Complication Of Infective Endocarditis Research Articles

Acute coronary syndrome as the initial manifestation of infective endocarditis in an apparently normal native valve: a case report

Abstract Background Acute coronary syndrome (ACS) is a rare complication of infectious endocarditis (IE). We present the case of a patient with a bicuspid aortic valve who presented an acute ST elevation myocardial infarction (STEMI) of the inferior wall secondary to vegetation that generated obstruction of the ostium of the right coronary artery (RCA). Case summary A 54-year-old patient with only a history of smoking was admitted for chest pain. An acute ST elevation myocardial infarction (STEMI) in the inferior wall was documented; he underwent an emergent coronary angiography, which showed a mass that obstructed the ostium of the right coronary artery that did not allow its channeling. An angiotomography of the aorta was performed, where dissection was ruled out and the presence of a mass in the right coronary sinus that protruded towards the ostium of the coronary artery was confirmed. In the extension studies, a bicuspid aortic valve, thrombosis in the right brachial artery and in the infrarenal abdominal aorta were documented. Discussion The case was taken to a medical meeting and given the embolic and mechanical compromise; it was decided to perform surgery where a mass that invaded the proximal segment of the right coronary artery was resected. The histopathological study documented findings of vegetation; the cultures were positive for Staphylococcus epidermidis, and he finally received antibiotic and anticoagulation treatment.

A rare complication of blood culture-negative infective endocarditis (BCNIE) on tricuspid valve: case report

Abstract Background Endocarditis is an infectious disease, with an incidence of about 15 cases per 100.000 people, affecting the tricuspid valve in 10% of cases. Infective endocarditis with negative blood cultures (BCNIE) accounts for more than 20% of cases of infective endocarditis. Perivalvular extension of the infection represents the most detrimental complications of BCNIE. Case Summary A 25-year-old South Asian male was admitted due to fever for 15 days and new onset chest pain. The blood tests showed an increase in inflammatory indices. A chest X-ray showed enlargement of the cardiac shadow. On cardiac examination, a holosystolic murmur at the left sternal edge border was heard. The transthoracic echocardiogram showed a filamentous formation on the tricuspid valve and communication between the aorta and right atrium with left-right shunt. A transesophageal echocardiogram (TEE) was performed to confirm the diagnosis of IE. Three sets of blood cultures were performed, with negative results, empirical therapy was managed and a decision for TEE-guided cardiac surgery was made. Discussion Fistula is a rare complication of IE representing the most insidious consequence of uncontrolled infection like BCNIE, a condition that has restricted the therapeutic possibilities to empirical therapy only and to early surgery. The TEE was instrumental in diagnosing right-sided infective endocarditis and allowing us to focus on the perivalvular spread of the infection in our case.

Infective endocarditis: Awareness, knowledge gaps and behaviours amongst adults with congenital heart disease

BackgroundAdults with congenital heart disease (ACHD) have an increased risk of infective endocarditis (IE), associated with significant morbidity and mortality. This risk is compounded by patient-related factors, including lack of awareness of IE and the presence of a learning disability (LD). Our study sought to evaluate patients' understanding of the risks and symptoms of IE and to identify patients who could benefit from targeted education. MethodsPatients attending the outpatient department of a tertiary ACHD referral centre completed a questionnaire that assessed their knowledge, attitudes and behaviours towards IE. Baseline demographics and clinical data were collected from electronic patient records. ResultsA total of 132 ACHD patients completed the questionnaires (age 41.7 ± 16.4 years, 50 % male, 11 % with an LD). Only 37.1 % of patients accurately defined IE, none of whom had an LD. Most patients chose pyrexia (47 %) and tiredness (39.4 %) as potential symptoms of IE, however, none correctly identified all symptoms. Only 19.7 % were aware of the requirement for prolonged antibiotic treatment for IE. A third of all patients reported that they would have made lifestyle changes had they been aware of the complications of IE. There was a statistically significant association between learning disability and poor level of awareness in the questionnaire. ConclusionsOur study demonstrates awareness issues regarding IE among ACHD patients, highlighting the need to invest further on patient education. This should start at the time of transition from paediatric to adult services and continue lifelong, with emphasis on patients with a learning disability.

Incidence, Management, and Outcomes of Pediatric Infectious Aneurysms.

Infectious intracranial aneurysms (IIAs) are rare cerebrovascular complications of infective endocarditis (IE) accounting approximatively for 0.5% to 6.5% of all aneurysms. In children, mycotic aneurysms secondary to IE are uncommon. This is a retrospective study of patients treated for pediatric IIA secondary to IE at our institution with an emphasis on presentation, etiologies, nuances in management, and outcomes. One hundred fifty-one patients were treated for IE secondary to congenital or acquired heart disease, of which 13 patients (8.6%) presented with intracranial hemorrhage. IIA occurred in 5 patients (2.6%) with IE. IIA accounted for 15% of intracranial aneurysms treated during the study period. Pediatric patients with ruptured IIAs have a high rate of rerupture, and early surgical intervention should be considered through an open or endovascular route when available.

Acute Limb Ischemia as a Complication of Early Infectious Endocarditis Following Surgical Closure of an Atrial Septal Defect: Case Analysis and Literature Review

Background: This study reports the case of a 47-year-old woman who presented with acute pain and coldness in the left lower limb, occurring 5 months after a surgical closure of an atrial septal defect (ASD). Initial examination suggested acute limb ischemia. Methods: Doppler ultrasound and computed tomography (CT) angiography of the lower extremity arteries confirmed the presence of an occlusion in the left popliteal artery. Echocardiography revealed vegetation on the surgical patch used for the ASD closure. Blood cultures were positive for Staphylococcus aureus. Treatment: The patient was treated with antibiotics for 6 weeks and underwent replacement of the surgical patch. Conclusion: This case underscores the importance of screening for endocarditis in patients with systemic embolism and a history of ASD patch closure, even though endocarditis is a rare complication. In cases of systemic emboli and large vegetations, a therapeutic approach often requires surgical removal and replacement of the closure patch.

Tip of the iceberg: extracardiac CT findings in infective endocarditis.

Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.

Methods of diagnosing infective endocarditis including nuclear imaging techniques - a review

Introduction and the purpose of work Infective endocarditis (IE) is a disease diagnosed more and more often in recent years. Its treatment and diagnostics require a team of qualified specialists and are based on microbiological and imaging diagnostics. The purpose of this work is a summary and comparison of individual IE diagnostic methods, including their advantages and disadvantages. State of knowledge: Diagnosis of infective endocarditis relies on positive blood cultures to identify the microorganism and its drug sensitivity. Advanced methods like MALDI-TOF MS and MIC are used for identification. The first-line imaging diagnostic method for IE is echocardiography, which assesses structural and functional heart damage. Variants include transthoracic (TTE), transesophageal (TOE), three-dimensional TOE, and intracardiac echocardiography. Echocardiography should be performed immediately when IE is suspected. Computed tomography (CT) is crucial for diagnosing infective endocarditis (IE), particularly perivalvular and periprosthetic complications. Whole-body CT, including the brain, detects distant lesions and sources of bacteremia. CT is more accessible in emergencies and effective in spotting ischemic and hemorrhagic complications. CT angiography identifies mycotic aneurysms in the vascular system. It also detects extracardiac sources of bacteremia, aiding treatment and pre-surgery planning. Nuclear imaging is also important in diagnosing IE, especially prosthetic valve endocarditis (PVE) when echocardiography is inconclusive. 18F-fluorodeoxyglucose-PET/CT and SPECT/CT with labeled leukocytes are recommended. Conclusions: In addition to basic methods such as positive blood culture and echocardiography, there are more specialized methods that also allow for the assessment of treatment progress and prognosis.

Neurological complications of infective endocarditis - a review

Introduction and purpose Infective endocarditis (IE) is a disease resulting from infection of the endocardium. In addition to cardiac symptoms, frequent complications of IE include various damage to the nervous system. The aim of this study is to describe the current state of knowledge about the neurological complications of infective endocarditis. Methods Medical publications were reviewed using the "PubMed" and "Google Scholar" databases. The obtained results were verified in terms of the following criteria: publication in 2016, retrospective analysis, obtaining 44 papaers covering a total of 8067 patients. The information was supplemented with case reports and meta-analyses. Description of the state of knowledge Neurologic complications occur in 20 to 60% of patients with IE. The most common is ischemic stroke, the symptoms of which may precede the diagnosis of IE. Less common complications that often remain asymptomatic include mycotic aneurysms and intracranial hemorrhages. Infectious material entering the brain may also cause meningitis and brain abscess. However, these complications do not occur often. Magnetic resonance imaging of the head is an effective test for detecting neurological damage in the course of IE. The recommendation for routine use of this test is debatable. In addition to antibiotic therapy, cardiac surgery is used to treat IE to remove bacterial vegetation. Research indicates the high effectiveness of this type of surgery in the prevention and treatment of neurological complications of infective endocarditis.

Infective Endocarditis in Patients With Bicuspid Aortic Valves: Unique Clinical and Microbiologic Features

Patients with bicuspid aortic valves (BAV) are at increased risk of infective endocarditis (IE). Information of the clinical presentation and the microbiology of BAV-associated IE, however, is limited. Therefore, our study aimed to characterise the clinical features native valve endocarditis (NVE) in the setting of BAV and compared them to patients with prosthetic valve endocarditis (PVE) following BAV replacement. Adult patients with BAV or history of BAV with aortic valve replacement (AVR) and a definite or possible IE diagnosis within the Mayo Clinic Enterprise (USA) from January 2008 to December 2021, were included. BAV was confirmed by trans-oesophageal echocardiography. IE was defined according to the modified Duke criteria and only an initial episode was included. Statistical analyses were performed to compare clinical characteristics, microbiology, and IE complications. Overall, 161 patients with BAV and IE (NVE [n=60], 37.3%) and PVE [n=101, 62.7%) were included. Mean age±SD was 56.5±16.1 years, and 139 (86.3%) patients were males. PVE patients were older (p<0.01) and had a higher rate of hypertension (p<0.01), chronic heart failure (p<0.01), chronic kidney disease (p<0.01), and perivalvular abscess (p<0.01). BAV patients with NVE had a higher prevalence of isolated mitral valve IE (p<0.01), moderate to severe aortic valve regurgitation (p<0.01) and combined aortic with mitral valve IE (p<0.01). Streptococcus mitis was the most common pathogen in NVE (30.0%) while Staphylococcus aureus was the most common in PVE (15.8%). Patients with BAV are at risk of both NVE and PVE. Each syndrome has unique clinical features, including microbiologic findings, that should be appreciated in IE diagnosis and management.

Unveiling the devastations of streptococcus sanguinis infective endocarditis masquerading as iron deficiency anaemia: a case report

Abstract Background Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis. Case summary A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle hematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days. Discussions This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasises the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.

Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement

BackgroundEvidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). ObjectivesThis study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. MethodsMedicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. ResultsA total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). ConclusionsLeadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.

MICROBIOLOGICAL SPECTRUM OF INFECTIVE ENDOCARDITIS COMPLICATED BY HEART FAILURE

Resume. Infective endocarditis (IE) is a serious disease that can lead to severe complications and death. The study of the microbiological spectrum of pathogens in such patients is great importance for optimizing treatment and increasing the effectiveness treatment. The spectrum of IE pathogens has changed significantly over the past decades. A positive microbiological blood test remains the cornerstone in diagnosis and etiotropic antimicrobial therapy of IE. Considering the global mobility of the population and the growing resistance of microorganisms to antibiotics, it is necessary to update our knowledge about the microbiological spectrum of infective endocarditis constantly. THE AIM was to investigate the microbiological spectrum of pathogens in patients with infective endocarditis complicated by heart failure. Materials and methods. Clinical data of 120 patients with active infective endocarditis who underwent treatment at the SE «Amosov National Institute of Cardiovascular Surgery» National Academy of Medical Sciences of Ukraine from 01.01.2019 to 06.30.2020 were enrolled in the study. The diagnosis of IE was established in accordance with Duke's criteria. The average age of the studied patients was 48.1±1.37 (19-77) years. Results. The rate of gram-positive and gramnegative microorganisms was 69 (93.2 %) cases and 5 (6.8 %) cases respectively. Gram-positive microorganisms were found – Staphylococcus spp. in 42 (56.8 %) cases and Enterococcus spp. in 20 (27.0 %) cases. A high level of oxacillin-resistant (p=0.072) and vancomycin-resistant (p=0.027) strains of microorganisms were found in the group of patients with preoperative heart failure. Conclusions: The microbiological spectrum of IE pathogens in patients with heart failure is characterized by the predominance of gram-positive strains that are resistant to oxacillin and vancomycin. Positive results of bacteriologic blood tests were found in 74 cases out of the total number, which is 61.7 %. Of these, gram-positive microorganisms were detected in 69 cases (93.2 %), while gram-negative microorganisms were detected in only 5 cases (6.8 %). The most common gram-positive microorganisms were Staphylococcus spp. (56.8 %) and Enterococcus spp. (27.0%). There was also found that risk factors such as nosocomial infections, hypothermia and drug abuse can contribute to the development of UI. The overall frequency of nosocomial factors in the development of the disease was 36.7 %. Urological interventions (12.5 %) and general surgical interventions (20.8 %) were among the most common. Our study included patients with active UI who had positive bacteriologic blood tests and signs of a systemic inflammatory response. In these patients, the mean body temperature at hospitalization was 38.3 °C, and the mean heart rate was 91.0 beats/min. The organ dysfunction detected in patients with complicated IE was also confirmed by high levels of creatinine (168.2 mcg/L) and urea (13.3 mmol/L). A comparative analysis of laboratory results also revealed a high level of resistant strains of microorganisms in the group of patients with complicated IE. Thus, the data obtained confirm the seriousness of the problem of infective endocarditis and emphasize the need for further research to develop effective strategies for the diagnosis and treatment of this disease, especially in patients with complicated course.

Venous Thromboembolism, an Unusual Complication of Infective Endocarditis Caused by Moraxella species: a Case Report

Venous Thromboembolism, an Unusual Complication of Infective Endocarditis Caused by Moraxella species: a Case Report

Cardiac Hemodynamic Features in Patients with Infective Endocarditis Complicated by Acute Heart Failure

Infective endocarditis (IE) is a rare but devastating disease. The main complications of IE are heart failure (HF), sepsis (in particular, due to perivascular spread of infection), and embolic events, most often those of cerebral local-ization. The diagnosis of IE combines various factors that are not specific to IE when considered separately. Echocardiog-raphy remains the first-line imaging modality for the diagnosis of IE. The aim. To determine the features of intracardiac complications that occur in patients with IE at the preoperative stage using ultrasound diagnostics. Materials and methods. The study included clinical data of 120 patients with IE who underwent examination and treatment from 01/01/2019 to 06/30/2020 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The diagnosis of IE was established in accordance with the modified Duke/Eu-ropean Society of Cardiology 2015 criteria. The mean age of the studied patients was 46.3 ± 1.37 (19-69 years). Results. A high rate of nosocomial factors in the development of the disease was determined: 49 (40.9%) cases, of which 15 (12.5%) cases and 25 (20.8%) cases were urological and general surgical interventions, respectively. Preopera-tive HF was found in 16 (13.3%) cases. In the group of patients with acute HF, cases of left heart valve disease with peri-annular complications dominated: 9 (56.3%) cases of abscesses and 3 (18.8%) cases of fistulae. Significant differences were found in the assessment of the cardiac index: in the group of patients with IE without signs of HF, the cardiac index was 4.9 ± 0.2, and in the group of patients with preoperative HF it was 3.7 ± 0.4 (p = 0.098). Patients with acute HF were characterized by a higher level of acute kidney injury (creatinine 168.2 ± 40.7 μmol/L, urea 13.3 ± 2.5 mmol/L). Conclusions. The obtained results indicate a high incidence of intracardiac complications in patients with IE, in par-ticular, those caused by nosocomial infections and medical interventions. Ultrasound diagnostics (echocardiography) is an important tool for detecting and monitoring intracardiac complications at the preoperative stage, which can affect the treatment strategy and prognosis. A thorough examination of a patient with IE allows to identify critical features of cardiac hemodynamic disorders and ensure timely cardiac surgery.

Silent Aortic Valve Perforation in a Patient with S. Salivarius Infective Endocarditis

Streptococcus salivarius is a commensal bacterium of the oral and gut flora and is rarely implicated in infective endocarditis (IE). Herein, we present a case of a 69-year-old male who presented with fatigue, weight loss, and no fever, ultimately diagnosed with IE complicated by severe aortic regurgitation. Initial investigations revealed leukocytosis, anemia, hyperkalemia, and elevated troponins. Imaging studies revealed bilateral common iliac artery aneurysms and atrophic kidneys with renal cysts. Transthoracic and transesophageal echocardiograms revealed mobile aortic vegetation, severe aortic regurgitation, and valve perforation. Blood cultures identified Streptococcus salivarius/vestibularis. The patient underwent aortic valve replacement, resulting in clinical improvement and negative blood cultures. The discussion highlights the rarity of S. salivarius causing IE and emphasizes the challenges in management, including the need for timely surgical intervention and multidisciplinary care in complicated IE cases. This case underscores the importance of considering atypical pathogens in IE and the complexities involved in its diagnosis and management. Further research is warranted to elucidate such cases' clinical implications and optimal management strategies.

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review

BackgroundPseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear.Case presentationA 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects.ConclusionSurgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature.

Gerbode defect resulting from Group B Streptococcus infective endocarditis: a case report

BackgroundGerbode defect is an unusual abnormal communication between the left ventricle and the right atrium and is a serious complication of aortic infective endocarditis. Group B Streptococcus is an uncommon cause of infective endocarditis and has a markedly destructive effect on valvular tissue. Acute fistulation between the left ventricle and the right atrium associated with this form of infective endocarditis is a life-threatening, aggressive complication that often requires urgent surgical intervention. However, the identification of actual communication is often extremely difficult. Herein, we describe an unusual case of Gerbode defect resulting from Group B Streptococcus infective endocarditis and discuss the issues surrounding such a rare cardiac defect and such an infection.Case presentationA 60-year-old man with underlying uncontrolled diabetes mellitus underwent endoscopic retrograde biliary drainage for acute cholangitis. On the 10th postoperative day, the patient developed multiple acute cerebral embolisms. Transthoracic echocardiography demonstrated severe aortic regurgitation and a large mobile vegetation near the tricuspid annulus. No obvious fistula between the left ventricle and the right atrium could be demonstrated. The blood culture examination was positive for Group B Streptococcus. The patient was diagnosed with Group B Streptococcus infective endocarditis, and antibiotic therapy was initiated. Transesophageal echocardiogram performed after referral to our hospital confirmed detachment of the right coronary cusp of the aortic valve from the annulus and an abnormal cavity immediately below the right coronary cusp. Color Doppler imaging finally revealed systolic blood flows from the left ventricle into the right atrium through the cavity. Therefore, we diagnosed the patient with Gerbode defect resulting from Group B Streptococcus infective endocarditis. In addition to aortic valve replacement, defect closure and left ventricular outflow tract repair were successfully performed urgently for severely complicated and uncommon infective endocarditis. The patient was uneventfully discharged without any complications.ConclusionsWe reported successful surgical treatment of unusual active IE and Gerbode defect caused by GBS. Careful preoperative echocardiographic work-up is imperative for accurate early diagnosis and successful repair.

Dalbavancin as consolidation therapy for infective endocarditis in patients with comorbidity. A real world experience.

Infective endocarditis (IE) is a potentially life-threatening infection, the incidence of which has in creased in recent decades, particularly among elderly patients with comorbidity. The primary objective of this study was to evaluate the effectiveness of dalbavancin in the consolidation therapy of IE in patients with comorbidity six months after the end of treatment (EOT). An observational and retrospective study was conducted on patients with a Charlson Comorbidity Index (CCI) ≥ 3 who were diagnosed with IE and received consolidation therapy with dalbavancin. Forty-eight patients were included, 58.3% were male, mean age of 76.2 years (IQR: 66-88), and a mean age adjusted CCI of 6.5 (IQR: 5-7.5). Definite IE was diagnosed in 77% of cases. The most frequently isolated microorganisms were Staphylococcus aureus (45.8%) followed by Enterococcus spp. (31.3%). Complications of IE were observed in 67.7% of cases, and cardiac surgery was performed in 27% of patients. The primary reason for using dalbavancin was outpatient parenteral antibiotic therapy in 85.4% of cases. The effectiveness at EOT was 93.8%. At six months, six IE-related deaths, four unrelated deaths, and two IE relapses were observed. The effectiveness was 77%. Adverse effects related to DBV were reported in 4.2% of cases, of which 2% were considered serious. Dalbavancin has proven to be an effective alternative as consolidation antibiotherapy for IE in elderly patients with comorbidity. Moreover, a very favorable safety profile with few associated adverse effects has been observed in this population.

Management of complicated infective endocarditis

Management of complicated infective endocarditis

Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis.

Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE. Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5). One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.