis: A Six Year Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S444-S444
Author(s):  
Niyas Vettakkara Kandy Muhammed ◽  
Rajalakshmi Ananthanarayanan ◽  
Aswathy Sasidharan
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Detection System ◽  
Tertiary Care ◽  
Prosthetic Valve Endocarditis ◽  
Health Indicators ◽  
Developed Countries ◽  
Care Hospital ◽  
Duke Criteria

Abstract Background The epidemiology and microbiology of infective endocarditis (IE) is not well studied in India. Studies from developed countries report a culture positivity of more than 90% in IE, while in India it has been lower (40–70%). Viridans Group Streptococci (VGS) are the commonest organism identified from previous Indian studies. The state of Kerala in India has better health indicators compared to the rest of India and it is likely that the epidemiology of IE in Kerala may be different. We therefore studied the epidemiology and microbiology of IE in patients admitted to a tertiary care hospital in Kerala over six years (2015 – 2020). Methods An electronic medical record search was conducted to identify patients who satisfied definite or possible IE criteria as per modified Duke criteria. Three sets of blood cultures were sent in BacT/Alert blood culture bottles for all suspected cases of IE. Blood culture was done using BacT-ALERT 3D automated microbial detection system (bioMérieux, France) and organisms were identified using VITEK-2 system. Transthoracic echocardiogram was done for all patients and a transoesophageal echocardiogram was done when indicated. Results 70 patients satisfied the inclusion criteria. Majority (70.4%) were male; mean age was 50.7±16.3 years. 71% patients had underlying valvular heart disease. Diabetes mellitus (53.5%) was the most common comorbidity followed by chronic kidney disease (18.3%). Mitral valve was most commonly affected (53.5%) followed by the aortic valve (19.7%) and both valves were involved in 5.7%. Right sided valves were affected in 8.5%. Prosthetic valve endocarditis accounted for 10% of cases. No echocardiographic evidence of endocarditis was seen in 11.3%. Blood culture was positivity was 64.8%. Staphylococcus aureus (20%) was the most common organism isolated, followed by VGS (17.1%). 50% of the Staphylococcus aureus isolated were methicillin resistant. Among 57 patients in whom an outcome was recorded, mortality was 12.2%. Microbiology profile of infective endocarditis Conclusion Staphylococcus aureus has emerged as the most common etiological agent of IE in our study, in contrast to previous studies from India where VGS was predominant. The high prevalence of MRSA is of concern. Disclosures All Authors: No reported disclosures

scholarly journals Bacteriological Profile of Heart Valves Resected from Infective Endocarditis Patients

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

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.

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