Cases Of Definite Infective Endocarditis Research Articles

Molecular and Serological Diagnostic Approach to Define the Microbiological Origin of Blood Culture-Negative Infective Endocarditis.

Blood culture-negative infective endocarditis (BCNIE) poses a significant challenge in determining the best antibiotic regimen for this life-threatening infection, which should be treated with as specific and effective a regimen as feasible. The goal of this study was to determine the prevalence of BCNIE among definite infective endocarditis (IE) cases and to study the impact of a molecular and serological diagnostic approach in defining the microbiological origin of BCNIE. This study included 94 definite IE cases. Serum and blood samples from BCNIE patients were tested using serological, broad-range PCR, and sequencing assays. Valve tissue sections obtained from 42 operated patients were subjected to culture and molecular studies. BCNIE accounted for 63 (67%) of the cases. Of these cases, blood PCR followed by sequencing could diagnose 11 cases. Zoonotic infective endocarditis was detected in 7 (11%) patients by serology and PCR (four Brucella, two Bartonella, and one Coxiella). Sequencing of valve PCR bands revealed 30 positive cases. Therefore, the percentage of BCNIE with unidentified etiology was reduced from 67% to 27.7% through a combination of all diagnostic procedures utilized in our study. Blood and valve PCR and sequencing assays are valuable techniques for the etiological diagnosis of BCNIE, especially in cases with previous antibiotic therapy. However, these tests should be used as part of a larger diagnostic strategy that includes serology, microscopy, and valve culture. The use of an automated blood culture system, and proper blood culture collection before ordering antibiotics, will guide IE etiological diagnosis.

A 10-year retrospective analysis of the clinical profile and outcomes of infective endocarditis at a tertiary hospital in KwaZulu-Natal, South Africa.

To examine the clinical profile and treatment outcomes of infective endocarditis (IE) at a tertiary hospital in KwaZulu-Natal. A 10-year retrospective analysis was conducted on cases of definite IE (modified Duke criteria). Ninety-seven subjects (HIV infected, n = 12) satisfied the study criteria (mean age 29.7 ± 15.6 years, M:F 1.4:1). Underlying rheumatic heart disease was present in 84.5% and severe dyspnoea in 67.0% of cases. Staphylococcus aureus was the commonest pathogen isolated (18.6%). Heart failure was present in 61.9% and vegetations were identified in 85 (87.6%) subjects, resulting in 41 (42.3%) embolic events. The clinical profile and outcomes were similar in the HIV-positive and -negative patients. Surgery was performed in 73 subjects (surgical mortality rate 9.5%, total mortality rate 26.4%). Multivariate analysis identified acute-onset IE [odds ratio (OR) 251.46, 95% confidence interval (CI) 1.18-5343.63, p = 0.043], vegetation size > 15 mm (OR 222.60, 95% CI 1.04-4730.34, p = 0.043) and medical management only (OR 20.89, 95% CI 2.12-200.06, p = 0.037) as predictors for increased in-hospital mortality. IE affects young people with underlying rheumatic heart disease and is associated with high morbi-mortality attributable to advanced disease at presentation and to haemodynamic failure resulting from valve destruction due to acute onset of aggressive infection.

Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed?

IntroductionWe aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM).MethodsWe merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only.ResultsAmong the 1030 included patients, we identified 42 patients with IE–BM (4.1%). Baseline characteristics of patients with IE–BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE (14/30, 46.7%). Three-month mortality was 28.6% in patients with IE–BM, 20.5% in patients with IE, and 16.6% in patients with BM.ConclusionsPatients with pneumococcal IE or altered mental status during IE must be investigated for BM. Patients with S. aureus, oral and group D streptococcal or enterococcal BM, or unfavorable outcome in pneumococcal meningitis would benefit from an echocardiography. Patients with the dual infection have the worst prognosis. Their identification is mandatory to initiate appropriate treatment.

Staphylococcus lugdunensis Endocarditis: Lower Mortality in the Contemporary Era?

BackgroundStaphylococcus lugdunensis is a virulent coagulase-negative Staphylococcus that is a rare cause of infective endocarditis (IE) associated with high mortality. A linear growth of IE has occurred over the past several years in Saskatchewan, with overlapping epidemics of human immunodeficiency virus (HIV)/hepatitis C virus driven by injection drug use (IDU). We hypothesized that given the unique challenges faced by our population with IDU and inequitable healthcare access, our cases of S. lugdunensis IE might differ from those in the published literature. MethodsWe retrospectively reviewed the cases of S. lugdunensis endocarditis admitted at our tertiary care hospitals in Saskatoon over a 6-year period and analyzed their baseline characteristics, antimicrobial susceptibility data, management, and outcome data, where available, for each patient. ResultsOf the 24 blood cultures positive for S. lugdunensis, as identified by our laboratory, we verified 6 cases of definite IE, and 2 cases of probable IE, applying the modified Duke’s criteria. A total of 5 of 8 cases involved native valves, with only 1 infection of the bioprosthetic mitral valve, seen in patient with IDU. A total of 5 of 8 cases involved the left-sided valves, with 1 of 8 involving the tricuspid valve. Only 1 death was recorded. ConclusionsThe male predominance and primarily left-sided valve infection we noted in our review were similar to results in the published literature. We noted a lower rate of surgical intervention and mortality than previously observed, which merits further study. We did not find coinfection with HIV and/or hepatitis C virus as an epidemiologic risk factor, likely owing to the low rate of IDU in our study.

Infective endocarditis in children with congenital heart disease compare to structurally normal heart

Epidemiologic of infective endocarditis (IE) is changing and paediatric population is heterogeneous. We compare clinical characteristics according cardiac status among children. A retrospective multi centric study was conducted over a decade. Clinical presentation, treatment, outcome, microorganism, underlying congenital heart disease data were recorded. We identified 64 cases of definite IE between January 2008 to December 2018 median age was 8.0 [0.8–13.2] and 26 were girls, S aureus was the most common pathogen, n = 22 (34%), presented in Table 1 . CHD represented 45 cases of IE and 38 patients had prior cardiac surgery, they were significantly younger and community acquired IE was more common. New cardiac murmur 11 (24%) vs. 11 (58%), P < 0.02, acute ischemic stroke 1 (2%) vs. 4 (21%), P < 0.02, and heart failure 11 (22%) vs. 10 (54%), P < 0.03 were significantly higher in non-CHD group. Major MDC was met more often in patients without CHD than in patients with CHD (84% versus 46%, P < 0.006). There was no difference between IE related to children with or without CHD considering the side of the localisation. Valvular replacement was more frequent in this population [13 (28%) vs. 1 (5%) P < 0.05]. Overall morbidity rate was not significantly different but neurologic complications were significantly more prevalent in patients without CHD 7 (15) vs. 11 (58). Children without CHD presented significantly more neurologic impairment 1 (2%) vs. 4 (21%), P < 0.05. CHD patients seem older, require more valve replacement and present community acquired infection when patients without CHD presented more neurological outcome and more hospital acquired infection.

Clinical and Echocardiographic Characteristics of Bartonella Infective Endocarditis: An 8-Year Single-Centre Experience in the United States

Infective endocarditis due to Bartonella species is rare. The clinical and echocardiographic characteristics are not well defined. We aimed to investigate the clinical and echocardiographic findings of Bartonella endocarditis in the contemporary era. The infective endocarditis (IE) registry and echocardiographic database at our institution were retrospectively analysed to evaluate the clinical and echocardiographic features of Bartonella endocarditis. Between January 2008 and December 2015, there were 11 patients with Bartonella IE (0.84% among a total of 1,308 cases of definite IE): median age 54 (30-69) years, all male, 9 Caucasian, 10 had a history of cat exposure, 10 had a pre-existing valvulopathy including 6 patients with a prosthetic valve with prosthesis age range between 3 to 5 years and 1 patient with implantable cardioverter defibrillator (ICD). Bartonella henselae was responsible for all the cases. Echocardiographic evidence of IE was found in 6 of 11 patients on transthoracic echocardiography (TTE), and 6 of 8 on transoesophageal echocardiography (TEE). Bartonella IE was associated with significant valvular destruction and dysfunction on echocardiography. Nine (9) patients were managed surgically with excellent outcomes, including two patients who failed initial medical therapy. Two (2) patients who were managed medically had progression of valvular dysfunction. At a median follow-up of 6 months, there were no deaths attributable to IE or other cardiovascular causes. In a contemporary single-centre cohort in the United States, Bartonella IE remains rare, but should be considered when pathogen could not be identified in patients with suspected IE, especially those with prosthetic valves or bicuspid aortic valve (BAV). The vast majority of patients with Bartonella IE were managed surgically with excellent outcomes.

PO317 The Yentl Syndrome: How to Get Gender Medicine Into Cardiology

Opiate pain reliever (OPR) misuse by injection is increasing in the United States. Infective endocarditis (IE), a devastating complication of injection OPR use, has been understudied.We conducted a retrospective chart review of IE cases at an academic tertiary care hospital in North Carolina. Hospital admissions from 2009-2014 were screened for cases of definite IE. Subjects reporting injection drug use (IDU) were classified as IDU-IE, and compared to those without reported IDU, classified as No IDU-IE. Rates of IDU-IE and No IDU-IE, patient demographics, microbiologic data and outcomes were compared between the groups.A total of 127 incident admissions for IE were identified, 48 (37.8%) were classified as IDU-IE and 79 (62.2%) as No IDU-IE. IDU-IE cases increased from 14% of hospitalizations for IE in 2009 to 56% in 2014; reporting of OPR injection increased in 2012 and continued through the study period. IDU-IE subjects were younger (32.6 ± 11.7 versus 54.4 ± 13.1, P < 0.0001), more likely to be single (n = 33 [68.8%] versus n = 23 [29.1%], P < 0.0001) and to reside in rural communities (n = 36 [75.0%] versus n = 25 [31.6%], P < 0.0001) than No IDU-IE subjects. Hospital length of stay (26 days versus 12 days, P < 0.0001) and intensive care unit length of stay (2 days versus 1 day, P = 0.04) were longer for IDU-IE patients and hospital mortality did not differ (10.4% IDU-IE versus 8.9% No IDU-IE, P = 0.77).IDU-IE rates increased over time, and OPR injection use in rural communities appears to be a major contributor. Interventions to reduce IDU-IE and OPR misuse are needed to halt this growing epidemic in at-risk rural communities.

Infective Endocarditis: how many ultrasonography studies are necessary to reach the diagnosis? A real world scenario (2008-2017)

Background: The central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE) has been clearly established. Both echocardiograpy and blood cultures are the major criteria to reach the diagnosis of IE. Although 2D transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have complementary roles, TEE has more sensitivity and specificity especially in the presence of intracardiac device. Sometimes, however, in spite of a high clinical suspicion, the first study that is carried out does not contribute with elements that confirm this suspicion and many expert and guidelines suggest to repeat the study in a relatively short time. To analize the role of repeated echoes in the diagnosis of definite IE. Methods & Materials: Retrospective, observational study of consecutives cases of Definite IE according to modified Duke Criteria, in adults patients admitted in a single cardiovascular referral center. Results: From January/2008 to June/2017, 148 definite EI (43 native valve, 72 prosthetic valve, 33 pacemaker-associated IE) were included. All ptes underwent TTE and TEE. The first echoe was made a median of 2 d since the hospitalization day (range = 0-13 d; SD +/- 2) and showed images suggesting IE in 106/148 pts (71.6%). A 2nd echoe was performed in 18 pts in a median time of 7 days and showed images not seen in the previous echoe in 11/18 pts (61%). Considering only “valvular IE” (n = 115) the first echo was “positive” for IE in 76.5% and 86% in the 2nd echoe: native valve IE 81.4% vs 83.7%; PVIE 73.6% vs 87.5% (early PVIE - n: 32 - 75% vs 90%) respectively. Conclusion: Ultrasonography is unequivocally the mainstay of diagnostic imaging in IE. Repeat the study in the case of a high clinical suspicion could notably increase the possibility of achieving the diagnosis of IE, especially when intracardiac device (e.g: prosthetic valves) are probably involved.

Added diagnostic value and impact on antimicrobial therapy of 16S rRNA PCR and amplicon sequencing on resected heart valves in infective endocarditis: a prospective cohort study

ObjectivesFor adequate management and therapy of infective endocarditis (IE), identification of the causative pathogen is crucial but molecular testing results are not currently included in diagnostic criteria. The added diagnostic value and impact on antimicrobial therapy of 16S rRNA PCR and amplicon sequencing (16S rRNA PCR) performed on excised heart valves from patients with IE was evaluated alongside the effect of pre-operative antibiotics on the performance of blood culture (BC), valve culture (VC) and 16S rRNA PCR. MethodsAll patients undergoing valve surgery for definite or possible IE, according to modified Duke Criteria, were prospectively included from July 2013 up to and including June 2016. ResultsIn all, 127 patients were included. Sensitivity for detecting the causative micro-organism in 120 post-operative definite IE patients was 26% for VC and 87% for BC and 16S rRNA PCR. 16S rRNA PCR, VC and BC were equally sensitive for different valve types and causative pathogens. In 27 (21%) definite IE patients, 16S rRNA PCR clarified discrepant culture results or was the only method identifying the causative pathogen. In 12 (10%) post-operative definite IE cases, molecular testing results influenced antimicrobial therapy. ConclusionsThe very good performance characteristics, added diagnostic value and impact on antimicrobial therapy of molecular testing of heart valves should support the incorporation of molecular testing in diagnostic criteria and guidelines for IE.

Opiate Injection-associated Infective Endocarditis in the Southeastern United States

BackgroundOpiate pain reliever (OPR) misuse by injection is increasing in the United States. Infective endocarditis (IE), a devastating complication of injection OPR use, has been understudied. MethodsWe conducted a retrospective chart review of IE cases at an academic tertiary care hospital in North Carolina. Hospital admissions from 2009-2014 were screened for cases of definite IE. Subjects reporting injection drug use (IDU) were classified as IDU-IE, and compared to those without reported IDU, classified as No IDU-IE. Rates of IDU-IE and No IDU-IE, patient demographics, microbiologic data and outcomes were compared between the groups. ResultsA total of 127 incident admissions for IE were identified, 48 (37.8%) were classified as IDU-IE and 79 (62.2%) as No IDU-IE. IDU-IE cases increased from 14% of hospitalizations for IE in 2009 to 56% in 2014; reporting of OPR injection increased in 2012 and continued through the study period. IDU-IE subjects were younger (32.6 ± 11.7 versus 54.4 ± 13.1, P < 0.0001), more likely to be single (n = 33 [68.8%] versus n = 23 [29.1%], P < 0.0001) and to reside in rural communities (n = 36 [75.0%] versus n = 25 [31.6%], P < 0.0001) than No IDU-IE subjects. Hospital length of stay (26 days versus 12 days, P < 0.0001) and intensive care unit length of stay (2 days versus 1 day, P = 0.04) were longer for IDU-IE patients and hospital mortality did not differ (10.4% IDU-IE versus 8.9% No IDU-IE, P = 0.77). ConclusionsIDU-IE rates increased over time, and OPR injection use in rural communities appears to be a major contributor. Interventions to reduce IDU-IE and OPR misuse are needed to halt this growing epidemic in at-risk rural communities.

Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non–severely ill patients

Although many international guidelines exist for the management of infective endocarditis (IE), recommendations are lacking on the opportunity of switching antibiotics from the intravenous (IV) to oral route during treatment. We present a cohort study of 426 cases of IE over a period of 13 years (2000–2012), including 369 cases of definite IE according to the Duke criteria. Predictors of mortality were identified using the Cox proportional hazard analysis. The median (range) age at diagnosis was 64.5 (7–98) years. One hundred six patients (25%) had healthcare-associated IE. Oral streptococci (n = 99, 23%) and Staphylococcus aureus (n = 81, 19%) were the predominant microorganisms. Ninety-two patients (22%) died during follow-up. After an initial phase of IV antibiotherapy, 214 patients (50%) were switched to oral route a median (range) of 21 (0–70) days after diagnosis of IE. Patients in the oral group had fewer comorbidities, and criteria of severity at inclusion and were less frequently infected by S. aureus. Oral antibiotics were amoxicillin alone in 109 cases or a combination therapy of clindamycin, fluoroquinolone, rifampicin and/or amoxicillin in 46 cases, according to the susceptibility of the microorganisms. In the multivariate analysis, a switch to oral route was not associated with an increased risk of mortality. During follow-up, only two relapses and four reinfections were observed in the oral group (compared to nine and eight in the IV group, respectively). In this study, switching to oral administration was not associated with an increased risk of relapse or reinfection. These promising results need to be confirmed by prospective studies.

0403 : What's the profil of infective endocarditis in university hospital of Casablanca?

infective endocarditis (IE) is a disease whose incidence has remained stable in recent years with high mortality despite advances made in the treatment. The aim of our retrospective study was to analyze the clinical profile, ultrasound, bacteriological, therapeutic of patients with IE who are hospitalized in the cardiology department of the University Hospital Ibn Rochd of Casablanca. Sixty-two definite IE cases were enrolled in a prospective observational study between January 2012 and October 2015. The average age of our patients was 38 years with a male predominance, the sex ratio was 1.29. 55 (88,7%) involved native valve, 7 patients, or 11,29% presented a prosthetic valve endocarditis, 6 or 9,6% patients showed endocarditis congenital heart disease,.The front door was identified in only 33.8% of cases with a predominance of dental and oral origin. Blood cultures were positive in 25.8% of patients insulating staphylococcus in 11.2%, streptococcus in 4.8%, bacillus and a fungus in 3.2% of cases, a morbillurum Gemella and a Gram-negative cocci in 1.6% for each of them. The transthoracic and / or transesophageal reveals a growing image in 77.4% of cases, cardiac abscess image in 8% cases, mutilation valvular in 9.6% of cases and one case of disinsertion of prosthesis was found among prosthesis wearers. Mitral location of IE was the most common, found in 41.9% of cases followed by the aortic valve in 27.4% of cases. Embolic and hemodynamic complications were observed respectively in 6.4% and 1.6%. The surgery has occurred in 33.8% of patients. Mortality during hospitalization was 9,6%. infective endocarditis continues to pose a diagnostic and therapeutic problem. Its epidemiological profile is remarkably changed in recent years.In our context bacteriological diagnosis is difficult. The indication for surgery is common. The short-term prognosis remains dark with heavy-hospital mortality. The author hereby declares no conflict of interest

The usefulness of serum troponin levels to predict 1-year survival rates in infective endocarditis

Infective endocarditis (IE) is associated with increased mortality and morbidity. In this study, we aimed to evaluate the role of troponin levels in predicting long-term survival in patients with IE. A retrospective analysis of the medical database of Yuksek Ihtisas Education and Research Hospital was performed to reach the patients that received the diagnosis of definite IE according to Duke criteria. Out of 84 definite IE cases, 48 patients (mean age 45.6 ± 17.3, 39.6% female) that had troponin T levels measured upon hospital admission were included. The survival status of the study subjects was assessed during a follow-up period of 1 year. A total of 20 (41.7%) patients died during the follow-up. Baseline median troponin T levels were significantly higher in fatal cases (0.08 [0.02-0.24] ng/ml vs. 0.02 [0.01-0.04] ng/ml p = 0.003). The optimal troponin T level to detect mortality was 0.05 ng/ml according to receiver operating characteristic curve (area under the curve 0.75, 95% Confidence Interval (CI) [0.61-0.9], p = 0.003) with 70% sensitivity and 79% specificity. Patient with elevated troponin levels were older, were more likely to be male and tended to have enterococcal infection. These patients had also higher creatinine levels and increased systolic pulmonary pressures. In the multivariate Cox regression analysis, renal failure (hazards ratio (HR) 8.23, CI 95% 2.53-26.9, p < 0.0001), heart failure (HR 4.48, CI 95% 1.73-11.61, p = 0.002) and troponin T ≥ 0.05 ng/ml (HR 3.11, CI 95% 1.13-8.56, p = 0.03) were associated with increased mortality rates. IE has poor outcome and baseline troponin T levels may predict long-term survival rates in these patients.

Prognostic Value of Skin Manifestations of Infective Endocarditis

Infective endocarditis (IE) is a rare disease with poor prognosis. When IE is suspected, skin examination is mandatory to look for a portal of entry and classic skin lesions to help diagnose and manage the condition. To describe the prevalence of and factors associated with dermatological manifestations in patients with definite IE. Observational, prospective, population-based epidemiological study between January 1 and December 31, 2008. Subsequently, collected dermatological data were subjected to post hoc analysis. Patients (n = 497) diagnosed in 7 French regions and hospitalized in France for definite IE satisfying modified Duke criteria. Patient and disease epidemiological information was collected, focusing on the most classic dermatological manifestations of IE (Osler nodes, Janeway lesions, purpura, and conjunctival hemorrhages). Disease outcome was also recorded. Among 497 definite IE cases, 487 had known dermatological status. Of 487 cases, 58 (11.9%) had skin manifestations, including 39 (8.0%) with purpura, 13 (2.7%) with Osler nodes, 8 (1.6%) with Janeway lesions, and 3 (0.6%) with conjunctival hemorrhages (5 patients had 2 skin manifestations). Patients with skin manifestations had a higher rate of IE-related extracardiac complications than patients without skin manifestations, particularly cerebral emboli (32.8% vs 18.4%, P = .01), without increased mortality. Patients with purpura had larger cardiac vegetations (18.1 vs 13.7 mm, P = .01), and Janeway lesions were associated with more extracerebral emboli (75.0% vs 31.8%, P = .02). Specific skin manifestations of IE are associated with a higher risk of complications and should alert physicians to examine for extracardiac complications, notably with cerebral imaging.

Prospective study of infective endocarditis from a developing country

There has been a considerable change in the profile of infective endocarditis (IE) worldwide. However, prospective studies of IE from developing countries are rare. The aim of this study was to evaluate predisposing factors, clinical presentation, echocardiography, microbiology, in-hospital course, and outcomes of patients with definite IE. This was a prospective observational study of consecutive cases of definite IE as per the modified Duke criteria. Between 2004 and 2006, a total of 104 cases of definite IE were identified. The mean age was 23.5 years (interquartile range, 9-38 years), with a male preponderance (2.5:1). Congenital heart disease accounted for 39.4% cases of IE, followed by native valve disease (29.8%), prosthetic valve disease (20%), and normal valves (7.7%). Echocardiography was diagnostic in 96.7% of the patients. Positive cultures were obtained in only 41% of the cases, with staphylococci and streptococci being the most common organisms. Seventy-three percent of the cases had at least 1 major complication. Only 15% of the cases underwent surgery for IE. The in-hospital mortality was 26%. On multivariate analysis, an underlying heart disease other than native valve disease and septic shock were independent predictors of mortality. The mean age of IE in India is significantly lower than that in the West. Unlike previous reports, congenital heart disease is the major predisposing factor. Culture positivity rates and surgery for IE are unacceptably low. In conclusion, IE in India is associated with a very high morbidity and mortality.

475 THE IMPACT OF PERCUTANEOUS CORONARY INTERVENTION (PCI) WITH STENT IMPLANTATION UPON MMP9 AND INFLAMATORY MARKERS IN PATIENTS WITH ACUTE CORONARY SYNDROMES

Infective endocarditis (IE) is associated with increased mortality and morbidity. In this study, we aimed to evaluate the role of troponin levels in predicting long-term survival in patients with IE.A retrospective analysis of the medical database of Yuksek Ihtisas Education and Research Hospital was performed to reach the patients that received the diagnosis of definite IE according to Duke criteria. Out of 84 definite IE cases, 48 patients (mean age 45.6±17.3, 39.6% female) that had troponin T levels measured upon hospital admission were included. The survival status of the study subjects was assessed during a follow-up period of 1 year.A total of 20 (41.7%) patients died during the follow-up. Baseline median troponin T levels were significantly higher in fatal cases (0.08 [0.02-0.24] ng/ml vs. 0.02 [0.01-0.04] ng/ml p=0.003). The optimal troponin T level to detect mortality was 0.05 ng/ml according to receiver operating characteristic curve (area under the curve 0.75, 95% Confidence Interval (CI) [0.61-0.9], p=0.003) with 70% sensitivity and 79% specificity. Patient with elevated troponin levels were older, were more likely to be male and tended to have enterococcal infection. These patients had also higher creatinine levels and increased systolic pulmonary pressures. In the multivariate Cox regression analysis, renal failure (hazards ratio (HR) 8.23, CI 95% 2.53-26.9, p<0.0001), heart failure (HR 4.48, CI 95% 1.73-11.61, p=0.002) and troponin T ≥ 0.05 ng/ml (HR 3.11, CI 95% 1.13-8.56, p=0.03) were associated with increased mortality rates.IE has poor outcome and baseline troponin T levels may predict long-term survival rates in these patients.

MS455 DISTRIBUTION AND SEVERITY OF ATHEROSCLEROSIS IN RENAL ARTERY: AN AUTOPSY STUDY

Infective endocarditis (IE) is associated with increased mortality and morbidity. In this study, we aimed to evaluate the role of troponin levels in predicting long-term survival in patients with IE.A retrospective analysis of the medical database of Yuksek Ihtisas Education and Research Hospital was performed to reach the patients that received the diagnosis of definite IE according to Duke criteria. Out of 84 definite IE cases, 48 patients (mean age 45.6±17.3, 39.6% female) that had troponin T levels measured upon hospital admission were included. The survival status of the study subjects was assessed during a follow-up period of 1 year.A total of 20 (41.7%) patients died during the follow-up. Baseline median troponin T levels were significantly higher in fatal cases (0.08 [0.02-0.24] ng/ml vs. 0.02 [0.01-0.04] ng/ml p=0.003). The optimal troponin T level to detect mortality was 0.05 ng/ml according to receiver operating characteristic curve (area under the curve 0.75, 95% Confidence Interval (CI) [0.61-0.9], p=0.003) with 70% sensitivity and 79% specificity. Patient with elevated troponin levels were older, were more likely to be male and tended to have enterococcal infection. These patients had also higher creatinine levels and increased systolic pulmonary pressures. In the multivariate Cox regression analysis, renal failure (hazards ratio (HR) 8.23, CI 95% 2.53-26.9, p<0.0001), heart failure (HR 4.48, CI 95% 1.73-11.61, p=0.002) and troponin T ≥ 0.05 ng/ml (HR 3.11, CI 95% 1.13-8.56, p=0.03) were associated with increased mortality rates.IE has poor outcome and baseline troponin T levels may predict long-term survival rates in these patients.

Candida Infective Endocarditis

Candida infective endocarditis (IE) is rare but often fatal. To increase understanding of this condition, researchers (with partial industry support) examined records from a database of IE cases registered from 61 centers in 28 countries. Among 2749 cases of definite IE between June 2000 and August 2005, 33 (1.2%) were attributable to Candida infection. Forty-eight percent of these cases were caused by C. albicans, 21% …

Pediatric Infective Endocarditis: HasStaphylococcus aureusOvertaken Viridans Group Streptococci as the Predominant Etiological Agent?

Viridans group streptococci (VGS) have traditionally been the most common etiological agents of infective endocarditis (IE). Advances in cardiovascular surgery and the increasing use of long-term central venous catheters may have altered the epidemiology of pediatric IE. A chart review of children younger than 17 years of age with IE was completed at the Stollery Children's Hospital (Edmonton, Alberta) between 1985 and 2004. The literature was reviewed to look for changes over time in the most common etiological agents of pediatric IE. There were 31 cases of definite IE and nine cases of possible IE at the Stollery Children's Hospital, 19 of which were nosocomial. Thirty cases (75%) had congenital heart disease. The etiological agents were Staphylocccus aureus (n=16), VGS (n=5), coagulase-negative staphylococci (n=3), enterococcus (n=3), other streptococci (n=8), Enterobacter cloacae (n=1) and Stenotrophomonas maltophilia (n=1), while three cases were culture negative. Two deaths were due to S aureus IE. Review of the literature identified an increasing number of case series in which S aureus was the predominant etiological agent, but VGS still predominated in some recent series. Congenital heart disease remains the primary risk factor for pediatric IE. Prospective population-based studies are required to determine whether S aureus has become the predominant pathogen.

Characteristics and regional variations of group D streptococcal endocarditis in France

The proportion of infective endocarditis (IE) caused by group D streptococci (GDS; formerly Streptococcus bovis) increased markedly in France, to account for 25% of all cases of IE by 1999. In an attempt to explain this phenomenon, a comparative analysis of GDS and oral streptococci (OS) causing IE was performed. This study was based on data collected from a large cross-sectional population-based survey that was conducted in 1999. In total, 559 cases of definite IE were recorded, of which 142 involved GDS and 79 involved OS. Patients with GDS IE were older (62.7 vs. 56.6 years, p 0.01) and had a history of valve disease less frequently than did patients with OS IE (33.8% vs. 67.1%, p <0.0001). At-risk procedures for IE were performed less frequently in patients with GDS than in patients with OS (14.8% vs. 24.1%, p 0.08), but co-morbidities were more frequent in the GDS group (59.9% vs. 32.9%, p 0.0001). Diabetes, colon diseases and cirrhosis were also more frequent in the GDS group (p 0.006, p <0.0001 and p 0.08, respectively). Rural residents accounted for 31.0% of the GDS group, but for only 15.2% of the OS group (p 0.001). Likewise, the proportion of GDS IE was higher in regions with mixed (urban and rural) populations (Franche-Comté 81.8%, Marne 68.7%, Lorraine 70.3% and Rhône-Alpes 65.3%) than in exclusively urban regions (Paris and Ile de France 58.0%). Further investigations are required to elucidate the link in France between the incidence of GDS IE, rural residency and nutritional factors.