scholarly journals More than Garden Variety: Massive Vegetations from Infective Endocarditis

Pathogens ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 998
Author(s):  
Christopher Radcliffe ◽  
Joyce Oen-Hsiao ◽  
Matthew Grant
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intervention ◽  
Case Reports ◽  
Source Control ◽  
Valvular Regurgitation ◽  
Vancomycin Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
History Of

Infective endocarditis classically involves non-sterile vegetations on valvular surfaces in the heart. Feared complications include embolization and acute heart failure. Surgical intervention achieves source control and alleviates valvular regurgitation in complicated cases. Vegetations >1 cm are often intervened upon, making massive vegetations uncommon in modern practice. We report the case of a 39-year-old female with history of intravenous drug abuse who presented with a serpiginous vegetation on the native tricuspid valve and methicillin-resistant Staphylococcus aureus bacteremia. The vegetation grew to 5.6 cm by hospital day two, and she successfully underwent a tricuspid valvectomy. Six weeks of intravenous vancomycin therapy were completed without adverse events. To better characterize other dramatic presentations of infective endocarditis, we performed a systematic literature review and summarized all case reports involving ≥4 cm vegetations.

Early Surgical Intervention for Infective Endocarditis

2002 ◽  
Vol 10 (4) ◽  
pp. 298-301 ◽  
Author(s):  
Hong Sheng Zhu ◽  
Pei Yan Yao ◽  
Jia Hao Zheng ◽  
A Thomas Pezzella
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Complex Disease ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

scholarly journals Adjunctive ceftaroline in combination with daptomycin or vancomycin for complicated methicillin-resistant Staphylococcus aureus bacteremia after monotherapy failure

2019 ◽  
Vol 6 ◽  
pp. 204993611988650 ◽  
Author(s):  
Joseph Patrik Hornak ◽  
Seher Anjum ◽  
David Reynoso
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Treatment Options ◽  
Source Control ◽  
Optimal Timing ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia

Background: Methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) may fail to improve with standard monotherapy, particularly in patients with multifocal infection, incomplete source control, or persistent bacteremia. Synergy observed in vitro between ceftaroline (CPT) and daptomycin (DAP) or vancomycin (VAN) may translate into clinical benefit. Here, we describe our experience with DAP/CPT and VAN/CPT for complicated MRSA-B after monotherapy failure. Methods: Single-center, retrospective review of consecutive patients treated with DAP/CPT or VAN/CPT for MRSA-B after monotherapy failure from 1 January 2016 to 30 November 2018. Results: We identified 11 instances of combination therapy in 10 patients (DAP/CPT = 6, VAN/CPT = 5) with 1 patient receiving VAN/CPT followed by DAP/CPT. Rates of multifocal infection, incomplete source control, persistent bacteremia, and infective endocarditis were high (100%, 80%, 60%, and 60%, respectively). Combination therapy was initiated most commonly for persistent bacteremia (60%). When patients were persistently bacteremic, median preceding duration was 13 days and median time to clearance was 3 days. Total microbiologic cure rate was 100%. There were zero instances of bacteremia relapse at 30 days (30D) or 60 days (60D). All-cause 30D and 60D mortality rates were 11.1% and 33.3%, respectively. Conclusions: Combination therapy demonstrated success in diverse cases of refractory MRSA-B, including instances of persistent bacteremia paired with incomplete source control. Optimal timing and therapeutic cadence for combination therapy remain unclear. Our findings suggest that DAP/CPT and VAN/CPT can be considered for complicated MRSA bacteremia when other treatment options fail or are unavailable. We propose persistent bacteremia with incomplete source control to be a clinical niche particularly worthy of further investigation.

Successful Treatment of Corynebacterium striatum Endocarditis with Daptomycin plus Rifampin

2005 ◽  
Vol 39 (10) ◽  
pp. 1741-1744 ◽  
Author(s):  
Monica Shah ◽  
Jeremias L Murillo
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Reports ◽  
Unsuccessful Attempt ◽  
Case Summary ◽  
Corynebacterium Striatum ◽  
History Of ◽  
Linezolid Therapy ◽  
Lipopeptide Antibiotic ◽  
Viable Treatment

OBJECTIVE: To report a case of Corynebacterium striatum endocarditis that was treated successfully with daptomycin plus rifampin following an unsuccessful attempt at vancomycin desensitization and failure of linezolid therapy. CASE SUMMARY: A 46-year-old woman with hemodialysis-dependent chronic renal failure was admitted for a graft-related infection. She presented with C. striatum endocarditis that was treated with daptomycin plus rifampin due to a history of allergies to vancomycin and β-lactam antibiotics and failure of linezolid therapy. The patient received daptomycin and rifampin for a total of 6 weeks. Three months after completion of treatment, no recurrence of endocarditis was evident. DISCUSSION: Daptomycin is a lipopeptide antibiotic, with rapid bactericidal activity. It has demonstrated efficacy in animal models of staphylococcal, streptococcal, and enterococcal endocarditis. Case reports of its activity in methicillin-resistant Staphylococcus aureus endocarditis have also been documented. CONCLUSIONS: Daptomycin, which has shown in vitro activity against C. striatum, may be a viable treatment option for patients with C. striatum endocarditis who are either allergic or refractory to traditional antibiotics.

scholarly journals 163. Infective Endocarditis in Qatar: Risk Factors, Clinical Characteristics, Microbiology, and Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S106-S107
Author(s):  
Ahmed Zaqout ◽  
Shaban Mohammed ◽  
Maliha Thapur ◽  
Hussam Al Soub ◽  
Muna Almaslamani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Infective Endocarditis ◽  
Clinical Characteristics ◽  
Surgical Intervention ◽  
Skin Infections ◽  
Cardiac Devices ◽  
Duke Criteria ◽  
Implantable Cardiac Devices ◽  
Culture Negative

Abstract Background Infective endocarditis (IE) is a serious and life-threatening disease. The aim of the study is to describe the epidemiology, clinical characteristics and outcomes of patients with IE in Qatar. Methods Patients were identified from the electronic records of Hamad Medical Corporation hospitals, the national referral center for the State of Qatar. Those aged ≥18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017 were included. Data were analyzed using STATA software Version 15. Results Fifty-seven cases were included, of which 70% were males. Mean age was 51 years (± 16.8). Eleven (19%) were in association with prosthetic valves and 6 (11%) with implantable cardiac devices (Table 1). Fever (84%), dyspnea (46%) and heart failure were the commonest presentations. The majority of patients had preexisting valvular heart disease or intra-cardiac devices (Table 1). Skin infections (10, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery and implantable cardiac devices (Table 1). Staphylococcus species were implicated in 19 (34%) and Streptococcaceae in 9 (16%); whereas 21 (37%) were culture-negative (Table 2). Left-side IE (49, 86%) was predominant. Acute kidney injury (AKI) (17, 30%) and heart failure (11, 19%) were common complications. The most frequently used treatment regimens included glycopeptides or Β-lactams (Table 2). Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock and AKI as the only risk factors independently associated with in-hospital mortality (Table 3). Conclusion Skin infections are an important risk for IE in Qatar. The majority of patients with IE have preexisting cardiac conditions. Staphylococci are the commonest confirmed bacterial etiology of IE in Qatar, but nearly one-third of cases are culture-negative. Only a small proportion of patients with IE undergo surgical intervention and overall mortality is high. The findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encourage early microbiological investigations and improved medical and surgical management. Disclosures All authors: No reported disclosures.

scholarly journals Dressler’s like pericarditis with pericardial effusion is the presenting feature of infective endocarditis

2018 ◽  
Vol 15 (1) ◽  
pp. 43-44
Author(s):  
Biswajit Majumder ◽  
Sharmistha Chatterjee ◽  
Rakesh Sarkar ◽  
Pritam Kumar Chatterjee
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Failure ◽  
Infective Endocarditis ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Medical Therapy ◽  
Surgical Intervention ◽  
Autoimmune Reaction ◽  
Pericardial Involvement

Summary: Infective Endocarditis (IE) being primarily the disease of valves and endocardium may occasionally be complicated with pericardial involvement in the form of pericarditis and pericardial effusion (PE). Pericarditis may be observed incidentally at the time of diagnosing IE and rarely does it remain the presenting feature of IE .The pericardial effusion may be attributed to ruptured aortic abscess extending into the pericardial space, autoimmune reaction, renal failure, HIV and congestive heart failure (CHF). Here we are presenting a 42 year old male having IE with vegetation in both mitral and aortic valve along with large sterile pericardial effusion was treated successfully by the medical therapy alone with favorable outcome. IE presenting with large exudative pericardial effusion being treated without any surgical intervention with substantial resolution of effusion has not been reported so far in medical literature.Nepalese Heart Journal 2017;12(2): 43-44.

scholarly journals 686. Comparing Treatments of Methicillin-Resistant Staphylococcus aureus Infective Endocarditis by People Who Inject Drugs

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S445-S446
Author(s):  
Nicholas Rebold ◽  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Dana Holger ◽  
Michael J Rybak
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Combination Therapy ◽  
People Who Inject Drugs ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Chi Square ◽  
Methicillin Resistant

Abstract Background People who inject drugs (PWID) are at high risk for infective endocarditis (IE) with high-mortality pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Stigma against PWID may cause differences in treatment and outcomes between these patients infected with MRSA IE. Methods Single center retrospective cohort study from August 2006 to February 2021 that includes adult patients diagnosed with IE. Primary outcomes included 90-day all-cause mortality, 60-day MRSA recurrence, 60-day readmission, and hospital length of stay (LOS). Statistical analysis was performed by chi-square, t-test, and Mann-Whitney-U as appropriate. Results A total of 214 patients were diagnosed with MRSA IE; 89 PWID and 125 non-PWID. The mean (SD) age was 47.4±12.4 years (PWID) vs 59.3 ±16.0 years (non-PWID) (p< 0.001). Patients were primarily male (56%), but differed in terms of race 34% African-American (AA) (PWID) vs 66% AA (non-PWID) (p< 0001). Mean APACHE II scores differed between groups: 16(±9.9) (PWID) vs 19(±8.1) (non-PWID) (p< 0.008). Among patients who cleared bacteremia, mean (SD) duration was 5.7(±3.9) days and was not significant between groups (p< 0.64). Valve-type was 93% native and 7% prosthetic and not different between groups (p< 0.16). Infectious Diseases consult did not differ at 96% overall (p< 0.31), but pursuit of source control nearly reached significance at 27% for PWID vs 41% non-PWID (p< 0.06). Similarly, use of combination therapy daptomycin and ceftaroline was nearly significant: 21% (PWID) vs 12% (non-PWID) (p< 0.09). Odds ratio of PWID and combination therapy remained non-significant after regression: 0.39(0.14-1.1,p< 0.07). Primary 90-day mortality was lower in PWID vs non-PWID (15% vs 30%) respectively (p< 0.01), but did not differ in 60-day MRSA recurrence (p< 1.0) at 9%, 60-day readmission (p< 1.0) at 33%, or median LOS (IQR) (p< 0.46) at 15 (10-24) days overall. Conclusion While PWID are significantly younger, less critically ill, and have lower mortality compared to non-PWID, they have similar LOS, MRSA recurrence, and readmission rates. Analyses suggest a potential difference in the pursuit of source control and combination therapy among PWID, however more studies may be needed to achieve significance. Disclosures Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)

scholarly journals Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis

2017 ◽  
Vol 10 ◽  
pp. 117954761772364 ◽  
Author(s):  
Amit Alam ◽  
Shankar Thampi ◽  
Shahryar G Saba ◽  
Rita Jermyn
Keyword(s):  
Heart Failure ◽  
Surgical Intervention ◽  
Diastolic Heart Failure ◽  
Treatment Options ◽  
Hypereosinophilic Syndrome ◽  
Restrictive Cardiomyopathy ◽  
Endomyocardial Fibrosis ◽  
History Of ◽  
The Right ◽  
Loeffler Endocarditis

Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis. Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with remote history of hypereosinophilic syndrome, attributed to treatment of rheumatoid arthritis with infliximab, who presented with symptoms of heart failure refractory to medical management and was found to have Loeffler endocarditis. The severe progression of the disease required surgical intervention with endocardial stripping to treat the right-sided diastolic heart failure.

scholarly journals A Rare Case of Hemophagocytic Lymphohistiocytosis Triggered by Sepsis Due to Methicillin-Resistant Staphylococcus aureus Bacteremia

2020 ◽  
Vol 8 ◽  
pp. 232470962097420
Author(s):  
Krishna Vedala ◽  
Mitchell Keel ◽  
Shoaib Khan ◽  
Anthony Kunnumpurath ◽  
Krishna Kakkera
Keyword(s):  
Staphylococcus Aureus ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Small Cell ◽  
Small Cell Lung ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Immune System Activation ◽  
History Of ◽  
System Activation

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease that occurs due to unregulated immune system activation induced by various causes including infection and cancer. In this article, we report a case of a 67-year-old male with history of small cell lung cancer who developed HLH triggered by methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The patient was initially admitted for septic shock and gastrointestinal bleed. Further workup showed that the patient met criteria for HLH diagnosis as he was positive for 5 of the 8 parameters. Unfortunately, the patient’s condition worsened and he eventually expired. With this case, we wish to draw attention to the fact that sepsis due to MRSA bacteremia can be a trigger for HLH.

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