Diagnosis Of Infective Endocarditis Research Articles

Clinical features and outcomes of infective endocarditis: a single-centre experience.

Infective endocarditis (IE) may present with a broad spectrum of symptoms and signs and several tools can be used for diagnosis. Many protocols can be used for in-hospital and out-patient management. The aim of this study was to assess the clinical features, tools used and outcomes of patients diagnosed with IE in one of the tertiary-care university hospitals. This study included 90 consecutive patients admitted to the Cardiology Department in a tertiary-care university hospital in Egypt with a diagnosis of IE. The mean age of the studied population was 36.72 years and 76.67% were males. The most common underlying condition was valvular heart disease (48.89%), followed by intravenous drug use (26.67%) and the most common risk factor was smoking (48.89%). The most common clinical presentation was fever (69.67%), followed by dyspnoea (55.56%), and the mean duration from symptom onset until admission was 13.28 ± 9.29 days. Positive cultures were encountered in 45.56% of patients. Surgery was indicated in 91.11% of the patients but it was performed in only 28.89%. Almost a third of patients (34.44%) died in the hospital. After one year of follow up, a further 8.47% of the patients had died, 11.86% had heart failure and 6.78% had undergone a re-do surgery. Nowadays IE tends to affect a younger group of patients and valvular heart disease is the main underlying condition. The mortality rate due to IE is high in developing countries and IE does not have only immediate and short-term complications, its effects extend to a longer period of time.

Challenges in Diagnosing Infective Endocarditis: A Case Report

Introduction: Infective endocarditis (IE) is an infection that affects the endocardial surface of the heart. Enforcing the diagnosis of IE is quite easy, but in some cases, it is sometimes very difficult to suspect the patient is experiencing an IE if the symptoms displayed are atypical or non-specific, so that the diagnosis and treatment are too late Case illustrations: A 51-year-old man was first referred from a Type C Hospital to the Emergency Room of Type B Hospital with diagnosis of congestive hepatopathy, transaminitis, hyperkalemia, hyponatremia related retention, suspected hypoalbuminemia due to chronic inflammation and hepatopathy, mild normochromic normocytic anemia due to chronic disease, pneumonia, sepsis, AKI (acute kidney injury) with differential diagnose ACKD (acute on chronic kidney disease) because suspect of prerenal suspicion that had been improving. Infective Endocarditis (IE) was diagnosed with modified Duke criteria, in which this patient found vegetation on the aortic valve 1.70 cmx0.66 cm. Treatment for patients was given empirical antibiotics (ampicillin 3 grams every 6 hours by intravenous/IV and gentamicin 180 mg every 24 hours by intravenous/IV) while waiting for blood culture results and the patient was referred to the Central General Hospital/Type A Hospital for further treatment. Conclusion: Infective Endocarditis is still a challenge in the field of medicine with its low incidence. In this case report, the patient experienced a clinical spectrum that was less specific for IE, causing difficulties in early diagnosis and management Keywords: Infective Endocarditis, Modified Duke Criteria, Aortic valve

Absence of infective endocarditis relapse when end-of-treatment fluorodeoxyglucose positron emission tomography/computed tomography is negative.

In non-operated infective endocarditis (IE), relapse may impair the outcome of the disease. The aim of the study was to evaluate the relationship between end-of-treatment (EOT) fluorodeoxyglucose positron emission tomography/computed tomography FDG-PET/CT results and relapse in non-operated IE either on native or prosthetic valve. We included 62 patients who underwent an EOT FDG-PET/CT for non-operated IE performed between 30 and 180 days of antibiotic therapy initiation. Qualitative valve assessment categorized initial and EOT FDG-PET/CT as negative or positive. Quantitative analyses were also conducted. Clinical data from medical charts were collected, including endocarditis team decision for IE diagnosis and relapse. Forty-one (66%) patients were male with a median age of 68 years (57; 80) and 42 (68%) had prosthetic valve IE. End-of-treatment FDG-PET/CT was negative in 29 and positive in 33 patients. The proportion of positive scans decreased significantly compared with initial FDG-PET/CT (53% vs. 77%, respectively, P < 0.0001). All relapses (n = 7, 11%) occurred in patients with a positive EOT FDG-PET/CT with a median delay after EOT FDG-PET/CT of 10 days (0; 45). The relapse rate was significantly lower in negative (0/29) than in positive (7/33) EOT FDG-PET/CT (P = 0.01). In this series of 62 patients with non-operated IE who underwent EOT FDG-PET/CT, those with a negative scan (almost half of the study population) did not develop IE relapse after a median follow-up of 10 months. These findings need to be confirmed by prospective and larger studies.

Risk and Outcome of Infective Endocarditis in Streptococcal Bloodstream Infections according to Streptococcal Species.

This study aimed to identify which streptococcal species are closely associated with infective endocarditis (IE) and to evaluate risk factors for mortality in patients with streptococcal IE. We performed a retrospective cohort study of all patients with streptococcal bloodstream infection (BSI) from January 2010 to June 2020 in a tertiary hospital in South Korea. We compared clinical and microbiological characteristics of streptococcal BSIs according to the diagnosis of IE. We performed multivariate analysis to evaluate the risk of IE according to streptococcal species and risk factors for mortality in streptococcal IE. A total of 2,737 patients were identified during the study period, and 174 (6.4%) were diagnosed with IE. The highest IE prevalence was in patients with Streptococcus mutans BSI (33% [9/27]) followed by S. sanguinis (31% [20/64]), S. gordonii (23% [5/22]), S. gallolyticus (16% [12/77]), and S. oralis (12% [14/115]). In multivariate analysis, previous IE, high-grade BSI, native valve disease, prosthetic valve, congenital heart disease, and community-onset BSI were independent risk factors for IE. After adjusting for these factors, S. sanguinis (adjusted OR [aOR], 7.75), S. mutans (aOR, 5.50), and S. gallolyticus (aOR, 2.57) were significantly associated with higher risk of IE, whereas S. pneumoniae (aOR, 0.23) and S. constellatus (aOR, 0.37) were associated with lower risk of IE. Age, hospital-acquired BSI, ischemic heart disease, and chronic kidney disease were independent risk factors for mortality in streptococcal IE. Our study points to significant differences in the prevalence of IE in streptococcal BSI according to species. IMPORTANCE Our study of risk of infective endocarditis in patients with streptococcal bloodstream infection demonstrated that Streptococcus sanguinis, S. mutans, and S. gallolyticus were significantly associated with higher risk of infective endocarditis. However, when we evaluated the performance of echocardiography in patients with streptococcal bloodstream infection, patients with S. mutans and S. gordonii bloodstream infection had a tendency of low performance in echocardiography. There are significant differences in the prevalence of infective endocarditis in streptococcal bloodstream infection according to species. Therefore, performing echocardiography in streptococcal bloodstream infection with a high prevalence of, and significant association with, infective endocarditis is desirable.

Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis.

Infective endocarditis is an infection of the inner layers of the heart, seen often in intravenous drug usersand patients with valvular lesionsor prosthetic heart valves. This entity has high mortality and morbidity. The most common causative microorganism is Staphylococcus aureus. In this comprehensive literature review, we focused on both Staphylococcus aureus infections, i.e., methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, demographics, use of transthoracic echocardiogram and/or transesophageal echocardiogram for diagnostics, and treatments. Although clinical criteria are relevant, transesophageal echocardiogram plays a vital role in establishing and identifying the presence of infective endocarditis and its local complications, with higher sensitivity in patients with prosthetic valves. The antibiotic selection posed a great challenge for clinicians due to antibiotic resistance and the aggressive nature ofStaphylococcus aureus. Early diagnosis of infective endocarditis, when suspected, and effective management by a multispecialty team can improve the outcome for the patients.

IMPACT OF ROUTINE BRAIN IMAGING ON THE PROGNOSIS OF PATIENTS WITH LEFT-SIDED VALVE INFECTIVE ENDOCARDITIS WITHOUT NEUROLOGICAL MANIFESTATIONS

Objective: There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE). Design and method: Among patients diagnosed with possible or definite IE in two tertiary referral centers, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All endpoints were compared after adjustment using inverse probability of treatment weighting (IPTW). Results: During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24–1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25–1.42). The risks of attributable mortality (defined as death directly related to IE) and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (&gt; 10 mm) or acute-onset microorganisms. Conclusions: Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings, such as in cases of large vegetation or acute-onset microorganisms, could improve clinical outcomes.

Prevalence of Right- and Left-Sided Endocarditis Among Intravenous Drug Use Patients at a Large Academic Medical Center.

Left-sided infective endocarditis (IE) is increasingly being recognized among intravenous drug use (IVDU) patients. We sought to assess the trends and risk factors that contribute to left-sided IE in this high-risk population at University of Kentucky. A retrospective chart review of patients with the diagnosis of both IE and IVDU admitted at University of Kentucky was carried out from January 1, 2015 to December 31, 2019. Baseline characteristics, trends of endocarditis and clinical outcomes (mortality and in-hospital interventions) were recorded. A total of 197 patients were admitted for management of endocarditis. One hundred and fourteen (57.9%) had right-sided endocarditis, 25 (12.7%) had combined left-sided and right-sided endocarditis, and 58 (29.4%) had left-sided endocarditis. Staphylococcus aureus was the most common pathogen. Mortality and inpatient surgical interventions were higher among patients with left-sided endocarditis. Patent foramen ovale (PFO) was the most common shunt found (3.1%), followed by atrial septal defect (ASD, 2.4%) with PFO being significantly more common among patients with left-sided endocarditis. Right-sided endocarditis continues to be predominant among IVDU patients and Staphylococcus aureus was the most common organism involved. Patients with evidence of left-sided disease were found to have significantly more PFO, needed more inpatient valvular surgeries, and had higher all-cause mortality. Further studies are needed to assess if PFO or ASD can increase the risk of acquiring left-sided endocarditis in IVDU.

The role of early defervescence in ruling out infective endocarditis: a cohort study

ObjectivesTo evaluate the role of defervescence within 4 days from antibiotic treatment initiation in ruling out infective endocarditis (IE) among patients suspected of such diagnosis. MethodsThis study was conducted at the Lausanne University Hospital, Switzerland (January 2014 to May 2022). All patients with suspected IE being febrile upon presentation were included. IE was classified according to the modified Duke criteria proposed by the 2015 European Society of Cardiology guidelines, before or after applying the criterion ‘resolution of symptoms suggesting IE within 4 days of the introduction of antibiotic therapy’ based solely on early defervescence. ResultsAmong 1022 episodes with suspected IE, 332 (37%) had IE according to Endocarditis-Team evaluation; 248 were classified by clinical Duke criteria as definite and 84 as possible IE. The rate of defervescence within 4 days from antibiotic treatment initiation was similar (p 0.547) among episodes without (606/690; 88%) and those with IE (287/332; 86%); among episodes classified as definite and possible IE by clinical Duke criteria, 211 of 248 (85%) and 76 of 84 (90%), respectively, defervesced within 4 days from antibiotic treatment initiation. By using early defervescence as a rejection criterion, the 76 episodes with final IE diagnosis classified as possible by clinical criteria could be reclassified as rejected. DiscussionThe majority of IE episodes defervesced within 4 days from antibiotic treatment initiation; thus, early defervescence should not be used to rule out the diagnosis of IE.

P194 DESTRUCTIVE AORTIC VALVE ENDOCARDITIS WITH INVOLVEMENT OF THE MITRO–AORTIC CURTAIN: A SUCCESSFUL “UFO” PROCEDURE

Abstract Infective endocarditis is a relatively rare disease with an estimated mean incidence of 3.6–7.0 cases per 100,000 subject–years. Aortic bicuspid disease, the most frequent congenital anomaly, is one of the main risk factors. Heart failure, uncontrolled infection (fistulas, abscesses, persistently positive blood cultures) and systemic embolization are among the most feared complications of endocarditis: these cases constitute an indication for emergency/urgent cardiac surgery. An example of extremely demolitive surgery is the Commando or "UFO" procedure, which consists in the double replacement of the aortic valve and the mitral valve with reconstruction of the mitro–aortic junction. The clinical case concerns a 36–year–old man who went to the emergency room for high fever with shivering. Having been found positive blood cultures for MSSA and having emerged mitro–aortic vegetation by echocardiogram, a diagnosis of infective endocarditis was made. During hospitalization, multi–organ cardioembolic phenomena (e.g. splenic, cerebral) with hemorrhagic cerebral infarction occurred: therefore, in accordance with current guidelines, a conservative treatment was temporarily opted for. However, in the following days the deterioration of the clinical–haemodynamic picture was such as to require emergency cardiac surgery. The patient was thus subjected to Commando or UFO procedure with reconstruction of the mitral–aortic junction. Severe bi–ventricular dysfunction was found for the first time at post–operative echocardiographic control, with the need for mechanical support to the circulation (AV ECMO, Impella). The remainder of the hospitalization was characterized by a progressive recovery of ventricular function (LVEF 16% to 44%), therefore patient was discharged in discrete hemodynamic compensation, despite the multiorgan sequelae (hepatic, neurological, renal).

Streptococcus cristatus bacteremia in a patient with poor oral hygiene: a case report

BackgroundStreptococcus cristatus is a member of the Mitis streptococcus group. Like other members of this group, it resides on mucosal surfaces of the oral cavity. However, little is known about its ability to cause disease as there are only a handful of cases in the literature. Two of these cases involved infective endocarditis with significant complications. However, these cases involved additional microbes, limiting the inferences about the pathogenicity of Streptococcus cristatus.Case presentationA 59-year-old African American male with end-stage cryptogenic cirrhosis and ascites presented with fatigue and confusion. A paracentesis was negative for spontaneous bacterial peritonitis, but two separate blood cultures grew Streptococcus cristatus. Our patient had a history of dental caries and poor oral hygiene, which were likely the source of the infection. Echocardiograms revealed new aortic regurgitation, indicating “possible endocarditis” per the Modified Duke Criteria. However, since his clinical picture and cardiac function were reassuring, we elected against treatment for infective endocarditis. He was treated for bacteremia with a 2-week course of cephalosporins consisting of 8 days of ceftriaxone, transitioning to cefpodoxime after discharge. Despite having end-stage liver disease, our patient did not experience any significant complications from the infection.ConclusionA patient with end-stage cirrhosis and poor oral hygiene developed bacteremia with an oral bacterium called Streptococcus cristatus. Unlike previous cases in literature, our patient did not meet criteria for a definitive diagnosis of infective endocarditis, and he experienced no other complications from the infection. This suggests coinfectants may have been primarily responsible for the severe cardiac sequelae in prior cases, whereas isolated Streptococcus cristatus infection may be relatively mild.

Infective Endocarditis during Pregnancy-Keep It Safe and Simple!

The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.

Ampicillin and Ceftobiprole Combination for the Treatment of Enterococcus faecalis Invasive Infections: "The Times They Are A-Changin".

Enterococcus faecalis is responsible for a large variety of severe infections. This study is a case series reporting our experience in the treatment of E. faecalis invasive infections with ampicillin in combination with ceftobiprole (ABPR). We retrospectively analyzed all the medical records of patients admitted to the University Hospital of Udine from January to December 2020 with a diagnosis of infective endocarditis or primary or non-primary complicated or uncomplicated bacteremia caused by E. faecalis. Twenty-one patients were included in the final analysis. The clinical success rate was very high, accounting for 81% of patients, and microbiological cure was obtained in 86% of patients. One relapse was recorded in one patient who did not adhere to the partial oral treatment prescribed. Therapeutic drug monitoring (TDM) was always performed for ampicillin and ceftobiprole, and serum concentrations of both drugs were compared to the MICs of the different enterococcal isolates. ABPR is a well-tolerated antimicrobial regimen with anti-E. faecalis activity. TDM can help clinicians optimize medical treatments to achieve the best possible efficacy with fewer side effects. ABPR might be a reasonable option for the treatment of severe invasive infections caused by E. faecalis due to the high level of enterococcal penicillin-binding protein (PBP) saturation.

Right-sided infective endocarditis: characterization and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right-sided infective endocarditis (RIE) involves native/prosthetic valves and any intracardiac devices present in the right cavities. It's caused by the seeding of any of these structures by bacterial or, less commonly, fungal organisms. It's commonly associated with intravenous drug use, intracardiac devices and central venous catheters, all of which became more prevalent over the past 20 years. Purpose We aimed to characterize the patients with right-sided infective endocarditis, including device endocarditis, admitted to our center and compare them with patients admitted with left-sided infective endocarditis (LIE). Methods We performed a retrospective study of a group of patients (pts) with infective endocarditis (IE) admitted to our center from 2000 to 2020. Pts were categorized with right-sided endocarditis when presented with endocarditis of the native/prosthetic valves right-sided and intracardiac devices. We considered, as composite endpoint, deaths, embolic events and recurrence of endocarditis in a medium follow-up of 37.4 ± 46.0 months. Results A total of 160 pts (106 males, mean age 66,3 ± 16 years) with the diagnosis of IE were included. 32 pts had RIE (11 with involvement of tricuspid valve and 23 with device involvement) and 126 had LIE (100 of native valve and 26 of prosthetic valve). We had 56 (15.5%) pts referred to surgery during hospitalization and 27 (7.5%) died during hospitalization. Compared with LIE, most of the pts with RIE were males (84% versus 61%, p= 0,015). The mean age was similar between the groups (p= 0,584). Pts with RIE had a lesser prevalence of known valvular heart disease (48% versus 21%, p= 0,007). Concerning complications of endocarditis, pts with RIE had less prevalence of fistula (18% versus 0%, p= 0,021). During hospitalization, the proportion of pts undergoing surgery was significantly less in patients with RIE (31% vs 61%, p=0,001). Considering the subgroup of patients with device endocarditis, 14 patients undergo device extraction (8 percutaneous and 6 surgical extraction). During a mean follow-up duration of 37.4 ± 46.0months, pts with the diagnosis of RIE had better outcomes for the composite endpoint (61% vs 33%, p=0.003). Even when we considered the events during the hospitalization (namely embolic events or death), this subgroup had fewer events (83% vs 63%, p=0.034). In a multivariate regression analysis, after adjusting for all the confounders (previous cardiac failure, development of severe valvular regurgitation, presence of fistula/perforation and development of abscess), RIE was an independent predictor of less prevalence of the composite endpoint (HR 0.38; 95% CI: 0.19-0.79). Conclusions RIE was associated with a better outcome, when considering death, embolic events, or recurrence of endocarditis. The patients with right-sided endocarditis were also less frequently submitted to surgery compared to others.

Surgery versus medical therapy in patients with infective endocarditis and surgical indication: a retrospective study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Infective endocarditis is a condition associated with poor outcomes. Even though we have guidelines that establish which patients could benefit from surgery, the decision to perform it is not straightforward and there are many factors to be considered before we decide surgical approach. Purpose To establish the impact of surgery versus medical treatment in patients with surgical indication according to the ESC guidelines, in our population. The primary outcome was a composite of death, embolic events, and recurrence of infective endocarditis. Methods We performed a retrospective study of the patients admitted to our center between 2000 and 2020, with the diagnosis of infective endocarditis. After selecting the patients with surgical indication, according to ESC guidelines, we divided them in two groups: group A (submitted to surgery) and group B (medical therapy only). Results A total of 70 patients (65.7% males, 34.3% females, mean age 68.5 ± 15.2) were included. Of these 51.4% were submitted to surgery and 48.6 % received only medical therapy. The group A patients were significantly younger (mean age 63.03 ± 16.03 versus 75.52 ± 10.40, p&amp;lt;0.001). There were no statistically significant differences in terms of previous history of heart failure (p=0.09), valvular heart disease (p=0.83), ischemic heart disease (p=0.47), diabetes (p=0.50), obesity (p=0.17), chronic kidney disease (p=0.68). In terms of local complications, group A had a higher prevalence of severe valvular regurgitation (72.2% vs 36.4%, p= 0.003), with no statistically significant differences in abscess, aneurysm, fistula. During a mean follow-up of 28.66 ± 39.07 months, 42 pts (60%) experienced the composite endpoint. Group A had significantly better outcomes compared to group B (47.2% versus 26.5%, p= 0.016). In a multivariate regression analysis, after adjusting for all the possible confounders, including age, not performing surgery was an independent predictor of the composite endpoint (HR 2.23 95% CI: 1.16-4.55, p=0.02). Conclusion In patients with surgical indication, surgery was associated with a significant improvement in prognosis. In our population, older patients were more likely to receive medical therapy. However, surgery was associated with better outcomes, independently of age, which suggests that this shouldn’t be the only factor that determines whether surgery is performed or not.

Predictors of in-hospital mortality in infectious endocarditis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Infectious endocarditis has a high rate of in-hospital complications and mortality, ranging between 15 and 30%. Still, there is a paucity of studies on the assessment of short-term prognosis in these patients. Purpose To determine predictors of in-hospital mortality in patients with infective endocarditis. Methods This was a retrospective study that included all patients hospitalized in a single centre with the diagnosis of infective endocarditis, between 2000 and 2020. The relationship between clinical, laboratory and echocardiographic variables and in-hospital mortality was evaluated. Results A total of 161 patients were selected, 65.8% were males, with a mean age of 66.4±16.4 years. The in-hospital mortality rate was 16.8%, occurring on average after 35.0±17.5 days of hospitalization. The average length of stay was 44.5±22.8 days. Age &amp;gt;70 years was associated with higher mortality rate (p=0.021). There were no other significant differences between groups regarding clinical variables and comorbidities. Although not statistically significant, in-hospital mortality group had higher mean ejection fraction (57.2±2.7% vs. 54.6±12.9%). Laboratory parameters associated with mortality included isolation of Staphylococcus (p=0.019) or Enterococcus (p=0.045) in blood cultures. Though the classification of endocarditis (in native vs. prosthesis valve) did not differ between groups, the presence of perivalvular complications on echocardiography (p= 0.042) namely pseudoaneurysm (p=0.003), were more frequent in the group with higher mortality rate. There were 70 patients with indication for urgent surgery, namely for locally uncontrolled infection in 29.2%, heart failure (20.0%) and prevention of embolic events (18.1%). The existence of urgent surgical indication (p=0.009) was associated with higher mortality, and surgery during hospitalization was associated with lower mortality (p=0.011). In a multivariate regression analysis, after adjusting for all the possible confounders, the independent predictors of in-hospital mortality were the previous history of heart failure (HR = 3.29, 95%CI 1.41-7.66), chronic liver disease (HR = 4.33, 95%CI 1.23-15.30) and evolution with septic shock (HR = 6.87, 95%CI 2.89-16.39). Conclusions The present study confirms the high mortality rate of patients with infective endocarditis, highlighting the importance of patient baseline characteristics and comorbidities, as it identified as independent predictors of in-hospital mortality the previous history of heart failure, chronic liver disease and evolution with septic shock.

Challenges in cardiology: diagnosis of native and prosthetic valve endocarditis.

New cardiovascular imaging technologies have strongly influenced the diagnosis of bacterial endocarditis [infective endocarditis (IE)]. The clinical presentation of IE is polymorphic, which explains the difficulty of diagnosis and the delay in treatment. Symptoms such as fever, chills, loss of appetite and weight, and embolic phenomena strongly support the diagnosis of endocarditis, but are not always present, particularly in elderly or immuno-compromised patients. Moreover, subtle symptoms in patients at high risk for the development of IE, such as those with prosthetic valves or intracardiac devices, patients with congenital heart disease, and drug addicts should lead to the suspicion that a diagnosis of IE is highly probable. In this review, we will focus on the diagnosis of complex IE in native valves and prosthetic valves.

The Epidemiology of Infective Endocarditis in New South Wales, Australia: A Retrospective Cross-Sectional Study From 2001 to 2020.

This study aimed to investigate the demographic differences amongst patients diagnosed with infective endocarditis (IE), predictors of adverse events, and the association between clinical decision-making and adverse health outcomes amongst patients with IE. A retrospective cross-sectional study was conducted using the New South Wales (NSW) Admitted Patient Data Collection (APDC) from the Centre for Health Record Linkage (CHeReL). All patients (N=18,044) from 2001 to 2020 in New South Wales who received a diagnosis of IE using ICD-10-AM diagnostic code 133.0 were included. Categorical variables were compared using the chi-square test or Fisher's exact test, while the t-test was used for continuous variables. The association between clinical decision-making and adverse health outcomes amongst patients with IE were examined via generalised linear mixed models. Sex, age, birthplace and referral impacted clinical decision-making, in-hospital death and severity of the disease. Women experienced a higher risk of death and fewer escalations of care. Admission and mortality increased with age, with those aged 60 and above responsible for 60.8% of hospitalisations. Despite octogenarians making up one-fifth of admissions and having the worst mortality rate (15.1%), they experienced only one in 10 intensive care (ICU) admissions. Overseas-born patients had fewer escalations of care and experienced less severe disease if referred by a medical practitioner. One out of 10 admissions that resulted in a hospital death were given non-emergency status, and one in two ICU patients died in hospital. Sex, age, place of birth, and clinical decision-making were important predictors of severe disease and death in hospital, lending weight that health care clinical decisions may adversely impact health outcomes for populations of interest.

Management of infectious endocarditis from the perspective of the Infectious Diseases specialist – a 2023 update

An increase in the number and the complexity of cardiac surgery has brought on a rise in the proportion of healthcare-associated Infectious Endocarditis (IE), and as a result, today S. aureus is the most common causative pathogen for this condition. Clinical suspicion for IE should be raised in front of a patient with predisposing risk factors, a new heart murmur and/or vasculitic/embolic events. The Duke Criteria have been long used to diagnose IE. However, they underwent several changes in order to improve their sensitivity in the diagnosis of Q-fever IE and to decrease the size of the possible IE group. Our primary goal is to enhance the knowledge regarding the diagnosis and treatment of infective endocarditis. In acute IE, prior to beginning antibiotic therapy, at least three sets of blood cultures must be taken, ideally from three distinct sites, as determining the etiologic agent is of highest importance. The diagnosis of IE cannot be made based just on a single positive blood culture. To diagnose subacute IE, three to five sets of blood cultures must be drawn over the course of 24 hours. Transthoracic echocardiography (TTE) remains the preferred investigation when the diagnosis of IE is suspected. Transesophageal echocardiography (TOE) is recommended when TTE is unremarkable but the suspicion is still high. A whole-body CT scan, an MRI, a cardiac CT, PET-CT, or radiolabeled leucocyte single-photon emission computed tomography may be helpful when TTE and TOE are inconclusive. Recommended empirical therapy for Native Valve Endocarditis (NVE) and late Prosthetic Valve Endocarditis (PVE) consists of IV Amoxicillin, Oxacillin and Gentamicin administered until blood culture results are available. If a patient is allergic to penicillin, IV Vancomycin and Gentamicin should be given. The recommended empirical antibiotic regimen for early PVE includes IV Vancomycin, Gentamicin, and Rifampin. Once the results of blood cultures are available, the treatment will depend on the isolated organism, its sensitivity to antibiotics, and whether it is an NVE or a PVE.

Role of cerebral imaging on diagnosis and management in patients with suspected infective endocarditis.

Cerebral embolic events (CEEs) are common complications of infective endocarditis (IE) and their presence can modify diagnosis and therapeutic plans. The aim of the present study was to assess the role of cerebral imaging (Cer-Im) on diagnosis and management of patients with suspected IE. This study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. CEEs and IE were defined according to modified Duke criteria of the European Society of Cardiology (ESC) guidelines. Among 573 patients with IE suspicion and Cer-Im, 239 (42%) patients had neurological symptoms. At least one CEE was found in 254 (44%) episodes. Based on Cer-Im findings, episodes were reclassified from rejected to possible or from possible to definite IE in 3 (1%) and 25 (4%) patients, respectively (0% and 2% in asymptomatic patients, respectively). Among the 330 patients with possible or definite IE, at least one CEE was found in 187 (57%) episodes. A new surgical indication (in association with left-side vegetation >10mm) was established in 74/330 (22%) IE patients; 30/155 (19%) asymptomatic IE patients, respectively. Cer-Im in asymptomatic patients with IE suspicion showed limited potential for improving the diagnosis of IE. Contrariwise, performing Cer-Im in asymptomatic patients with IE may be useful for decision making, since Cer-Im findings led to the establishment of new operative indication for valvular surgery in one fifth of patients according to ESC guidelines.

Lactococcus lactis endocarditis and liver abscess in an immunocompetent patient: a case report and review of the literature

BackgroundOver the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections.Case presentationA 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcuscremoris, is a rare cause of human infections. The first case of Lactococcus lactiscremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases.ConclusionsTo our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.