Bacterial Endocarditis In Patients Research Articles

INCIDENCE OF THE INFECTIVE ENDOCARDITIS IN PATIENTS WITH TUNNELED CATHETERS IN ONE BULGARIAN DIALYSIS CENTER PER YEAR

Background: Infections are common complications among patients on chronic hemodialysis. Catheter-related bloodstream infections (CRBSIs) are estimated to be 0.15 to 3.5 cases per 1000 catheter-days (CD) in case of tunneled catheters, and the frequency of bacterial endocarditis is estimated at 3.5 to 10% of these. Materials and methods: We retrospectively present data from the study, which was conducted in our clinic for a one-year period from January 1 to December 31, 2018. The average number of patients undergoing hemodialysis was 104, and 33 (32%) of them had tunneled catheters. There was 12 045 total CD. We took chemocultures of all patients with clinical signs dubious about CRBSIs. All patients with positive chemocultures were examined by echocardiography. Results: We have found 19 episodes of CRBSIs in 15 patients (1.5/1000 CD). We found a total of 21 causative microbial agents in positive chemocultures, two of which were polymicrobial. Thirteen of the bacteria (62%) were Gram-positive [G (+)] and eight Gram-negative [G (-)] (38%). The most common G (+) bacterium was Staphylococcus aureus 9 and G (-) – Citrobacter coseri. In six patients (32%) with CRBSIs, we found bacterial endocarditis. Four of them (67%) were infected with G (-) negative agent, and two (33%) – with G (+). Conclusions: We conclude that our high incidence of bacterial endocarditis is probably due to the fact that we have examined all of the patients for this complication and that gram-negative bacteria are more often the cause of bacterial endocarditis in patients undergoing hemodialysis with a tunnel catheter.

CURRENTLY ADOPTED CONDUCTS IN THE ODONTOLOGICAL CLINIC FOR THE PREVENTION OF BACTERIAL ENDOCARDITIS IN CARDIOPATHIES

Objective: To demonstrate the current drug and behavioral behaviors advocated by the literature in the prevention of bacterial endocarditis in patients at risk in the dental clinic. Study Design: Literature narrative review that consisted of data collection from the Medline and SciELO databases, selecting text in the format of scientific literature review articles and protocols, regarding the use of drugs in the dental clinic for the prevention of bacterial endocarditis in patients at risk. The analysis was done on 6 articles published between 2007 and 2013 by Brazilian students and graduates in dentistry. Results: Bacterial endocarditis is a disease in which infectious agents invade the endocardial surfaces, producing inflammation and damage. Bacteria of the oral microbiota play important roles as etiologic agents of this disease, so its prevention is essential for the dentist. As a preventive measure, antibiotic prophylaxis has generated divergent opinions among scholars regarding its effectiveness. Conclusion: We can understand the relevance of performing antibiotic prophylaxis in at-risk patients before invasive dental procedures, as well as the importance of oral hygiene orientation, since the lack of maintenance of oral health corroborates the occurrence of bacterial endocarditis. Objective: To demonstrate the current drug and behavioral behaviors advocated by the literature in the prevention of bacterial endocarditis in patients at risk in the dental clinic. Study Design: Literature narrative review that consisted of data collection from the Medline and SciELO databases, selecting text in the format of scientific literature review articles and protocols, regarding the use of drugs in the dental clinic for the prevention of bacterial endocarditis in patients at risk. The analysis was done on 6 articles published between 2007 and 2013 by Brazilian students and graduates in dentistry. Results: Bacterial endocarditis is a disease in which infectious agents invade the endocardial surfaces, producing inflammation and damage. Bacteria of the oral microbiota play important roles as etiologic agents of this disease, so its prevention is essential for the dentist. As a preventive measure, antibiotic prophylaxis has generated divergent opinions among scholars regarding its effectiveness. Conclusion: We can understand the relevance of performing antibiotic prophylaxis in at-risk patients before invasive dental procedures, as well as the importance of oral hygiene orientation, since the lack of maintenance of oral health corroborates the occurrence of bacterial endocarditis.

Perioperative antibiotic prophylaxis in dermatosurgery-2019 status quo

Perioperative antibiotic prophylaxis (PAP) is determined as ashort-term, in general single-shot administration of an antibiotic prior to asurgical intervention. The main goal of PAP is to reduce postoperative surgical site infections. In addition, PAP is administered to avoid development of bacterial endocarditis in patients who are at high risk. Regarding the increasing prescription of antibiotics by dermatologists and the rising emergence of resistant bacterial strains, arational use of PAP in dermatosurgery has to be demanded. Thus, identification of risk factors being determined either by the patient, the type of surgery or the location will help to identify those patients requiring PAP. Moreover, utilizing established criteria will avoid the unnecessary administration of PAP-which only creates afalse sense of safety.

Implications of Antimicrobial Usage to Prevent Bacteremia for Periodontal Therapy

This review examines the current literature on periodontal treatment, bacteremia and prophylactic antibiotic usage to prevent the systemic adverse outcomes. Currently, it is not clear whether prophylactic antibiotic administration prevents bacterial endocarditis in patients with high risk. Recent publications have resulted in significant changes in the concept of antibiotic prophylaxis. Available evidence does not support the previously published guidelines recommending prophylactic antibiotic usage prior to dental treatment. Potential harms and costs of antibiotic administration should be weighed against expected benefits. Clinicians are advised to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before prescription.

Another Look at Antimicrobial Prophylaxis for Dental Procedures in Patients with Prosthetic Heart Valves

The benefit of antimicrobial prophylaxis against bacterial endocarditis in patients with prosthetic heart valves remains controversial. Recent

PM243 Bacterial Endocarditis in Patients With Chronic Renal Failure Hemodialysis Catheter Users

PM243 Bacterial Endocarditis in Patients With Chronic Renal Failure Hemodialysis Catheter Users

Congenital bicuspid aortic valve: steps toward providing an answer to the question of antibiotic endocarditis prophylaxis

We report a case of congenital bicuspid aortic valve infective endocarditis in an 18-year-old male with no significant past medical history. He presented to the emergency department from an ophthalmology clinic with new right-eye vision changes. Initial EKG revealed sinus tachycardia and he was hemodynamically stable. Expedited diagnostic transesophageal echocardiography revealed vegetations on both aortic leaflets, an aortic root abscess, and a fistulous tract extending from the left ventricular outflow tract into the right ventricular outflow tract. Although he was evaluated by the cardiothoracic surgery team and scheduled for operative repair, he acutely became bradycardic, developed pulseless electrical activity, and was resuscitated on multiple occasions, but died suddenly from PEA arrest within 24 hours of presenting to the emergency department. This case demonstrates complications of acute bacterial endocarditis. We discuss the current debate surrounding the role of antibiotic prophylaxis for infective endocarditis. Additionally, we suggest that patients with a bicuspid aortic valve, a common congenital defect with a known increased risk for bacterial endocarditis, might represent a unique cohort to prospectively study whether antibiotic prophylaxis reduces the incidence, morbidity, and mortality of bacterial endocarditis in patients at increased risk.

Bacterial Endocarditis in Patients With Adult Congenital Heart Disease

Congenital heart disease (CHD) confers an increased risk of infective endocarditis (IE), though the lesion-specific risk is poorly defined. Furthermore, the contribution of recent valve replacement surgery to IE-risk is unknown.

Predisposition to Infection and Bleeding in Mechanical Assist Devices (LVADs) Recepients after Dental Procedures: A Single Center Experience

<h3>Purpose</h3> Currently more than 7,000 patients with heart failure are supported with LVADs. Few patients with LVADs undergo dental procedures and are at risk of bleeding due to their anticoagulation/antiplatelet medication profile and acquired VWF deficiency. Many centers follow the AHA guidelines for the prophylaxis of bacterial endocarditis in patients with prosthetic devices. Though these guidelines are comprehensive, they do not specifically address prophylactic recommendations for patients with LVADs. We would assume that these guidelines hold true for LVADs; however there is no current evidence. <h3>Methods and Materials</h3> To assess the risk of infections and bleeding complications during dental procedures in patients with LVADs, we designed a protocol based pilot study of LVAD patients using the AHA guidelines. We followed 19 patients respective clinical course for administration of preprocedural antibiotics, continuation of their anticoagulation/antiplatelet medication, episodes of infective endocarditis, bacteremia, dental abscess, and bleeding episodes till six months after the procedure. <h3>Results</h3> [figure 1] <h3>Conclusions</h3> There was no increased risk of infections (dental abscess, pneumonia, infective endocarditis, and bacteremia) and no bleeding complications when the designed protocol was followed.

Prescription of Antibiotics for Prophylaxis to Prevent Bacterial Endocarditis

Systematic review conclusion. There is no evidence that antibiotic prophylaxis before dental procedures is effective or ineffective against bacterial endocarditis in patients already at risk of developing the disease.Critical summary assessment. On the basis of evidence from one case-control study, no definite conclusion can be drawn on the usage of antibiotic prophylaxis before dental procedures.Evidence quality rating. Limited. Does prophylactic antibiotic administration before invasive dental procedures in people at increased risk of bacterial endocarditis influence mortality, serious illness or endocarditis incidence? The authors conducted a comprehensive search of six electronic databases from 1950 through June 2008. The initial search identified 980 abstracts of which the authors reviewed 118 full articles. The authors excluded 83 articles because they were discussion articles, editorials or guidelines and 34 articles because they were duplicate studies. They included one article, which was a case-control study. The one study that was included reported on all cases of endocarditis in the Netherlands during a two-year period from November 1986 through November 1988, according to the authors. In the study, the authors defined cases as patients who had a predisposing cardiac disease and had undergone a medical or dental procedure with a definite or possible indication for prophylaxis and developed endocarditis within 180 days of this procedure. In the study, control patients had one of the following pre-existing conditions: congenital heart defect, history of rheumatic fever, high risk of developing endocarditis with prosthetic heart valves or a history of endocarditis. Control patients were matched for age and had undergone a medical or dental procedure with a definite or possible indication for prophylaxis and had not developed endocarditis within 180 days of the procedure. Indications for “definite prophylaxis” were dental extraction and “dental root work,” and an indication for “possible prophylaxis” was dental scaling. Of 349 patients who developed native-valve endocarditis, 44 had undergone dental treatment with a definite or possible indication for prophylaxis. Seven of these patients had been treated with prophylactic antibiotics before the dental procedure. Of the patients meeting the criteria for the control group, 181 had undergone a dental procedure with a definite or possible indication for prophylaxis. Seventeen of the control patients had been administered prophylactic antibiotics before they underwent the dental procedure. The odds of development of endocarditis among those receiving antibiotic prophylaxis was 1.62 (95 percent confidence interval, 0.57–4.57). The authors did not locate any studies that assessed mortality, illness or other adverse effects. Since no conclusive evidence supporting a benefit was identified, the authors did not look for information on harms. There is no evidence that antibiotic prophylaxis is effective or ineffective against bacterial endocarditis when it is administered before an invasive dental procedure in people who are at risk of developing the disease.

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: Case report and review of the literature

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.

Prospective Determination of Bacteremia and Associated Complications in Patients Undergoing Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS FNA) of Rectal and Perirectal Lesions

Background: The risk of bacteremia associated with endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of rectal and perirectal lesions has never been studied. As a result, the need for antibiotics in this setting is uncertain and practices vary. Aim: Our aim was to prospectively determine the rate of bacteremia and associated complications associated with EUS FNA of rectal and perirectal lesions. Methods: Patients were considered for enrollment if referred with solid lower GI tract pathology indicating the potential need for EUS FNA. Patients were excluded if they had an indication for pre-procedure antibiotics as determined by the ASGE guidelines or had taken antibiotics, for any reason, within the prior 7 days. The first set of blood cultures (aerobic and anaerobic, 20-30cc/each) were obtained immediately prior to the procedure (Set #1), another set was obtained following routine flexible sigmoidoscopy/radial EUS (Set #2), and the last set 15 minutes following EUS FNA (Set #3). Patients were monitored in the immediate post-procedure period and followed for evidence of associated complications. Results: 151 patients were enrolled of whom 76 underwent EUS FNA (53 male, 23 female) having a mean age of 60 years (range 25-93). Eighty-one sites were sampled leading to a total of 358 FNA's (mean 4.7/patient) (Table 1). In addition, a total of 224 mucosal biopsies were obtained (mean 2.9/patient). Positive blood cultures were acquired in 4 patients (5.3%; 95% CI: 2.1-12.8%). Coagulase negative Staphylococcus grew in one patient (3rd set of blood cultures), and Moraxella grew in another patient (2nd set of blood cultures). Both were considered contaminates. Bacteroides fragilis grew in one patient (2nd set of blood cultures), and Gemella morbillorum grew in another patient (3rd set of blood cultures). Both were considered true positives. As a result, true positive blood cultures occurred in 2 patients (2.6%, 95% CI: 0.7-9.1%). None of the 79 patients (0%, 95% CI:0-1%), regardless of blood culture status, developed infectious complications. Conclusion: These data suggest that bacteremia and associated complications are uncommon after EUS FNA of solid rectal and perirectal lesions, occurring at a rate commonly associated with diagnostic colonoscopy. As a result, antibiotic prophylaxis may not be warranted for spontaneous bacterial endocarditis in patients without specific indications for prophylaxis.

Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Prospective Risk Assessment of Bacteremia in Patients Undergoing Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS FNA) of Rectal and Perirectal Lesions

Background: There are no data regarding the risk of bacteremia following endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of rectal and perirectal lesions. Our aim was to prospectively evaluate the frequency of bacteremia and associated complications following EUS FNA of rectal and perirectal lesions. Methods: Patients referred for EUS FNA from the lower GI tract were candidates for this IRB approved protocol. Patients were excluded if they had an indication for pre-procedure antibiotics as determined by the ASGE guidelines or had taken antibiotics, for any reason, within the prior 7 days. A first set of blood cultures (aerobic and anaerobic, 20-30 cc/each) were obtained immediately prior to the procedure (Set #1), a second set was obtained following routine flexible sigmoidoscopy/radial EUS, and a third set 15 minutes following EUS FNA. Patients were monitored in the immediate post-procedure period and by phone follow-up one week after the procedure for the development of complications. Results: 42 subjects were enrolled of whom 27 underwent EUS FNA (17 male, 10 female) with a mean age of 61 years (range 40-93). A total of 117 FNA's (mean 4.3/patient) were performed at 29 sites (mean 1.1 sites/patient) (Table 1). In addition, a total of 74 biopsies of mucosal lesions were performed (mean 2.7/patient). Cultures grew organisms in 2 patients (7.4%; 95%CI:3-17%). Coagulase negative Staphylococcus grew in patient (3rd of 3 blood cultures), and Moraxella grew in another patient (2nd of 3 blood cultures). These were interpreted as contaminates. Therefore, of the 81 blood cultures, two (2.5%, 95%CI:1-6%) blood cultures were contaminates. None of the 27 patients developed true positive blood cultures and none developed immediate or delayed infectious complications. Conclusion: These preliminary data suggest that bacteremia is uncommon after EUS FNA of rectal and perirectal GI lesions. EUS FNA of rectal and perirectal solid lesions is likely a low risk procedure for infectious complications and may not warrant antibiotic prophylaxis for spontaneous bacterial endocarditis in patients without specific indications for prophylaxis.

The Incidence of Bacteremia in Endodontic Manipulation: Preliminary Report

Endodontic procedures have been under criticism by certain members of the profession for a long time, particularly as related to focal infection. Many still believe that pulpless teeth, especially those with an area of rarefaction, are a focus of infection which ultimately could produce a focal infection. The elimination of this possible focus of infection by conservative endodontic methods has been and still is questioned. Exodontic procedures, on the other hand, have never been censored. It is believed that removal of the tooth eradicates the focus and thereby eliminates the complication of a metastatic or focal infection. We should like to offer evidence that proper endodontic procedures can produce less likelihood of focal infection than exodontic procedures. It has been demonstrated clinically and experimentally that focal infection can develop as a result of a bacteremia (1) following extraction of teeth. The incidence of bacteremia as a result of exodontic and periodontal manipulation has been reported by numerous investigators (2–7). In the extraction of teeth, it has been shown that heavy trauma invariably produces a greater dispersal of microorganisms into the blood stream from the original focus. Therefore, the reduction of trauma can curtail the number of bacteria that enter the blood stream and thus prevent the complication of the development of certain organic diseases, particularly the dread subacute bacterial endocarditis in patients who have a history of rheumatic heart disease. Investigations of the relationship of endodontic procedures to bacteremia are very meager. Robinson and his group (5) did not detect the presence of bacteria in the blood in seven cases following reaming procedures and filling of the root canals. They did not state how many of each were done and whether or not cultures were taken of the root canals to determine the presence of microorganisms. In all instances they used the rubber dam. While many laboratory procedures were discussed, specific procedures for this series of cases were not given. Beechen and his group (8) found no evidence of positive blood cultures in pulpotomy procedures in one permanent molar and twenty-two deciduous molars. Their patients ranged in age from 4 to 11 years. The coronal portion of the pulp was cultured, and the organisms were identified in each case. They were able to obtain a 10 ml. sample of blood in their young patients. Ross and Rogers (9) treated six cases and found that in three cases of vital extirpation blood cultures were all positive, while in three cases of necrosis of the pulp they were all negative. They explain that the positive blood cultures were due to the organisms being carried into the blood stream through the pulpal circulation by means of the broaches and reamers as they traversed the infected portion of the carious process in the coronal portion of the pulp. The three cases of necrosis of the pulp produced negative cultures because there was no pulpal circulation to propel the bacteria into the blood stream. They did not take cultures of the coronal portion or root canals of the teeth tested. The following study was done to determine whether or not endodontic procedures can produce a bacteremia. If no bacteremias or a smaller incidence of bacteremias occur following endodontic procedures as compared to exodontic procedures, endodontics may be the treatment of choice, particularly for patients with valvular heart disease.

RISKS FOR AND PREVENTION OF INFECTIVE ENDOCARDITIS

It is accepted medical practice to prevent bacterial endocarditis in patients with susceptible congenital or acquired cardiac malformations who are likely to experience predictable procedure-related bacteremia. Patients in general, those with congenital heart disease specifically, are insufficiently aware of the need for such prophylaxis. It is responsibility of the physician to determine which patients are susceptible to endocarditis and the need for endocarditis prophylaxis for each patient for any given instance and to educate the patient as to this need. The American Heart Association provides wallet-sized cards that may be given to each patient. Those patients not previously known to have heart disease are, of course, not eligible for chemoprophylaxis. Because these represent many of the patients with endocarditis each year, it can be argued that only a minority of patients have preventable cases. Regarding the clinical application of anti-infective endocarditis prophylaxis, the American Heart Association gives this perspective: This statement represents recommended guidelines to supplement practitioners in the exercise of their clinical judgement and is not intended as a standard of care for all cases.... Because no adequate, controlled clinical trials of antibiotic regimens for the prevention of bacteria endocarditis in humans have been done, recommendations are based on vitro studies, clinical experience, data from experimental animal models, and assessment of both the bacteria most likely to produce bacteremia from a given site and those most likely to result in endocarditis. Bacterial endocarditis is one of the few infectious disease that almost always result in death unless treated. The dramatic nature of the morbidity and mortality of infective endocarditis in those so afflicted makes the prevention of even a few cases worth the effort.

Bacterial endocarditis in patients with chronic liver disease.

Although patients with cirrhosis have an increased susceptibility for bacterial infections, endocarditis complicating cirrhosis has been reported only infrequently. In this study, our objective was to determine whether, bacterial endocarditis is, in fact, a complicating factor in cirrhosis. We retrospectively studied all cases of bacterial endocarditis that occurred over the last 15 yr in patients with known cirrhosis. Ten patients (three males, seven females) were identified, whose mean age was 55 yr (range 29-65 yr). Bacterial organisms included Staphylococcus aureus, coagulase-positive (eight patients), Peptostreptococcus (one patient), and Enterococcus (one patient). Underlying liver disease consisted of alcoholism (five patients), autoimmune chronic active hepatitis (two), cryptogenic cirrhosis (two), and primary biliary cirrhosis (one). Distribution of heart valves affected were mitral valve (six), aorta (two), and there were two involving both mitral and aortic valves. Echocardiograms revealed vegetation in 50% of the patients. Laboratory studies were markedly abnormal, with mean values of albumin 2.4 mg/dl, creatinine 2.5 mg/dl, BUN 76.5 mg/dl, and total bilirubin 8.2 mg/dl. Potential associated sources of infection were upper gastrointestinal bleeding (four), pneumonia (two), and one each of spontaneous bacterial peritonitis, hip replacement, heart catheterization, and abdominal abscess. The outcome was poor, with death in eight of 10 patients. Bacterial endocarditis may complicate cirrhosis, may be more frequent in females, typically involves the mitral valve, and probably is due to Staphylococcus aureus.

Bloodstream infections in patients older than eighty years.

During a period of 3 years in a University Hospital in Israel, 339 episodes of bacteraemia were observed in patients 80 years of age or older, and 658 episodes in patients 60-79 years of age. Patients older than 80 were more often residents of nursing homes, frequently had a history of a cerebrovascular accident, but were less often neutropenic. Twenty-four per cent of bacteraemia episodes in the very old were hospital acquired compared with 40% in the old patients. The most common source of bacteraemia was the urinary tract, 50% of episodes in the very old, and 34% of episodes in the old. The percentage of episodes in which anaerobic bacteria were isolated was 5% in the very old and 1% in the old, and the difference was significant when corrected for the sources of bacteraemia. All cases of community-acquired bacterial endocarditis in patients of 80 or over were caused by pathogens originating from the gut. Thirty-five per cent of patients of 80 and over and 30% of patients aged 60-79 years died during hospitalization. Fatality was not associated with advanced age in the very old. Factors significantly and independently associated with fatality in both groups were a hospital-acquired infection, shock, low serum albumin, renal dysfunction and inappropriate antibiotic treatment.

Bacterial endocarditis in patients with native or prosthetic heart valves: bacteriological and clinical findings.

The clinical course of 12 episodes of native valve endocarditis (NVE) and 15 episodes of prosthetic valve endocarditis (PVE) was studied. The mortality in NVE was 3/12 episodes and in PVE 5/15. No significant differences in prognosis were observed in relation to the bacterial taxonomy, which was stated in all cases. Though surgical valve replacement was performed on the relative indications heart failure, resistance to treatment, or major embolism, the regimen was primarily conservative, and the results comparable to the reports in the literature of a more surgically active attitude.

Bacterial Endocarditis in Patients with Native or Prosthetic Heart Valves: Bacteriological and Clinical Findings

Bacterial Endocarditis in Patients with Native or Prosthetic Heart Valves: Bacteriological and Clinical Findings