Cases Of Infective Endocarditis Research Articles

1413. Regional variation in substance use associated infectious endocarditis in New York State: 2000-2014.

Abstract Background Injection drug use is a significant and growing public health concern in New York State (NYS). Infectious endocarditis (IE) is a serious complication of injection drug use, and is associated with significant morbidity and mortality, prolonged hospitalizations, and high healthcare costs. Methods Data was extracted from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP)’s New York State Inpatient Database (SID) to determine incidence of IE in New York between 2000-2014. The HCUP-SID database includes inpatient discharge records from hospitals across the state regardless of payer and contains information on inpatient healthcare utilization. Regional incidence was then calculated using population values from the 2010 regional census. Cost of hospitalization was derived from the HCUP using the cost to charge ratio (CCR) file to estimate the cost of inpatient hospital stays. Results During the study interval the number of statewide substance use-associated IE cases fluctuated between a low of 262 cases in 2000, and a high of 362 cases in 2007. Approximately 70-80% of the patients with substance use-associated IE in NYS in this study were insured through public programs (Medicare or Medicaid). In-hospital mortality from substance use-associated IE appears to be decreasing slightly, however, there is an accompanying increase in hospital costs, in part due to long average length of hospital stays between 13 and 18 days. The mean cost of hospitalization rose notably from $51,934 to $134,325 over the course of our study. Over 10% of hospitalizations culminated in patient directed discharges. Over the study period New York City’s incidence rates appeared to decrease while other region’s incidence rates appeared to increase, specifically in the Capital District, Central New York, and Southern Tier regions. Trends in substance use associated infectious endocarditis in NYS This figure shows trends in endocarditis in the study period. It shows a rise in cases in substance use associated endocarditis in NYS in less urban areas. Conclusion Between 2000 and 2014 the rates of substance use-associated infective endocarditis in NYS fluctuated but remained fairly constant. Despite the relatively constant statewide rates, there was important regional variation, including decreasing incidence rates of SUIE in New York City and rising incidence rates in non-New York City counties. Disclosures Shashi Kapadia, MD, GIlead: Grant/Research Support.

876 VENTRICULAR SEPTAL DEFECT AND RIGHT-SIDED INFECTIVE ENDOCARDITIS

Abstract Introduction Right-sided infective endocarditis (IE) accounts for 5-10% of IE cases; it is most frequently associated with intravenous drug abuse but can also be observed in patients with cardiac implantable electronic devices, central venous catheters or congenital heart diseases. Case report A 34-year-old female, with unrepaired perimembranous ventricular septal defect (VSD) and right ventricle and tricuspid valve (TV) IE with lung septic embolism treated conservatively with antibiotic therapy 16 years ago, was admitted to our hospital for persistent fever and cough unsuccessfully treated with empiric antibiotic therapy. She denied intravenous drug abuse and recent surgical or dental procedures. Blood cultures resulted positive for multi sensitive Staphylococcus lugdunensis, so antibiotic therapy with Oxacillin and Gentamicin was started. Suspecting IE, transesophageal echo (TEE) was performed and showed, inside VSD, a small fluctuating vegetation and, along the right side of the interventricular septum, next to the VSD, a voluminous hypomobile vegetation; septal and anterolateral TV leaflets appeared thickened and infiltrated by vegetations floating into the right atrium; at color-Doppler moderate TV regurgitation. A whole-body computed tomography showed right lung abscess and right kidney septic infarct. Endocarditis Team, considering hemodynamic stability and inflammatory biomarkers and surveillance blood cultures negativization, decided for medical therapy with echocardiographic follow-up. TEE performed at the end of antibiotic therapy demonstrated complete disappearance of the above described vegetations and surgical VSD closure was scheduled. Discussion Patients with unoperated small VSDs and without volume overload signs usually remain asymptomatic and do not require surgery; nevertheless, a small percentage of them develops problems later in life and IE represents one of the main concerns. Even if unrepaired VSD is associated with increased risk of IE compared with the general population, antibiotic prophylaxis is still recommended only for high-risk patients undergoing at-risk dental procedures, while non-specific oral and cutaneous hygiene measures should always be applied. Latest ESC Guidelines for the management of adult congenital heart disease state that in patients with no significant left to right shunt, but a history of repeated episodes of IE, VSD closure should be considered (IIa, C); it's still matter of debate whether closure should be performed after the first episode of IE. Conclusion IE should always be suspected in patients with VSD and persistent fever. Optimal oral and skin hygiene are effective prevention measures, while prophylactic antibiotic therapy is indicated only in selected cases. Surgery should be considered after repeated episodes of IE.

1992. Risk of Infective Endocarditis in Streptococcal mitis Bloodstream Infections Among Patients with Neutropenia from Hematologic Malignancies

Abstract Background Streptococcus mitis is a common colonizer of the human oral and gastrointestinal tract. Patients with neutropenia due to hematologic malignancy (HM), particularly those prescribed fluoroquinolone prophylaxis are at increased risk of a S. mitis bloodstream infection (BSI). Risk of infective endocarditis (IE) in this patient population remains unclear. Methods This was a multicenter, retrospective study of neutropenic (ANC < 500 K/uL) patients with HM from November 2016 - February 2022. Patients were included if they had S. mitis isolated in at least 1 blood culture bottle. The primary outcome was number of patients who developed IE based on cardiac imaging. Secondary outcomes included number of patients who underwent IE workup via cardiac imaging and BSI recurrence within 12 weeks. Results Among 171 patients who met the inclusion criteria, 101 (59%) were male and median age was 60 years old (range 19-86). Patient demographics, microbiologic information and outcomes are shown in Table 1. All patients in the cohort had native cardiac valves. Acute leukemia/myelodysplastic syndrome was the most common HM (n=129, 75%), followed by lymphoma (n=27, 16%), multiple myeloma (n=10, 6%) and chronic leukemia (n=5, 3%). Most patients had a transthoracic echocardiogram (TTE) (n=97, 56.7%) within 7 days of BSI. Of these patients, 1 had suspected valvular vegetations on TTE, but transesophageal echocardiogram (TEE) was negative. Two patients had negative TTEs, but there was a high clinical suspicion, so cardiac computed tomography was performed and showed no valvular vegetations. Despite negative cardiac imaging, 1 patient completed 6 weeks of empiric treatment for IE based on radiographic findings in the torso suggesting visceral infarcts. One patient had S. mitis BSI recurrence within 12 weeks of first positive culture. Median duration of antimicrobial therapy for BSI was 15 days (range 8-43). Conclusion IE is uncommon in neutropenic HM patients with native cardiac valves and S. mitis BSI. In this cohort where approximately half had a TTE after bacteremia and median duration of BSI therapy was 15 days, recurrent BSI was rare, suggesting that IE cases were not underdiagnosed in those without cardiac imaging. Cardiac imaging such as TTE to rule out IE may not be necessary for all patients in this population. Disclosures Ramy H. Elshaboury, PharmD, Eli Lilly: Honoraria|Gilead Sciences: Grant/Research Support David W. Kubiak, PharmD, BCPS, BCIDP, FIDSA, Astellas Pharma, Inc.: Advisor/Consultant|AVIR Pharma Inc: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant Sarah P. Hammond, MD, F2G: Advisor/Consultant|F2G: Grant/Research Support|GSK: Grant/Research Support|Scynexis: Grant/Research Support.

1993. Serratia is a rare cause for Infective Endocarditis of the Tricuspid Valve

Abstract Background Serratia marcescens is a Gram-negative motile bacillus that is a facultative anaerobe and non-lactose fermenting. Serratia can be isolated from water, soil, plants, and the intestinal microbiome. Serratia produces a unique Identifying reddish pigment called prodigiosin. Serratia is responsible for only 0.14% of infective endocarditis cases, with a mortality rate of 85%. Methods A 37 YO female with a history of Intravenous heroin abuse was admitted with fevers and dyspnea. Vital signs were BP 76/50, HR 140, RR 26, temp 102 F, and SpO2 98% on room air. She was toxic-appearing. Labs: WBC 26000(4,000 – 11,000 /uL) with 14% bands, Hb 5.6 (12.6 – 17.0 g/dL), PLT 15*10^3(150-372*10^3/uL), creatinine 2.5 (0.50 - 1.60 mg/dL), lactic acid 15.8 (0.5-2.2 mmol/L). We started vancomycin, piperacillin-tazobactam, and norepinephrine for septic shock. A transthoracic echo showed a large mass on the tricuspid valve, and a transesophageal echo depicted it as vegetation. Blood cultures grew Serratia. She underwent excision of anterior and posterior tricuspid valve leaflets with reconstruction and ring annuloplasty. She reported washing her syringes with tab water and reusing them again. Serratia has a predilection for left-side heart valves even in the IVDU population but this patient presented with a tricuspid valve endocarditis. Results Serratia is a rare cause for IE in the ICE study; out of 2.761 definite IE cases identified over five years, only forty-nine instances were due to gram-negative bacilli. Of those, only four cases were due to Serratia. The clinical presentation of Serratia includes constitutional symptoms, new-onset murmur, and cutaneous and neurologic manifestations. Serratia produces multiple pathogenic factors allowing Serratia to result in valvular destruction and perivalvular complications, and distant septic emboli metastasis. Conclusion Serratia is sensitive to third and fourth-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, and aminoglycosides. Treatment is complex due to the production of AmpC B-lactamase, which hydrolyzes third and fourth-generation cephalosporins. The 2005 IDSA suggested a combination of B-lactam and an aminoglycoside for Serratia endocarditis, and these are not guidelines but merely recommendations. Disclosures All Authors: No reported disclosures.

Utility of Metagenomic Next-Generation Sequencing in Infective Endocarditis: A Systematic Review.

Blood cultures have been the gold standard for identifying pathogens in infective endocarditis (IE). Blood culture-negative endocarditis (BCNE), however, occurs in 40% or more of IE cases with the bulk of them due to recent antibiotic exposure prior to obtaining blood cultures. Increasingly, molecular techniques are being used for pathogen identification in cases of BCNE and more recently has included metagenomic next-generation sequencing (mNGS). We therefore performed a literature search on August 31, 2022, that assessed the mNGS in IE and 13 publications were identified and included in a systematic review. Eight (61.5%) of them focused only on IE with mNGS performed on cardiac valve tissue in four studies, plasma in three studies and cardiac implantable electronic devices (CIED) in one study. Gram-positive cocci, including Staphylococcus aureus (n = 31, 8.9%), coagulase-negative staphylococci (n = 61, 17.6%), streptococci (n = 130, 37.5%), and Enterococcus faecalis (n = 23, 6.6%) were the predominant organisms identified by mNGS. Subsequent investigations are needed to further define the utility of mNGS in BCNE and its impact on patient outcomes. Despite some pitfalls, mNGS seems to be of value in pathogen identification in IE cases, particularly in those with BCNE. This study was registered and on the Open Science Framework platform.

The success story of complicated Streptococcus Gordonii infective endocarditis management: A case report

Infective endocarditis is a recognized complication that may occur post-dental procedure in high-risk patients. Streptococcus gordonii is one of the unusual causative organisms of infective endocarditis. We report a case of Streptococcus gordonii infective endocarditis involving mitral and aortic valves complicated with splenic abscess, stroke, and limb ischemia following a tooth extraction procedure.

Granulicatella adiacens infective endocarditis

Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcal infective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks.

Fungal Infective Endocarditis Post Device Occlusion in Perimembranous Ventricular Septal Defect

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Management and Long-Term Outcomes of Patients With Infectious Intracranial Aneurysms.

Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited. To retrospectively study long-term outcomes of IIAs in patients treated medically or surgically. Adult cases of IE and/or IIAs admitted to Emory or Grady Healthcare Systems between May 2015 and May 2020 were reviewed for demographic, clinical, and radiographic variables for up to 2 years. Primary outcome measure was 2-year survival. Among 1714 cases of IE, intracerebral hemorrhage occurred in 322 patients and IIAs in 17 patients. The presence of IIAs in IE was associated with higher odds of disposition to hospice/death (odds ratio = 6.9). Including non-IE patients, 24 patients had 38 IIAs mainly involving the distal middle cerebral artery and 16 were ruptured on admission. IIAs were predominantly treated with antibiotics as the primary approach. Open microsurgery was the primary approach for 5 aneurysms and was used as salvage in 7 IIAs. Endovascular management was the primary approach for 2 IIAs and used as salvage for 5 IIAs with antibiotic failure. Medical management had high rate of treatment failure (15/31) which predominantly occurred within 2 weeks of onset. The 2-year survival in this cohort was 70% (17/24). IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.

A case of infective endocarditis in an 8-year-old boy 3 months after transcatheter atrial septal defect closure using Figulla Flex II occluder.

Infective endocarditis is a rare complication of atrial septal defect closure using transcatheter procedure. We report about infective endocarditis in an 8-year-old boy 3 months after transcatheter closure using a Figulla Flex II atrial septal defect occluder. Transesophageal echocardiography showed vegetation attached to the left atrium side of the device. Device removal and atrial septal defect closure were performed. The device was less endothelialized on the left than on the right atrium side. Therefore, insufficient endothelialization may cause infective endocarditis.

Abstract 14458: It Takes Three to Tango: A Case of Occult Streptococcus Gordonii Infectious Endocarditis After Dental Cleaning Identified by History, Multi-Modal Imaging, and a Multi-Disciplinary Effort

Introduction: We present a case of a 65 year-old man with severe aortic regurgitation requiring a stented 23mm Edwards bioprosthetic aortic valve (BioAVR), who presented with 3-months of fevers and fatigue found to have Streptococcus gordonii ( S. gordonii ) infectious endocarditis (IE). He underwent dental cleaning 3-months prior sans prophylactic antibiotics. An echocardiogram on admission revealed increased peak/mean systolic gradients across the BioAVR to 46/26mmHg compared to gradients one year prior (32/19mmHg). Initially, a vegetation was not visualized by transthoracic echocardiogram (TTE) despite radiographic evidence of multi-organ emboli. Serial TTEs and transesophageal echocardiograms (TEEs) were performed due to persistent symptoms. Eventually, a new vegetation was visualized by TEE. A team effort involving cardiology, infectious disease, neurology, and cardiac surgery was required for management. Revision of the BioAVR was not pursued due to resolution of the vegetation. The patient was discharged after a prolonged hospitalization with recommendations to take amoxicillin 2g prior to future dental work. Results: Figure 1. A new 0.5cm vegetation visualized by TEE (A) with enlargement to 0.8cm (B), followed by a healed vegetation (C), and resolution 7-months later. Conclusions: S. gordonii has historically been a rare cause of IE therefore requiring a high clinical suspicion for diagnosis. Approximately 8% of IE cases are caused by streptococci. However, a recent study in Denmark on streptococci IE implicated S. gordonii in 44.2% of IE cases . S. gordonii is a gram-positive cocci found in oral flora known to cause subacute bacterial endocarditis. Our case highlights the importance of detailed history-taking to identify sources of infection, serial multi-modal imaging evaluation despite initial negative findings particularly with persistent clinical symptoms, and a multidisciplinary approach to IE cases due to multi-organ involvement.

Abstract 13195: A Case of Ebstein Anomaly Diagnosed Following Tricuspid and Pulmonic Valve Infective Endocarditis in an Adult Patient

Background: We present a rare case of infective endocarditis (IE) involving both tricuspid (TV) and pulmonic valves (PV) in the setting of newly diagnosed Ebstein anomaly (EA) with isolated, small membranous VSD. Case: A 48 yo woman with no known medical history presented with two weeks of fever, flu-like symptoms, and dyspnea. Vitals showed fever, tachycardia, and tachypnea. Poor dentition, grade III systolic murmur, and S3 gallop were noted on physical exam. EKG showed sinus tachycardia and right bundle branch block. Laboratory studies showed leukocytosis and elevated CRP. A chest CT revealed bilateral lung infiltrates in a rounded configuration concerning for septic emboli. Blood cultures grew Streptococcus mitis , and IV antibiotics were initiated. TTE revealed 3.2cm apical displacement of the TV resulting in right ventricular atrialization, diagnostic for EA. TTE also found a 26x17mm vegetation on the septal and anterior leaflets of the TV with moderate tricuspid regurgitation and an 11x6mm vegetation on the PV, confirmed by TEE. Cardiac MRI also noted a focal aneurysm of the membranous interventricular septum with a hemodynamically insignificant shunt. Discussion: While interatrial communications are seen in a majority of EA patients (80-94% of cases), this patient presented solely with a small membranous VSD and absence of ASD and PFO. Moreover, this patient had no PDA to depend on for pulmonary flow. Remarkably, she had an asymptomatic course with EA until the development of endocarditis. It is believed the presence of an isolated VSD in this patient’s severe EA likely promoted forward pulmonic flow in an already inadequate right ventricle. Right-sided IE is itself rare (5-10% of cases) with isolated PV involvement being even rarer (2% of cases). This patient’s uncorrected EA with redundant TV and PV leaflet tissue likely contributed as a nidus for simultaneous infection of both valves.

Delirium as late manifestation of infective endocarditis after transcatheter aortic valve implantation.

More than one-third of the cases of infective endocarditis (IE) occur in older patients. The disease is often characterized by atypical symptoms. The incidence of neurological complications is high and represents a strong independent predictor of severe outcomes and mortality. IE is a rare but serious complication of transcatheter aortic valve implantation (TAVI). A persistent delirium as a unique manifestation of post-TAVI IE in an older patient is presented in this clinical case.

Unexpected septic pulmonary embolism imaging with 18-F FDG PET/CT in an infective endocarditis case: case report

BackgroundInfective endocarditis (IE) is a severe disease that is diagnosed using a combination of clinical, microbiologic, and imaging criteria (modified Duke criteria). The prognosis relies on the degree of valvular involvement and crucially the presence of systemic infectious embolism. We present an educational infective endocarditis case with images of 18-F fluoro-D-glucose positron emission tomography/computed tomography (18-F FDG PET/CT) showing hypermetabolic lesions on the prosthetic tricuspid valve and papillary muscle of right ventricle. Besides these lesions, PET/CT showed an unexpected hypermetabolic extra-cardiac focus.Case presentationA 36-year-old male patient with IE history was underwent 18-F FDG PET/CT imaging. FDG PET revealed hypermetabolic lesions on the prosthetic tricuspid valve and papillary muscle of right ventricle. Besides these lesions, PET/CT showed an unexpected hypermetabolic focus in the lower lobe of the right lung, which was consistent with septic pulmonary embolism.Conclusions18-F FDG PET/CT is a valuable, noninvasive imaging modality in diagnosis of prosthetic valve IE. It could change treatment planning since detecting extra-cardiac lesions.

Perceived Stress in Relation to Demographics and Clinical Forms among Patients with Infective Endocarditis: A Cross-Sectional Study.

(1) Background: Infective endocarditis (IE) is a disease of the endocardial surface of the heart, caused by infection of the native or prosthetic valve or an indwelling cardiac device. Apart from IE predisposing risk factors that include heart conditions and medical procedures, the novel trajectories from demographic factors to perceived stress conditions have been under investigation in recent years. The aim of the present study was to evaluate the associations between perceived stress and demographic characteristics as well as clinical forms of IE among survivors of IE in Kaunas, Lithuania. (2) Methods: A cross-sectional study among IE cases (n = 135) at the Lithuanian University of Health Sciences Kaunas Clinics Cardiology department during the period 2014-2017 was performed. Data about IE clinical features, sociodemographic characteristics and perceived stress level (Perceived Stress Scale (PSS-10)) upon diagnosis were collected. Package "SPSS 25.0" was used in the statistical analysis. Logistic regression analysis was performed including gender, previous occupation, place of residence and clinical forms of IE in the analysis of perceived stress among survivors of IE. The STROBE checklist for cross-sectional studies was used in this study. (3) Results: Perceived stress was experienced by 54.8 percent of the respondents. In the final model, the OR (odds ratio) of perceived stress for females was 2.07 as compared to men; for rural residents, the OR was 2.25 as compared to urban residents. These results were statistically significant. A tendency for increased OR of perceived stress for low-skilled workers as compared to high-skilled ones and classical IE clinical form as compared to non-classical form was observed, but these results were not statistically significant. (4) Conclusions: The present study is an attempt to focus the attention of IE researchers on the effects of psychological state in the disease development. Differences in perceived stress and some demographic characteristics, as well as tendencies of IE clinical forms, were observed among survivors of IE in Kaunas, Lithuania.

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.

Paravalvular vegetations in prosthetic valve endocarditis with a malignant course: a case report

Prosthetic valve endocarditis (PVE) accounts for 20.1% of all infective endocarditis cases. We report a case of PVE complicated by arrhythmias, embolic phenomenon, and sepsis. A 64-year-old female with history of mitral valve replacement presented to the hospital with febrile episode and malaise. Echocardiography showed vegetation at paravalvular area, and Staphylococcus aureus was found on blood culture. Aggressive intravenous antibiotic cover and hemodynamic support were initiated. The management of PVE remains a challenge due to its malignant course and heterogenous complications.
 Citation: Suwanto D, Lefi A, Chandra E, Putra TS, Mulia EPB. Paravalvular vegetations in prosthetic valve endocarditis with a malignant course: a case report. Anaesth. pain intensive care 2022;26(5):723-726.
 DOI: 10.35975/apic.v26i5.2012

Infectious Endocarditis in Children: Epidemiological, Clinical, Paraclinical and Therapeutic Profile

Introduction: Infective endocarditis (IE) in children is a serious pathology with high mortality and morbidity. The aim of our study was to describe the clinical, microbiological, therapeutic and evolutionary characteristics of infective endocarditis in children. Materials and methods: This is a retrospective study, listing all children aged less than 15 years, diagnosed in pediatric cardio consultation and hospitalized in the department of Pediatrics A-Mother and Child Hospital of Marrakech for infective endocarditis between 2010 and 2020. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: During the study period, 25 children presented with infective endocarditis, with a sex ratio equal to 1.08. The mean age of the patients was 9 years and 6 months. Underlying heart disease was found in 76% of cases. A cardiac murmur was noted in 96% of cases, and the most frequent germs were Staphylococcus and Streptococcus. Cardiac ultrasound revealed endocardial vegetations in 72% of the children. Intravenous antibiotic therapy was initiated in all children for a median of 45 days, and an indication for valve replacement was given in 16% of cases. According to the modified Duke criteria, 28% of the infective endocarditis cases were definite and the evolution was favorable in 80% of the children. The most frequent complications were valve failure, heart failure, and embolic complications, and death in 5 cases. Conclusion: The analytical study concluded that embolic complications, heart failure and neurological complications are predictive of mortality. Therefore, its management must be multidisciplinary, early and adequate.

Temporal trends in the incidence of endocarditis among patients with a prosthetic heart valve: a nationwide study

Abstract Background The incidence of infective endocarditis (IE) is increasing in the adult population, as is the insertion of prosthetic heart valves. Patients with prosthetic heart valves are considered at high risk of IE – a complication with a high mortality. However, data on temporal changes in the incidence of IE among patients with prosthetic heart valves from unselected cohorts are sparse Purpose We aimed to examine nationwide temporal trends in the incidence of IE in patients with an implanted prosthetic heart valve in Denmark from 1999 to 2018. Methods Using Danish nationwide health-care registries we identified all patients, who underwent heart valve implantation between 1996–2018. Crude annual incidence rates per 1,000 person years (PY) of IE were computed and presented in two year intervals. Analyses were stratified by sex and age groups (<50, 50–59, 60–69, 70–79, >80 years). Results We identified 26,604 patients with first time prosthetic valve implantation with a median age of 72.7 years at the time of implantation, 63.1% were men with a median follow-up of 6.5 years. We found 1,442 cases of first time IE. The IE incidence rate ranged from 5.4 /1,000 PY (95% CI 3.9–7.4) in calendar period 2001–2002 to 10.0/1,000 PY (95% 8.84–11.11) in calendar period 2017–2018 with an unadjusted increasing trend during the study period (ptrend<0.0001), (Figure 1). Overall, men had a higher crude incidence rate compared with women, however no significant temporal changes were seen in the incidence rate during the study period. For age groups, a trend of stepwise increase in the incidence rate of IE was observed for increasing age groups, however no temporal changes were observed (Figure 2). Conclusion The incidence of IE following prosthetic heart valve implantation has increased slightly over the last 20 years in Denmark. Funding Acknowledgement Type of funding sources: None.

GEMELLA MORBILLORUM BIOPROSTHETIC AORTIC VALVE INFECTIVE ENDOCARDITIS WITH SEPTIC SHOCK CAUSING LEAFLET PERFORATION AND AORTIC ROOT ABSCESS

GEMELLA MORBILLORUM BIOPROSTHETIC AORTIC VALVE INFECTIVE ENDOCARDITIS WITH SEPTIC SHOCK CAUSING LEAFLET PERFORATION AND AORTIC ROOT ABSCESS