Diagnosis Of Bacterial Endocarditis Research Articles

Prediction of impending central-line-associated bloodstream infections in hospitalized cardiac patients: development and testing of a machine-learning model

While modelling of central-line-associated blood stream infection (CLABSI) risk factors is common, models that predict an impending CLABSI in real time are lacking. To build a prediction model which identifies patients who will develop a CLABSI in the ensuing 24h. We collected variables potentially related to infection identification in all patients admitted to the cardiac intensive care unit or cardiac ward at Boston Children's Hospital in whom a central venous catheter (CVC) was in place between January 2010 and August 2020, excluding those with a diagnosis of bacterial endocarditis. We created models predicting whether a patient would develop CLABSI in the ensuing 24h. We assessed model performance based on area under the curve (AUC), sensitivity and false-positive rate (FPR) of models run on an independent testing set (40%). A total of 104,035 patient-days and 139,662 line-days corresponding to 7468 unique patients were included in the analysis. There were 399 positive blood cultures (0.38%), most commonly with Staphylococcus aureus (23% of infections). Major predictors included a prior history of infection, elevated maximum heart rate, elevated maximum temperature, elevated C-reactive protein, exposure to parenteral nutrition and use of alteplase for CVC clearance. The model identified 25% of positive cultures with an FPR of 0.11% (AUC= 0.82). A machine-learning model can be used to predict 25% of patients with impending CLABSI with only 1.1/1000 of these predictions being incorrect. Once prospectively validated, this tool may allow for early treatment or prevention.

Antimicrobial activity of dalbavancin tested against Gram-positive organisms isolated from patients with infective endocarditis in US and European medical centres.

The management of endocarditis requires aggressive and prolonged antimicrobial treatment. We evaluated the in vitro activity of dalbavancin against bacteria from patients with infective endocarditis. A total of 626 Gram-positive organisms were collected from patients with a diagnosis of bacterial endocarditis in the USA (n = 222) and Europe (n = 404) from 2007 to 2017 via the SENTRY Antimicrobial Surveillance Program and were tested for susceptibility to dalbavancin and comparators by broth microdilution. The most common organisms were Staphylococcus aureus (48.4%), Enterococcus faecalis (19.6%) and viridans group streptococci (VGS; 12.5%). Dalbavancin and daptomycin showed complete activity (100.0% susceptibility per CLSI criteria) against S. aureus, but dalbavancin MIC values were 4- to 8-fold lower. Vancomycin, linezolid and teicoplanin were also active against all S. aureus when CLSI criteria were applied. Ceftaroline was active against all MSSA (MIC90 0.25 mg/L) and 78.4% of MRSA isolates at ≤1 mg/L. All E. faecalis isolates were susceptible to ampicillin, daptomycin and linezolid, whereas 97.6% of isolates were susceptible to dalbavancin (MIC90 0.06 mg/L) and 96.7% were susceptible to vancomycin (MIC90 2 mg/L). All VGS and CoNS isolates were susceptible to dalbavancin, daptomycin, vancomycin and linezolid. Against Enterococcus faecium, 65.7% of isolates were inhibited by ≤0.25 mg/L dalbavancin and 62.9% were vancomycin susceptible. Dalbavancin exhibited potent in vitro activity against a large collection of Gram-positive isolates recovered from patients with endocarditis in US and European medical centres. These results support further investigations to determine the role of dalbavancin in the treatment of infective endocarditis.

1081. Antimicrobial Activity of Dalbavancin Tested Against Gram-Positive Organisms Isolated From Patients With Infective Endocarditis in United States and European Medical Centers

BackgroundThe management of endocarditis requires aggressive and prolonged antimicrobial treatment. Dalbavancin (DALBA) has demonstrated potent in vitro activity against Gram-positive (GP) organisms commonly responsible for endocarditis and is being evaluated for treatment of complicated bacteremia and infective endocarditis.MethodsA total of 626 GP organisms were collected from patients with a diagnosis of bacterial endocarditis in the United States (n = 222) and Europe (n = 404) from 2007 to 2017 via the SENTRY Antimicrobial Surveillance Program and were tested for susceptibility (S) against DALBA and comparators by CLSI broth microdilution.ResultsThe most common organisms were S. aureus (48.4%), E. faecalis (EF; 19.6%), and viridans group streptococci (VGS; 12.5%). DALBA and daptomycin (DAPTO) showed complete activity (100.0%S) against S. aureus, but DALBA MICs were 4- to 8-fold lower (table). Linezolid (LZD) and teicoplanin were also active against all SA; whereas vancomycin (VAN) and trimethoprim–sulfamethoxazole were active against 99.7% of isolates. Ceftaroline (CPT) exhibited potent activity against methicillin-susceptible S. aureus (MSSA; MIC90, 0.25 mg/L; 100.0%S) and inhibited 78.4% of methicillin-resistant S. aureus (MRSA) isolates at ≤1 mg/L. All EF isolates were S to ampicillin, DAPTO, and LZD, whereas 97.6% (120/123) of isolates were S to DALBA (MIC90, 0.06 mg/L) and 96.7%S to VAN (MIC90, 2 mg/L). Against EF, DALBA MIC values were 16- to 32-fold lower than DAPTO and VAN. All VGS and coagulase-negative staphylococcal (CoNS) isolates were S to DALBA, DAPTO, VAN, and LZD, and the highest CPT MICs were 0.5 mg/L for VGS and 4 mg/L for CoNS (93.5% inhibited at ≤1 mg/L). Against E. faecium (EFM), 65.7% of isolates were inhibited at ≤0.25 mg/L of DALBA and 62.9% were VAN-S. All EFM were S to DAPTO and LNZ. β-Hemolytic streptococci (BHS) was S to most antimicrobial agents, and only 66.7% of S. pneumoniae (SPN) isolates were PEN-S at ≤0.06 mg/L.ConclusionDALBA exhibited potent in vitro activity against a large collection of GP isolates recovered from patients with endocarditis in the United States and Europe medical centers. These results support further investigations to determine the role of DALBA in the treatment of infective endocarditis. Disclosures H. S. Sader, Allergan: Research Contractor, Research support. R. E. Mendes, Allergan: Research Contractor, Research support. M. A. Pfaller, Allergan: Research Contractor, Research support. R. K. Flamm, Allergan: Research Contractor, Research support.

Analysis of Oritavancin Activity against Gram-Positive Clinical Isolates Responsible for Bacterial Endocarditis in United States and European Hospitals (2008–2016)

BackgroundOritavancin (ORI) has documented in vitro activity against gram-positive (GP) isolates. This study analyzed ORI tested against organisms causing endocarditis in United States (US) and European (EU) sites.MethodsA total of 424 organisms recovered from patients with a diagnosis of bacterial endocarditis at US and EU sites during the SENTRY Antimicrobial Surveillance Program (2008–2016) were included (see Table). Isolates were identified by standard biochemical algorithms and MALDI-TOF. Susceptibility (S) testing was performed by CLSI methods, and MICs were interpreted per CLSI and/or EUCAST criteria.ResultsAmong the 424 isolates, 212 (50.0%) were S. aureus (SA; 31.6% methicillin-resistant [MRSA]), 47 (11.1%) were coagulase-negative staphylococci (CoNS), 81 (19.1%) were E. faecalis (EFC), 21 (5.0%) were E. faecium (EFM), 24 (5.7%) were BHS, and 39 (9.2%) were viridans group streptococci (VGS). ORI had similar MIC90 values (0.06 µg/mL) against SA and CoNS, inhibiting 98.8% of these isolates at ≤0.12 µg/mL. ORI MIC50 values were 8- to 32-fold lower than those for vancomycin (VAN), daptomycin (DAP), and ceftaroline (CPT) against staphylococci. ORI showed MICs against EFM (MIC50/90, 0.008/0.03 µg/mL) that were 2-fold lower than against EFC (MIC50/90, 0.015/0.03 µg/mL; 97.5%S against all or 100%S against indicated VAN-S isolates). ORI inhibited 98.0% of all enterococci, including VAN-resistant isolates at ≤0.12 µg/mL. VAN, DAP, ampicillin (MIC50/90, ≤1/2 µg/mL), and linezolid (LZD) (MIC50/90, 1/2 µg/mL) were similarly active against EFC, while DAP and LZD had coverage (100.0%S) against EFM. Overall, BHS were highly S to all agents tested, except for erythromycin (70.8%S) and tetracycline (43.5%S). ORI was the most active agent (MIC90, 0.12 µg/mL) tested against VGS.ConclusionORI showed potent in vitro activity against isolates recovered from patients with endocarditis in US and EU sites. The data presented here warrant further investigations to determine whether ORI has a role for treating endocarditis.Disclosures M. A. Pfaller, The Medicines Company: Research Contractor, Research grant; H. S. Sader, The Medicines Company: Research Contractor, Research grant; D. Shortridge, The Medicines Company: Research Contractor, Research grant; R. K. Flamm, The Medicines Company: Research Contractor, Research grant; R. E. Mendes, The Medicines Company: Research Contractor, Research grant

A probable clinically significant interaction between warfarin and cloxacillin: three case reports

Three patients were admitted to the Imam Hospital, Tehran, Iran with a diagnosis of bacterial endocarditis. The patients had indications for valve replacement surgery and anticoagulant therapy. The administration of cloxacillin reduced the effect of warfarin, and subsequent increases in warfarin doses were unable to overcome this effect. A decrease in warfarin anticoagulation effects was detected in our three patients following cloxacillin therapy for infective endocarditis. Penicillinase-resistant penicillins remain essential antibiotics in the treatment of severe infections caused by Staphylococcus aureus due to their bactericidal activity, safety, and cost. Thus, in situations where anticoagulants are indicated in patients with infective endocarditis, it would be better to replace warfarin with low-molecular-weight or unfractionated heparin.

Tratamento ambulatorial da endocardite bacteriana estreptocócica

A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.

Is It Antiphospholipid Syndrome?

The diagnosis of bacterial endocarditis remains a challenge, as nearly half of cases develop in the absence of preexistent heart disease and known risk factors. Not infrequently, a blunted clinical course at onset can lead to erroneous diagnoses. We present the case of a 47-year-old previously healthy man in which a presumptive diagnosis of antiphospholipid syndrome was made based on the absence of echocardiographically detected heart involvement, a negative blood culture, normal C-reactive protein (CRP) levels, a positive lupus anticoagulant (LAC) test, and evidence of splenic infarcts. The patient eventually developed massive aortic endocarditic involvement, with blood cultures positive for Streptococcus bovis, and was referred for valvular replacement. This case not only reminds us of the diagnostic challenges of bacterial endocarditis, but also underlines the need for a critical application of antiphospholipid syndrome diagnostic criteria.

Fusobacterium nucleatum Endocarditis Mimicking Polymyalgia Rheumatica

A case of Fusobacterium nucleatum endocarditis in an 80-year-old man is reported. The patient presented with a headache and nonspecific musculoskeletal symptoms and was misdiagnosed as having polymyalgia rheumatica. The diagnosis of bacterial endocarditis was delayed because of an insidious presentation, typical in infections with low virulence micro-organisms. The musculoskeletal symptoms, unresponsive to protracted corticosteroids, completely resolved with intravenous ampicillin treatment. Rheumatologic symptoms may hinder the correct diagnosis of subacute infective endocarditis. An atypical evolution of a common rheumatic disorder such as polymyalgia rheumatica should alert physicians to the possibility of bacterial endocarditis.

Echocardiography in diagnosis of bacterial endocarditis. Possibilities and limits

Echocardiography in diagnosis of bacterial endocarditis. Possibilities and limits

Subacute Bacterial Endocarditis and Cerebral mycotic Aneurysm

A 30-year-old man was transferred to Yonsei Cardiovascular Hospital after 20 days of hospitalization under the diagnosis of bacterial endocarditis with mitral regurgitation and septic splenic infarct. He had suffered from intermittent high fever and general weakness for 3 months. Echocardiogram showed moderate mitral regurgitation and multiple large vegetations in both leaflets. Streptococcus viridans was confirmed by blood cultures, and administration of cefazoline and gentamycin was initiated. During the antibiotic therapy, abdominal and left calf pain developed, and abdominal computed tomography showed splenic and right renal infarct. He also complained intermittent headache and visual distrubance. Brain computed tomography and four vessels angiography showed a small aneurysm in right hemisphere and other small aneurysm in fronto-occipital area of left middle cerebral artery. No more systemic embolization developed until the completion of six weeks of antibiotic therapy. The patient underwent mitral valve replacement with #29 Carpenitier-Edwards Bioprosthesis. At operation, the anterior and posterior mitral leaflets were found perforated and covered with leaflets were found perforated and covered with multiple vegetations. Follow-up cerebral angiography taken at seventh postoperative day, showed enlargement of cerebral aneurysm. Clipping of saccular aneurysms on left M3 and M4 were performed and complete resolution of aneurysm was confirmed by brain computed tomography. On operative finding, an aneurysm was found on with saccular type. The patient was dischanged without complication on eighth postoperative day.

The surgical management of bacterial valvular endocarditis.

Bacterial endocarditis is an important cause of cardiac valvular problems. The diagnosis of bacterial endocarditis can be difficult, and, often, an aggressive clinical evaluation including serial blood cultures is necessary. The pathophysiology of endocarditis is changing with the rise of intravenous drug use; staphylococci are an increasingly common cause. Endocarditis often warrants surgical intervention. Operations for bacterial endocarditis range from valve repair to valve replacement to homograft replacement. The operations are technically challenging, but new methods of myocardial protection have markedly improved the surgical outcomes. Valve excision is an option for intravenous drug users with tricuspid valve endocarditis. Surgical management of endocarditis is a technically challenging but rewarding procedure that should be offered to appropriate patients.

Echocardiographic findings in a dog with vegetative bacterial endocarditis (Case report)

Definitive diagnosis of mitral and aortic valvular endocarditis in a dog was based on echocardiograpic findings and was then confirmed by positive blood culture. Abdominal ultrasound examination revealed a renal abcess. This case illustrates that echocardiography associated with abdominal ultrasound has become an essential tool for the diagnosis of bacterial endocarditis and for the detection of sequela or initial source of bacteriemia, while waiting for blood culture results. A short review of echocardiographic and Doppler abnormalities associated with bacterial endocarditis is presented.

Aneurysmal pouch on left coronary cusp accompanied by bacterial endocarditis

A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.

Clinical and echocardiographic findings in 10 dogs with vegetative bacterial endocarditis

ABSTRACTTen cases of bacterial endocarditis in the dog were studied by retrospective analysis of case records. Diagnosis of bacterial endocarditis was based on either strict clinical criteria or post mortem examination. A wide spectrum of presenting signs was seen including pyrexia, lameness, epistaxis, haemoptysis and dyspnoea. Haematological and biochemical abnormalities were non‐specific and were attributed to the effects of septicaemia, embolism or chronic inflammation. Haemostatic abnormalities and, or, severe dysrhythmias appeared to be associated with a significantly poorer prognosis. Blood cultures were positive in four cases of eight that were cultured. Lesions compatible with bacterial endocarditis were detected in all eight cases that underwent echocardiographic examination. Right‐sided vegetations present in two dogs were not detected by echocardiography. Two‐dimensional echocardiography is a useful technique for the detection of vegetative endocarditis in the dog and allows rapid therapeutic intervention while blood culture results are pending.

Cerebral Toxoplasmosis in the Acquired Immunodeficiency Syndrome: Case Report and Review of the Literature

Cerebral Toxoplasmosis in the Acquired Immunodeficiency Syndrome: Case Report and Review of the Literature

Transient Hilar Lymphadenopathy Due to Bacterial Endocarditis

Transient hilar and mediastinal lymphadenopathy accompanying right-sided bacterial endocarditis without concurrent roentgenographically-demonstrable pulmonary parenchymal abnormalities has not, to our knowledge, been previously reported. The roentgenographic finding of hilar or mediastinal lymphadenopathy should not be considered incompatible with the diagnosis of bacterial endocarditis in the appropriate clinical setting. Possible mechanisms for the development of lymphadenopathy secondary to bacterial endocarditis are discussed.

Late rupture of a mycotic aneurysm after ?cure? of bacterial endocarditis

Rupture of a mycotic aneurysm often occurs before the diagnosis of bacterial endocarditis is made or whilst the patient is being treated with antibiotics. It is recognised that cerebral embolism continues to occur after adequate antibiotic treatment, but the late rupture of a mycotic aneurysm seems to be very unusual. We report such a case where rupture of a peripherally sited aneurysm, demonstrated angiographically and pathologically, occurred 6 months after bacteriologically adequate treatment of streptococcal bacterial endocarditis.

Treatment of Staphylococcal Infections-Reply

There were no statistical differences between the number of endocarditis patients in groups 1 and 2 (nine vs seven). We agree that endocarditis in drug addicts appears to be a relatively benign disease; however, our patient was sufficiently ill for his physicians to request special laboratory tests. Case 17, while not having a complicated course, did fulfull our criteria for endocarditis as outlined in the report. Using these criteria for the clinical diagnosis of bacterial endocarditis, we accurately predicted the presence of endocarditis found at autopsy in the four patients who died. In addition, patient 15 likely had endocarditis, as his blood cultures were persistently positive for 24 hours despite the absence of a heart murmur or evidence of peripheral emboli. The addition of case 15 as an episode of infectious endocarditis would then give nine such cases in group 1 and eight in group 2. Nolan and Beaty 1 actually

Bacterial endocarditis: Survey of patients treated between 1963 and 1975

A study of forty-nine patients admitted to the University of Kentucky Medical Center hospital from 1963 to 1975 with a diagnosis of bacterial endocarditis was conducted. Data collected demonstrated a greater incidence in males than in females, a high mortality rate, especially among patients with prosthetic valves, and rheumatic heart disease as being the most prevalent predisposing factor. Straphylococcus aureus was the most frequently isolated microorganism, with the greatest in vitro antibiotic sensitivity being demonstrated to chloramphenicol.

Tracking Down Salmonella typhi

Therapies based on a tentative diagnosis often hinder its confirmation at a later date. Liver or cyanocobalamin given to a patient with suspected pernicious anemia can vitiate subsequent microscopic diagnosis by altering the morphology of the blood and the bone marrow. Thyroid taken by a patient with suspected hyperthyroidism will so change the values of protein-bound iodine and thyroxine as to make their interpretations valueless for diagnostic corroboration. A particularly rich source of such therapeutically vitiated diagnoses is antibiotic therapy. An antibiotic taken for the treatment of an uninvestigated sore throat can render a throat swab useless should it become necessary to rule out a β-streptococcal infection. A bacteriologic diagnosis of bacterial endocarditis may become impossible after the patient has been treated with antibiotics for a fever as yet undiagnosed. Penicillin taken for the treatment of gonorrhea may suppress the clinical manifestations of a coexistent syphilitic infection. A recent addition