High Incidence Of Endocarditis Research Articles

Retrospective Comparison of the Supported and Unsupported Bovine Jugular Vein Conduit in Children

Bovine jugular vein (BJV) conduits are commonly used for pulmonary valve replacement in pediatric patients. They are available in supported (sBJV) and unsupported (uBJV) versions. The purpose of this study was to compare outcomes of sBJV and uBJV conduits. In this single-center retrospective review of patients younger than 18 years undergoing BJV placement (2009 to 2017), blinded cardiologists reviewed postoperative 6-, 12-, 24-, 36-month, and the most recent echocardiogram before any valve-related event or death. Outcomes assessed included conduit stenosis (m/s), regurgitation (none to mild vs moderate to severe) and right ventricular function (normal vs abnormal). Cox proportional models and Kaplan-Meier analyses were performed. BJV conduits (N= 109) were placed (39 supported, 70 unsupported) in 101 patients. Patient characteristics and conduit size were not different between cohorts. sBJV had more stenosis at 6 and 12 months (p= 0.02 and p= 0.03), but Vmax in both groups was mild (≤2 m/s). A greater proportion of uBJV had moderate to severe regurgitation at 12 months compared with sBJV (p= 0.03). Right ventricular function did not differ at any time point. On last follow-up echocardiogram, sBJV conduits had higher gradients (p= 0.01). This was not associated with increased intervention or replacement. Freedom from replacement or intervention did not differ between valve types (median follow-up, 3.6 years). There was a 9% incidence of endocarditis at median follow-up 2.4 years. Seventy percent of cases with endocarditis were managed medically. There were no clinically significant echocardiographic or outcome differences between sBJV and uBJV conduits. We identified a relatively high incidence of endocarditis, which is consistent with prior reports.

Subclinical thrombus formation in bioprosthetic pulmonary valve conduits

ObjectivesBioprosthetic pulmonary valve conduits have been reported with an increased risk of endocarditis. Thrombus formation is considered as source of these serious and life-threatening infections. We reviewed a series of explanted valved pulmonary conduits for histological evidence for thrombus formation. Materials and methodsExplanted bioprosthetic pulmonary valves were fixed in formalin and embedded in paraffin or in methylmethacrylate. Standard staining as well as immunohistochemical staining techniques were applied. Native pulmonary valves of German domestic pigs served as controls. Results47 valved pulmonary conduits (Hancock n = 23, Homograft n = 7, Contegra n = 7, Melody n = 7, other n = 3) were analyzed histologically. Average time of implantation had been 63 months (6 to 342 months). Indications for explantation included significant obstruction (n = 45), regurgitation (n = 7), and/or endocarditis (n = 6). In 44/47 (93%) specimen, we found accumulation of thrombotic material at the basis of the semilunar valve sinus to a variable degree. 11 patients had been treated with antiplatelet agents, 2 had received anticoagulants at the time of explantation. There was no suspicion of thrombus formation clinically or echocardiographically prior to explantation in any of the patients.Control porcine pulmonary valves (n = 5) did not show any evidence of accumulation of thrombotic material. ConclusionsIn a large series of explanted valved pulmonary conduits, formation of subclinical, mostly non-infectious thrombotic material was an almost ubiquitous finding. We speculate that high incidence of endocarditis in bioprosthetic valves may in part be explained by thrombus apposition at the basis of conduit valve sinus.

Iotrophia defectiva: A Rare Gut Pathogen Resulting Endocarditis in Inflammatory Bowel Disease

Abiotrophia defectiva (formerly referred to as nutritionally variant Streptococcus) is a normal flora of the human gastrointestinal tract. Abiotrophia defectiva is associated with high morbidity and mortality, yet timely diagnosis is challenging. Higher incidence of endocarditis was reported among patients with inflammatory bowel disease (IBD) from a retrospective study. We highlighted the diagnostic and management challenges of a case of rare subacute endocarditis by Abiotrophia defectiva in an IBD patient without predisposing valvular defect, prior central catheter insertion or intravenous drug abuse, suggesting gut translocation as a possible etiology of infective endocarditis among IBD patients. J Microbiol Infect Dis 2017; 7(4):217-219

Risk of Infective Endocarditis in Patients with End Stage Renal Disease.

Endocarditis is a serious complication in patients treated with RRT. The study aimed to examine incidence and risk factors of endocarditis in patients with ESRD. The Danish National Registry on Regular Dialysis and Transplantation contains data on all Danish patients receiving renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD. Incidence of endocarditis was estimated for each RRT modality. Independent risk factors of endocarditis were identified in multivariable Cox regression models. From January 1st, 1996 to December 31st, 2012, 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation). Endocarditis developed in 267 (2.5%); of these 31 (12%) underwent valve surgery. The overall incidence of endocarditis was 627 per 100,000 person-years in patients receiving RRT. Incidence was higher in patients receiving hemodialysis compared with those receiving peritoneal dialysis or kidney transplantation (1092 per 100,000 person-years, 212 per 100,000 person-years, and 85 per 100,000 person-years, respectively). Adjusted hazard ratios for endocarditis in patients receiving hemodialysis were 5.46 (95% confidence interval [95% CI], 3.28 to 9.10) and 0.41 (95% CI, 0.18 to 0.91) for kidney-transplanted recipients, respectively, as compared with patients in peritoneal dialysis. The incidence of endocarditis in hemodialysis recipients with central venous catheters was more than two-fold higher as compared with those with arteriovenous fistulas. Overall mortality, subsequent to endocarditis, was 22% in-hospital and 51% at 1 year. The first 6 months in RRT, aortic valve disease, and previous endocarditis were identified as significant risk factors of endocarditis. Patients receiving RRT have a high incidence of endocarditis, in particular during hemodialysis treatment using central venous catheters. The first 6 months in RRT, aortic valve disease, and previous endocarditis are significant risk factors for developing endocarditis.

Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures. A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015. Mean age was 62 ± 11 years in Group1and 64± 16 years in Group 2. Group 1 patients were in poorer health, with a lower ejection fraction and higher functional class. Early mortality was 3% in Group 1 and 2.5% in Group 2. Patients undergoing a modified Bentall procedure had a higher incidence of thromboembolism and hemorrhage, whereas those undergoing a David I procedure had a higher incidence of endocarditis. Actuarial survival was 70 ± 6% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. Actuarial freedom from reoperation was 97 ± 2% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. In Group 2, freedom from procedure-related reoperations was 98 ± 2% at 10 years. At last follow-up, no cases of moderate or severe aortic regurgitation were observed. The modified Bentall and David I procedures showed excellent early and late results. The modified Bentall procedure with a mechanical conduit was associated with thromboembolic and hemorrhagic complications, whereas the David I procedure was associated with unexplained occurrences of endocarditis. Thus, the David I procedure appears to be safe, reproducible, and capable of achieving stable aortic valve repair and is therefore our currently preferred solution for patients with annuloaortic ectasia. However, the much shorter follow-up for David I patients limits the strength of our comparison between the two techniques.

A Systematic Review of Infective Endocarditis in Patients With Bovine Jugular Vein Valves Compared With Other Valve Types

ObjectivesThe aim of this study was to systematically evaluate the incidence of infective endocarditis (IE) in right ventricle–to–pulmonary artery conduits and valves, comparing bovine jugular vein (BJV) valves with all others. BackgroundRecent evidence suggests that the incidence of IE is higher in patients with congenital heart disease who have undergone implantation of BJV valves in the pulmonary position compared with other valves. MethodsSystematic searches of published research were conducted using electronic databases (MEDLINE, Embase, and CINAHL) and citations cross-referenced current to April 2016. Included studies met the following criteria: patients had undergone right ventricle–to–pulmonary artery conduit or percutaneous pulmonary valve implantation, and investigators reported on the type of conduit or valve implanted, method of intervention (surgery or catheter based), IE incidence, and follow-up time. ResultsFifty studies (Levels of Evidence: 2 to 4) were identified involving 7,063 patients. The median cumulative incidence of IE was higher for BJV compared with other valves (5.4% vs. 1.2%; p < 0.0001) during a median follow-up period of 24.0 and 35.5 months, respectively (p = 0.03). For patients with BJV valves, the incidence of IE was not different between surgical and catheter-based valve implantation (p = 0.83). ConclusionsThere was a higher incidence of endocarditis with BJV valves than other types of right ventricle–to–pulmonary artery conduits. There was no difference in the incidence of endocarditis between catheter-based bovine valves and surgically implanted bovine valves, suggesting that the substrate for future infection is related to the tissue rather than the method of implantation.

Staphylococcus aureus bacteraemia associated with injected new psychoactive substances.

Injecting drug use is often associated with deep-seated infection. In Lothian in Scotland there has been a recent increase in the use of injected new psychoactive substances (NPS). Patients who have injected NPS have presented with Staphylococcus aureus bacteraemia (SAB) with life-threatening complications. We describe a unique case-series of 14 episodes of SAB in ten patients. Users of injected NPS had a significantly higher incidence of endocarditis and cavitating pulmonary lesions (P < 0·05) compared to those who inject only opiates. Cases of SAB in people who inject NPS have contributed to a significant rise in the overall incidence of SAB in people who inject drugs (P < 0·05) which has in turn impacted on the ability of Lothian to meet national targets for reducing the incidence of SAB.

Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation

To evaluate right-sided endocarditis and compare the incidence, clinical presentations, and outcomes in patients with a surgical and percutaneous pulmonary valve. All patients with infective endocarditis occurring between January 2009 and June 2013 were identified and studied. All consecutive patients who received a pulmonary valve surgically or by percutaneous pulmonary valve implantation (PPVI) during the same period were also evaluated for endocarditis. During the study period, 31 patients were identified with right-sided endocarditis: 13 had valves implanted during the study period and 18 before. The person-time incidence rates of endocarditis were 1.2 and 3.9 cases/100 person-years in the surgical and PPVI groups, respectively (P=.03). Clinical presentations, microbiology, and outcomes were comparable in both groups. The implantation-endocarditis time interval was much shorter in the patients in the PPVI group (P=.0065). A past history of endocarditis was found to correlate with endocarditis (P=.004). Infective endocarditis was more frequent in patients with bovine jugular vein valves compared with others (7.1% vs 0.84%, P=.0117; odds ratio, 9). Probability of survival at 12, 24, and 36 months was 99.5%, 93.8%, 93.8% in the surgical group and 98.9%, 96.8%, 92.3% in the PPVI group, respectively (P=.6). Event-free probability including endocarditis was comparable (P=.1). There is a higher incidence of endocarditis in patients with PPVI compared with surgical pulmonary valves. Clinical and biological features were comparable in both groups. The role of bovine jugular veins in the development of endocarditis is concerning. However, despite a higher incidence of endocarditis in the PPVI group, the probabilities of survival and event-free survival were similar to the surgical group.

Erysipelothrix bacteremia without endocarditis: rare event or under-reported occurrence?

A patient presented with inflamed hands and Erysipelothrix rhusiopathiae bacteremia. Because a high incidence of endocarditis has been reported with this organism, a transesophageal echocardiogram was obtained, which was normal. Treatment with oral moxifloxacin resolved all manifestations of illness. The association between E. rhusiopathiae bacteremia and endocarditis may be spurious.

Staphylococcus aureus bacteraemia: evaluation of the role of transoesophageal echocardiography in identifying clinically unsuspected endocarditis

Staphylococcus aureus bacteraemia (SAB) is an important cause of community and nosocomial sepsis, with a significant mortality rate. Infective endocarditis (IE) is a serious complication, occurring in up to 25% of cases. Transoesophageal echocardiography (TOE) significantly improves the sensitivity of diagnosis. We compared the sensitivity and specificity of clinical evaluation alone in diagnosing IE. We evaluated all adult patients with SAB at our centre from 1998 to 2006 in order to determine what proportion of clinically unsuspected cases were diagnosed with IE on TOE. IE was defined according to modified Duke criteria. The median age of the patients was 68years, 77% were male and the majority of cases did not have a known pre-existing condition. Twenty-onepercent were methicillin-resistant Staphylococcus aureus (MRSA). Intravascular device was the most common cause of bacteraemia. TOE was performed in 144 (100%) of the cases. IE was suspected clinically in 15% of cases, and the overall prevalence of possible or definite IE on TOE-inclusive Duke criteria was 29% (n = 41). Following TOE, 22 (15%) cases were reclassified as either possible or definite endocarditis. TOE detected a vegetation in 37 (90%) of the 41 cases of IE. Nineteen (46%) were not suspected clinically by Duke criteria. Sensitivity improved in the presence of pre-existing valve lesion or community acquisition. The overall in-hospital mortality was 10%. There is a high incidence of endocarditis in SAB and a large percentage of cases are not evident on clinical grounds. TOE evaluation is indicated for all medically suitable adult patients with SAB in order to improve the detection of endocarditis.

EXPERIMENTAL ENDOCARDITIS IN RABBITS.

In order to investigate the course of Serratia marcescens endocarditis in groups of rabbits with and without an indwelling catheter, 130 rabbits were pretreated to produce left-sided endocarditis. Three clinical isolates of S. marcescens were used to infect the rabbits, i.e. CDC O13 (serum sensitive, proteolytic), SM 104 (serum resistant, proteolytic) and SM 55 (highly serum resistant, non-proteolytic). Ten rabbits with an indwelling catheter were challenged with CDC O13 and none of them died or showed evidence of endocarditis 28 days later. In groups of rabbits with indwelling catheters which were challenged with SM 104 or SM 55 there was a high incidence of endocarditis (19/20, 18/20, respectively), while groups without catheters inoculated with the same strains had a lower incidence (5/20, 15/20, respectively). In contrast to earlier observations with Streptococcus faecalis, the clinical and pathological data were not significantly influenced by the presence or absence of proteolytic capacity of the infecting strains. The results indicate that the ability of S. marcescens to establish endocarditis depends significantly on the degree of serum resistance of the strains. This difference was only demonstrable in experiments without an indwelling catheter during the infection period. The distrurbing influence of an indwelling catheter is discussed, and it is concluded that experimental models using indwelling catheters are inappropriate for studies on the pathophysiology of endocarditis.

Changing patterns of Staphylococcus aureus bacteremia.

Medical records of 134 patients with Staphylococcus aureus bacteremia at the Cincinnati General Hospital during 1975-1977 were reviewed. Bacteremia was community-acquired in 48 patients and hospital-acquired in 73 patients. In addition, 13 patients were on chronic hemodialysis. In 22 patients, bacteremia was associated with an infected intravenous catheter; all except one of these patients acquired the infection in the hospital. Thus 21 of 73 (29%) episodes of hospital-acquired S aureus bacteremia were associated with an infected intravenous catheter. Four of the 22 patients with intravenous catheter-associated bacteremia had endocarditis (18%). The overall incidence of endocarditis in this study was 16% (21 of 134 patients). This contrasted with the much higher incidence of endocarditis (64%) in Staphylococcal bacteremia reported from this same hospital in patients during 1940-1954. Possible reasons for this difference are discussed.