Infective Endocarditis Factors Research Articles

Outcome and prognostic factors in infective endocarditis in dogs: 113 cases (2005-2020).

BackgroundFactors associated with outcome in dogs diagnosed with infective endocarditis (IE) are not well characterized.ObjectivesEvaluate outcome and prognostic factors in dogs with IE.AnimalsOne hundred and thirteen dogs with IE.MethodsMedical records for dogs that fulfilled the modified Duke criteria between 2005 and 2020 were retrospectively reviewed. Signalment, preexisting conditions, clinicopathologic findings, treatment regimen, and outcomes were recorded. Univariate logistic regression was performed to identify categorical factors associated with mortality, and then multivariate analysis was performed.ResultsDogs were categorized as survivors (n = 47), non‐survivors (n = 57), or lost to follow‐up (n = 9). Survival to discharge and at 1 month was documented in 79 (70%) of 113 and 56 (54%) of 104 dogs, respectively, with median survival time (MST) of 72 days. Risk factors associated with mortality included development of congestive heart failure (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.4‐97.8), thromboembolic events (OR, 5.7; 95% CI, 2.3‐14.4), and acute kidney injury (OR, 6.2; 95% CI, 2.0‐18.8). Administration of antithrombotic medications was associated with survival (OR, 0.35; 95% CI, 0.13‐0.97). Dogs that were not treated with antithrombotics had MST of 92 days, whereas dogs treated with antithrombotics did not reach MST during the study period. The heart valves involved and etiologic agent identified did not correlate with outcome.Conclusion and Clinical ImportanceDogs with IE that had thromboembolic events, acute kidney injury, or congestive heart failure had higher risk of mortality. Administration of antithrombotics was associated with prolonged survival time.

685. Evaluating the Role of Medication-assisted Treatment (MAT) in the Management of Infectious Endocarditis in People Who Inject Drugs (PWID)

Abstract Background An estimated 1.29-2.59 million people practice intravenous drug use (IVDU) in the United States making it a growing risk factor for infective endocarditis (IE). In people who inject drugs (PWID), IE accounts for 5-10% of total yearly deaths. IE often requires weeks of intravenous therapy with extensive medical follow-up. The purpose of this study was to evaluate if medication-assisted treatment (MAT) increased treatment retention and survival to optimize addiction assistance and IE treatment efforts. Methods A single-center, retrospective chart review was approved for patients admitted with an ICD-10 code of IE. A multidisciplinary group was created in April, 2019 aimed to improve endocarditis patient outcomes, formed of complex case coordination, infectious disease, cardiology, and pharmacy pain management service members. The historical period was January 1, 2018-March 31, 2019 and the IE pathway (IEP) group was April 1, 2019-June 30, 2020. Patients were excluded if there was no documentation of IVDU (Figure 1). The primary outcome was successful endocarditis therapy, defined per study protocol. Secondary outcomes include: against medical advice (AMA) departures, discharge naloxone prescriptions, clinical opioid withdrawal score (COWS) and patient reported pain. Figure 1. Study Population Methods for study population inclusion and exclusion Results A total of 419 IE patients were evaluated with 166 patients meeting inclusion criteria. The primary outcome was achieved in 51.2% of historical group and 48.8% of the IEP group (p=0.302). AMA departures and inpatient mortality were similar between the two groups. There was increased presence of the pharmacy pain management service with decreased time to consult in the IEP group (Figure 2). Last documented COWS were increased in the IEP group (p=0.002), while last reported patient pain scores decreased (p=0.030). More patients were started on MAT and discharged with naloxone in the IEP group (Table 3). Readmission was found to be higher in the IEP group (p=0.046). Post hoc analysis evaluating outcomes for patients seen by the endocarditis pathway team were similar between the two groups (Table 4). Figure 2. Secondary Outcome (Consult Services) The secondary outcomes of the study population are described comparing the presence and time to various consult services. **P-value indicates statistical significance. Abbreviations: n, number; ID, infectious disease; CT, cardiothoracic Table 3. Secondary Outcomes Table 4. Post Hoc Analysis Conclusion The multidisciplinary group was effective helping to guide the inpatient care of PWID and improve symptom management, but this did not translate to increased successful IE therapy or fewer readmissions. Disclosures All Authors: No reported disclosures

Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience

BackgroundIntravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE.MethodsWe retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020.ResultsPatients reporting IDA (N = 54; 12.2%) were significantly younger (p < 0.001) and presented fewer comorbidities (p < 0.001). IDA was associated with a higher proportion of relapses (27.8 vs. 3.3%, p < 0.001) and, at multivariable analysis, was an independent predictor of long-term mortality (HR 2.3, 95%CI 1.1–4.7, p = 0.015). We did not register multiple relapses in non-IDA patients. Among IDA patients, we observed 1 relapse after discharge in 9 patients, 2 relapses in 5 patients and 3 relapses in 1 patient. In IDA patients, neither clinical and laboratory variables nor the occurrence of even multiple relapses emerged as indicators of an adverse risk–benefit ratio of surgery in patients with surgical indication.ConclusionsIE secondary to IDA affects younger patients than those with IE not associated with IDA. Probably due to this difference, IE secondary to IDA is not associated with significantly higher mortality, whereas the negative, long-term prognostic impact of IDA emerges in multivariate analysis. Considering the good prognosis of patients with uncomplicated IE treated medically, surgery should be reserved to patients with a strict- guidelines-based indication. However, since there are no clear predictors of an unfavourable risk–benefit ratio of surgery in patients with surgical indication, all patients with a complicated IE should be operated, irrespective of a history of IDA.

P1506Prolonged and recurrent hospital admissions predict risk of cardiac implantable electronic device infections in hospitalized patients with bacteriaemia

Abstract Background As the use of Cardiac Implantable Electronic Devices (CIED) is expanding, the burden of device-related infections, particularly infectious endocarditis, is also increasing. Furthermore, with the increase in life expectancy, these devices are being implanted in patients who are older, with more serious co-morbidities and who are frequently hospitalized. Purpose To assess incidence and predisposing factors for infective endocarditis (IE) in hospitalized patients with CIED and nosocomial bacteraemia. Methods We performed a retrospective analysis of all hospitalized patients with CIED and positive blood cultures admitted to the Cardiology department between January 2012 and February 2019. Endocarditis was defined according to modified Duke criteria. We analyzed clinical parameters, device- and procedure-related characteristics, length of hospital stay and hospitalizations in the previous year. Results 25 patients had positive blood cultures, 4 patients (16.0%) were diagnosed with infective endocarditis (median age 59.25 years, 75.0% male). Patients characteristics are displayed in the Table. In univariable analysis, the number and presence of hospitalizations in the previous year and the length of hospital stay was significantly associated with the possibility of endocarditis (respectively, OR 3.411, 95% CI 1.164-9.998, p-value 0.025; OR 18.000, 95% CI 1.375-235.686, p-value 0.028; and OR 1.047, 95% IC 1.001-1.096, p-value 0.046). Conclusion In this group of patients with positive blood cultures during hospitalization, the possibility of CIED infection was predicted by the length of hospital stay and the presence and number of hospitalizations in the previous year. With CIED-IE Without CIED-IE p-value Age in years, median (IQR) 63 (16) 76 (16) 0.002 Heart failure, n (%) 4 (100%) 10 (47.6%) 0.105 LVEF in %, median (IQR) 21 (9) 51 (30) 0.008 LV dilation, n (%) 4 (100%) 8 (38.1%) 0.039 Device revision/upgrade/substitution, n (%) 2 (50.0%) 6 (28.57%) 0.570 LOS in days, median (IQR) 58.5 (83) 20 (15) 0.004 Hospital admissions in the previous year, n (%) 3 (75.0%) 3 (14.3%) 0.031 No. of hospital admissions in the previous year, mean (standard deviation) 1.67 (1.528) 0.29 (0.784) 0.005 Use of central venous access, n (%) 4 (100%) 4 (19.05%) 0.008 LOS – Length of Stay; LV – Left Ventricle; LVEF – Left Ventricle Ejection Fraction

The influence of race in older adults with infective endocarditis

BackgroundAge is a risk factor for infective endocarditis, and almost half of diagnosed patients are age ≥ 60 years. Large national studies have not evaluated inpatient mortality and surgical valvular interventions between older White and Black patients hospitalized with infective endocarditis.MethodsWe used the Nationwide Inpatient Sample database to identify older adults ≥60 years in North America with a principle diagnosis of infective endocarditis. Multivariate logistic regression was used to compare in-hospital mortality and valvular repairs/replacement between older Black and White patients.ResultsOf 10,390 adults, age ≥ 60 years hospitalized for infective endocarditis during 2013 and 2014, 7356 were White and 1089 Black. Blacks were younger (mean age: 70.5 ± 0.5 vs. 73.5 ± 0.2 years, p < 0.01), lived in more zip codes with a median annual income <$39,000/yr. (40.4% vs 18.8%, p < 0.01), and had higher co-morbidity burden (Charlson comorbidity score ≥ 3: 54.6% vs 40.7%, p < 0.01). After multivariate adjustment, Blacks had higher odds for in-hospital mortality (Odds Ratio (OR) = 2.0, [Confidence Interval (CI) 1.1–3.8]; p = 0.020), and lower odds for mitral valve repairs/replacements (OR = 0.53, CI: 0.29–0.99, p = 0.049).ConclusionsBlacks age ≥ 60 years hospitalized in North America with infective endocarditis are less likely to undergo mitral valvular repairs/replacement and had higher in-hospital mortality compared to White patients.

Infective Endocarditis by Rare Organism Granulicatella Adiacens

Infective endocarditis (IE) is a life-threatening infection of the cardiac valves especially in patients with preexisted valvular disease. Having a rheumatic heart disease, congenital heart disease, prosthetic valves or previous episodes of IE are some of the traditional risk factors for infective endocarditis (Hoen &amp; Duval, 2013).&#x0D; Although most cases were reported by streptococci especially streptococcus viridans, which is one of the commensal bacteria isolated from the mouth, some of the cases of IE can be caused by fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. These organisms need supplemented media, prolonged incubation time, and special culture conditions to grow and be isolated.&#x0D; Abiotrophia was reclassified in a new genus Granulicatella, as Granulicatella adiacens, balaenopterae, elegans and G. para adiacens. The genus Abiotrophia consists of only one species -A.defectiva.

Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda

BackgroundAlthough rheumatic heart disease remains the leading cause of valve heart disease (VHD) in developing countries, other forms of valve disease have been over shadowed and not regarded as a public health problem. However, several facts suggest that the role of non-rheumatic VHD as a significant cardiovascular disease should be reconsidered. We aimed to assess the prevalence and characteristics of different forms of primary left sided valve diseases from a series of 15,009 echocardiographic studies.MethodsThis was a retrospective review of echocardiographic reports for studies performed between January 2012 and December 2013 (24 months) at Uganda Heart Institute. All patients with primary left-sided valve disease were classified into one of five major diagnostic categories and in each diagnostic category; patients were sub-classified into stages A-D of primary valve disease as defined by the American College of Cardiology.ResultsThree thousand five hundred eighty-two echocardiography reports qualified for final data analysis. The “sclerotic valve changes with normal valve function”, a Stage A sub-class of “degenerative valve disease” overwhelmingly overshadowed all the other diagnostic categories in this stage. “Rheumatic Heart Disease”, “Degenerative Valve Disease”, “Bicuspid Aortic Valve”, “Mitral Valve Prolapse” and “Endomyocardial Fibrosis” diagnostic categories accounted for 53.0%, 41.8%, 2.2%, 1.4% and 1.7% respectively in stages B-D of primary VHD. Rheumatic heart disease disproportionately affected the young, productive age groups. It was the major risk factor for infective endocarditis; and was the indication for valve surgery in 44 of 50 patients who had undergone valve replacement procedures.ConclusionsWe acknowledge that rheumatic heart disease remains a leading cause of progressive and severe primary left-sided valve disease among young adults in Uganda. But we bring to light the contemporary footprints of other forms of primary valve disease that require coordinated multidisciplinary approach to research, education and clinical management to ensure improved patient outcomes.

Prognostic factors in infective endocarditis in general hospitals in the Netherlands.

IntroductionDespite advances in treatment, infective endocarditis (IE) still ranks amongst the most lethal infectious diseases. We sought to determine prognostic factors in general hospitals in the Netherlands as research in this setting is scarce.ResultsBetween 2004 and 2011, we identified 216 cases of IE, 30.1 % of which were prosthetic valve IE. This leads to an annual incidence of IE of 5.7 new cases per 100,000 persons per year. Women were less likely to undergo surgical intervention (OR = 1.96, 95 % CI 1.06–3.61, p = 0.031). Also, ageing was an independent prognostic factor for not receiving surgery in a multivariate analysis (annual OR = 1.04, 95 % CI 1.02–1.06, p < 0.001). Female sex was a prognostic factor for mortality (OR = 2.35, 95 % CI 1.29–4.28, p = 0.005). Age was also an independent prognostic factor for mortality (OR = 1.05, 95% CI 1.03–1.08, p < 0.001). Conservative treatment was a prognostic factor for mortality (OR = 3.39, 95 % CI 1.80–6.38, p < 0.001) whereas surgical intervention was an independent prognostic factor for adverse events (OR = 3.03, 95% CI 1.64–5.55, p < 0.001). Staphylococcus aureus was an independent prognostic factor for adverse events (OR = 2.05, 95 % CI 1.10–3.84, p = 0.024) but not for mortality.ConclusionThis study shows that endocarditis in general hospitals has a high rate of morbidity and mortality. Even when treated, it ranks as one of the most lethal infectious diseases in the Netherlands, especially in women and the elderly.

Streptococcus sanguinis as an opportunistic bacteria in human oral cavity: Adherence, colonization, and invasion

Streptococcus sanguinis (formerly S. sanguis) is a Gram-positive, facultative anaerobe, nonmotile , normal inhabitant of the human oral cavity, and a member of the viridans group of streptococci. Among the streptococcus, S. sanguinis is a primary colonizer in the human tooth surface or it is recognize as a ‘pioneer’ by forming dental plaque. The aim of this paper is to review the role of Streptococcus sanguinis in the adherence to and invasion of human tissues. S. sanguinis has been reported that it is associated with healthy tooth surfaces but not with caries. S. sanguinis tend to involved in an interspecies interactions with Streptococcus mutans, which is known as competition/coexistence within dental biofilm. In their colonization, this bacteria used enzyme sortase A (SrtA) to cleave LPXTG-containing proteins sequence and anchored the cell wall, while virulence factors in infective endocarditis involved housekeeping functions such as cell wall synthesis, amino acid and nucleic acid synthesis, and the ability to survive under anaerobic conditions.

Infective endocarditis in a 12-year-old with subclinical rheumatic carditis

Infective endocarditis is rare in children. It occurs mostly in children with an underlining heart defect. The clinical feature could be variable and most of the immunological features seen in adults are often absent in children. Rheumatic fever is a huge disease burden in developing countries and rheumatic valvular heart disease remains a risk factor for infective endocarditis. Therefore the case of a 12-year-old girl who hitherto had no complaint suggestive of underlining cardiac defect was diagnosed with infective endocarditis and subclinical rheumatic carditis which was confirmed by echocardiography; she responded to antibiotics and aspirin treatment and was discharged after 6-weeks on admission; she is being currently followed-up in the cardiac clinic.

Plasma cholinesterase activity in children with infective endocarditis

Objectives: Although pre-existing heart disease in children is the most frequent predisposing factor for infective endocarditis (IE), we report 6 children of IE with no apparent preexisting cardiac disease. Patients and Methods: Our study included six patients with acquired infection from central catheter; the microbial pathogens were Streptococcus viridans (n=3) and Staphyloccocus aureus (n=3). The diagnosis of IE was based on positive blood culture (2 positive cultures of blood samples drawn >12 hours), evidence of endocardial involvement (positive ECHO), measuring raised erythrocyte sedimentation rate and plasma cholinesterase (PChE) activity. We measured PChE activity (µmol min -1 ml -1 ) in children with IE (group A, n=6) and in IE-free children (group B, n=10). For determination of PChE activity vein blood samples were collected and stored at -20°C until analyzed. PChE activity was determined by the spectrophotometric method of Ellman using butyryltiocholine as the substract (Sigma Chemical Co., St.Luis, Mo, USA). Statistical analysis was made by Student’s t-test. Results: In group A of examined children with IE we measured decreased PChE activity (1.89 ± 0.24) relation to patients of control group B (3.97 ± 0.20). Conclusion: Our study indicates that PChE activity can also be an important parameter for the diagnosis of IE.

Plasma cholinesterase activity in children with infective endocarditis

Objectives: Although pre-existing heart disease in children is the most frequent predisposing factor for infective endocarditis (IE), we report 6 children of IE with no apparent preexisting cardiac disease. Patients and Methods: Our study included six patients with acquired infection from central catheter; the microbial pathogens were Streptococcus viridans (n=3) and Staphyloccocus aureus (n=3). The diagnosis of IE was based on positive blood culture (2 positive cultures of blood samples drawn >12 hours), evidence of endocardial involvement (positive ECHO), measuring raised erythrocyte sedimentation rate and plasma cholinesterase (PChE) activity. We measured PChE activity (µmol min -1 ml -1 ) in children with IE (group A, n=6) and in IE-free children (group B, n=10). For determination of PChE activity vein blood samples were collected and stored at -20°C until analyzed. PChE activity was determined by the spectrophotometric method of Ellman using butyryltiocholine as the substract (Sigma Chemical Co., St.Luis, Mo, USA). Statistical analysis was made by Student’s t-test. Results: In group A of examined children with IE we measured decreased PChE activity (1.89 ± 0.24) relation to patients of control group B (3.97 ± 0.20). Conclusion: Our study indicates that PChE activity can also be an important parameter for the diagnosis of IE.

THE TENDENCIES OF SURGICAL TREATMENT OF INFECTIVE ENDOCARDITIS DURING THE PERIOD OF 2007-2009 YEARS IN VILNIUS UNIVERSITY HOSPITAL SANTARIŠKIŲ KLINIKOS

This article describes the tendencies of surgical treatment of the patients, admitted to Vilnius University Hospital Santariškių Klinikos due to infectious endocarditis, during the period of 2007-2009 years. Objective. To assess the factors influencing the timing of surgery. To determine if timing of surgery impacts an outcome of infective endocarditis. Design and methods: Demographic, clinical, transthoracic/ transesophagal echocardiographic, microbiological, operation protocol data were analyzed. During the research patients were defined into two different groups by timing of surgical treatment. Surgery performed during the first 7 days after an admission to hospital was named as an emergent/ urgent (n=50), later surgery – as an elective (n=50). Finally, 100 patients with Duke Criteria based diagnosis entered the research. Results. There was a relation between the timing of surgery and etiologic factors of infective endocarditis evaluated, p = 0,034. Patients with diagnosis of prosthetic infective endocarditis received an elective surgical treatment usually - 9 (90%), p = 0,008. Refracteric lung edema required an urgent surgical treatment - 9 (82%), p = 0,050. If intracardiac complications were present, surgical treatment was usually delayed - 20 (70%) cases, p=0,008. The length of vegetations (more than 15 mm) did not influence on timing of surgery. The timing of surgical treatment due to infective endocarditis had no influence on the mortality rates, which were the same - 14% - in both groups.

Infective endocarditis affecting the pulmonary valves in pregnant intravenous drug users

Intravenous drug use is a recognised risk factor for infective endocarditis (IE) (Henderson et al. 1989). Over the last few decades, there has been a change in the predisposing factors for IE. The ...

Acute aortic dissection associated with undetected congenital bicuspid aortic valve and infective endocarditis diagnosed intraoperatively

The congenital bicuspid aortic valve (BAV) is recognized as a cause of acute aortic dissection (AAD) and also as a risk factor for infective endocarditis (IE) especially ring abscess. We experienced a case of all these combined and operated emergently. A 59-year-old man was transferred to us, and emergent operation was indicated for AAD and aortic stenosis (AS) due to BAV. However, he was strongly suspected of also having IE during the operation and the procedure was changed to a modified Bentall's method. The diagnosis was confirmed by pathological examination postoperatively. He recovered well after postoperative antimicrobial therapy without recurrent infection. It is important to remember that BAV is a risk factor for not only AAD but also IE, which sometimes occurs simultaneously and requires an emergent operation due to high mortality.

It is Unclear if Toothbrushing is a Risk Factor for Infective Endocarditis in Children

Article Title and Bibliographic Information Prevalence, intensity and nature of bacteraemia after toothbrushing. Lucas VS, Gafan G, et al. J Dent 2008;36(7):481-7. Reviewer Jan Bergstrom, PhD, DDS Purpose/Question Does professional dental cleaning have an influence on prevalence and intensity of bacteraemia? Source of Funding Information not available Type of Study/Design A cohort study Level of Evidence Level 2: limited-quality patient-oriented evidence Strength of Recommendationgrade Grade B: Inconsistent or limited-quality patient-oriented evidence

Infective endocarditis in elderly patients

Dear Sir,Increased age was reported a risk factor for infective endocarditis due to degenerative changes in valves and decreased immunoglobulin levels because of the involution of their immune syst...

P1474 Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteraemia

P1474 Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteraemia

A forgotten but important risk factor for infective endocarditis in patients with prosthetic valve: Pedicure

We report a case of infective endocarditis developing after pedicure in a 36-y-old female. Methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis was diagnosed. Even aggressive therapy was ineffective. To our knowledge, we report the first case of infective endocarditis secondary to pedicure in the literature.

Infective endocarditis with lung and systemic embolization in an injection drug user

Injection drug use (IDU) is a well-known risk factor for infective endocarditis (IE). The clinical manifestations of IE in injection drug users (IDUs) are often atypical, so that the correct diagnosis requires a high index of suspicion. A 24-year-old male with history of IDU, HIV-negative, presenting with profound malaise, was …