Infective Endocarditis In Adults Research Articles

312 Infective endocarditis in adults with congenital heart disease

The aim of this retrospective study was to describe features ofinfective endocarditis (IE) in adults with congenital heart disease (CHD). The records of all episodes of IE diagnosed from 1974, in patients with CHD and more than 18 years of age at diagnosis, were retrospectively reviewed. Fourty-four episodes of IE occurred, 36 after 1990 (81.8%), 28 males (63.6%). Age at diagnosis was 30.3±9years (median 28years). Ten were recurrent episodes (22.7%). CHD was previously repared in 15 cases (34%), palliated in 7 (16%) and non-operated in 22 (50%). Dental causes were predominant (34%), followed by cutaneous causes (25%) ; others were postoperative (4.5%), miscellaneous (7%) or unknown causes (29.5%). A microbial agent as identified in 95.4% of the cases : oral streptococcus and staphylococcus aureus were the leading causative agents (respectively 41% and 36%). Left heart locations were predominant (75%). Severe clinical cardiac complication occurred in 10 cases (23%), an echocardiographic complication in 18 (40%). Twenty-four patients experienced embolic events (54.5%) ; early surgical treatment was required in 25% of the cases. Three patients died due to IE (6.8%). Antibiotic prophylaxis had been neglicted despite known risk in 41% of the cases. IE is an ongoing life-threatening complication in adults with CHD, with a significant morbidity, a high rate of prophylaxis negligence and of recurrence.

Epidemiologic Features of Infective Endocarditis in Taiwanese Adults Involving Native Valves

Little is known about the incidence and clinical outcomes of infective endocarditis (IE) involving native valves in Asian countries. This nationwide study investigated epidemiologic features and in-hospital mortality associated with IE in adults (age > or =18 years) based on Taiwan's National Health Insurance database from 1997 through 2002. Of 7,240 enrolled patients with IE involving native valves, the mean age was 53 +/- 19 years and 70% were men. The mean annual crude incidence was 7.6 per 100,000 inhabitants. The incidence was significantly higher in men than in women (10.4 vs 4.6 per 100,000; p <0.001). The incidence of IE increased steadily with age, ranging from 3.8 per 100,000 persons in patients <30 years of age to 33 per 100,000 persons in patients > or =80 years of age (p <0.001). Staphylococcal (32%) and streptococcal species (61%) were the most common causative pathogens. The mean in-hospital mortality rate was 18%. Multivariate analysis showed that male gender, older age (> or =50 years), diabetes mellitus, heart failure, neurologic complications, renal insufficiency, respiratory failure, shock, and Staphylococcus species as the causative microorganism were independent predictors of in-hospital mortality. In conclusion, this Taiwanese study revealed a high incidence of IE in men and elderly subjects. The in-hospital mortality rate remained high. Patients with IE who also developed shock and respiratory failure were the most likely to have a poor outcome.

Prophylaxis and treatment of infective endocarditis in adults: a concise guide

Infective endocarditis (IE) is a life-threatening disease with substantial morbidity and mortality which affects individuals with underlying structural cardiac defects who develop bacteraemia, often as a result of dental, gastrointestinal, genitourinary, respiratory or cardiac invasive/surgical procedures. Prompt recognition of the clinical diagnosis by a wide variety of medical personnel, early involvement of specialist cardiologists, cardiac surgeon and a microbiologist, and prompt treatment with the most appropriate antimicrobial agents offer the greatest chance of improving the outcome for these patients. The guidance given here to clinicians involved in the management of patients with IE briefly covers diagnosis, antibiotic prophylaxis, medical treatment and the indications for surgery.

Azithromycin and dentistry - a useful agent?

Azithromycin has recently replaced clindamycin oral suspension for prop hylaxis of infective endocarditis (IE) in children. It is also currently recommended by the American Heart Association as an alternative to penicillin, along with clindamycin for prophylaxis of infective endocarditis in adults. The objectives of this paper were to firstly, review the current literature on the efficacy of azithromycin as a suitable prophylactic agent in the prevention of infective endocarditis; and secondly, to review its pharmacological properties as a suitable therapeutic agent in the management of odontogenic infections. A review of the literature. The available evidence from animal models on infective endocarditis supports the efficacy of this drug as a prophylactic agent against oral streptococci. The pharmacological properties of this agent would make it a very promising therapeutic adjunct in the management of odontogenic infections. At present there are only a small number of studies available with valuable data on the efficacy of this relatively new drug. Further investigations comparing this compound with other commonly used adjuncts would be of great benefit.

Azithromycin — an alternative to penicillin?

Objectives Azithromycin has recently replaced clindamycin oral suspension for prophylaxis of infective endocarditis (IE) in children. It is also currently recommended by the American Heart Association as an alternative to penicillin, along with clindamycin for prophylaxis of infective endocarditis in adults. The objectives of this paper were to firstly, review the current literature on the efficacy of azithromycin as a suitable prophylactic agent in the prevention of infective endocarditis; and secondly, to review its pharmacological properties as a suitable therapeutic agent in the management of odontogenic infections. Design A review of the literature. Conclusions The available evidence from animal models on infective endocarditis supports the efficacy of this drug as a prophylactic agent against oral streptococci. The pharmacological properties of this agent would make it a very promising therapeutic adjunct in the management of odontogenic infections. At present there are only a small number of studies available with valuable data on the efficacy of this relatively new drug. Further investigations comparing this compound with other commonly used adjuncts would be of great benefit.

Infective Endocarditis in Adults with Congenital Heart Disease.

Although modern medicine has improved survival in congenital heart disease dramatically, the long-term course carries a risk of late complications. The incidence of infective endocarditis in adults with congenital heart disease is more than 10 times higher than that of the normal population. Identification of the high-risk groups, a high diagnostic alert, and no random prescription of antibiotics to these patients are important issues to health care providers. There is also a need for a structured education of patients on preventive measures and symptoms of infective endocarditis.

A clinical study of culture-negative endocarditis.

Culture-negative infective endocarditis (CNE) is a diagnostic problem in spite of improved echocardiographic and blood culturing techniques. We conducted the present study to estimate the proportion of CNE in patients with infective endocarditis, to investigate data regarding risk factors, and to evaluate the Duke and the modified Beth Israel criteria in patients with CNE. We evaluated 820 consecutive suspected episodes of infective endocarditis in adults at the Departments of Infectious Diseases in Göteborg and Borås, Sweden (1984-1996). All patients were diagnosed and treated according to a protocol; 487 episodes were identified as infective endocarditis. Episodes with absence of bacterial growth at blood culture were defined as CNE and were classified with the Duke and the modified Beth Israel criteria. We identified 116 CNE episodes (median age, 67 yr). Mortality was 7%, and in 15%, cardiac surgery was performed. The Duke criteria classified 20 definite, 80 possible, and 16 reject episodes. The modified Beth Israel criteria distinguished 13 definite, 15 probable, 27 possible, and 61 reject episodes. The proportion of CNE among patients with infective endocarditis varied from 19% to 27% at the 2 departments. Antibiotic treatment preceded blood culture in 45% of the CNE episodes. About 20% in a Scandinavian population of infective endocarditis patients have CNE. Antibiotic pretreatment explains less than 50% of all CNE episodes. The Duke criteria are more sensitive but less specific than the modified Beth Israel criteria in classifying patients with CNE.

Risk Factors for Infective Endocarditis

Letters20 July 1999Risk Factors for Infective EndocarditisBrian L. Strom, MD, MPH, Judith L. Kinman, MA, and Elias Abrutyn, MDBrian L. Strom, MD, MPHUniversity of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Strom)University of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Kinman)MCP Hahnemann University; Philadelphia, PA 19102-1192 (Abrutyn)Search for more papers by this author, Judith L. Kinman, MAUniversity of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Strom)University of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Kinman)MCP Hahnemann University; Philadelphia, PA 19102-1192 (Abrutyn)Search for more papers by this author, and Elias Abrutyn, MDUniversity of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Strom)University of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Kinman)MCP Hahnemann University; Philadelphia, PA 19102-1192 (Abrutyn)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-2-199907200-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:In response to Dr. Jacobson's letter, although 27 participants did receive antibiotic prophylaxis, they constituted only 21% of the 127 participants who had dental treatment in the 3-month period. More important, among those with indications for antibiotics (that is, patients with previously known cardiac valve abnormalities undergoing dental work), only 17 of 29 (59%) case-patients with dental treatment received antibiotic prophylaxis, compared with 3 (50%) of 6 controls (P = 1.0). In fact, the unadjusted odds ratio for the association between dental therapy and infective endocarditis was 0.5 (95% CI, 0.01 to 9.6) among those with antibiotic prophylaxis, compared with ...Reference1. Lacassin F, Hoen B, Leport C, Selton-Suty C, Delahaye F, Goulet V, et al . Procedures associated with infective endocarditis in adults. A case control study. Eur Heart J. 1995;16:1968-74. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Brian L. Strom, MD, MPH; Judith L. Kinman, MA; Elias Abrutyn, MDAffiliations: University of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Strom)University of Pennsylvania School of Medicine; Philadelphia, PA 19104-6021 (Kinman)MCP Hahnemann University; Philadelphia, PA 19102-1192 (Abrutyn) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDental and Cardiac Risk Factors for Infective Endocarditis: A Population-Based, Case-Control Study Brian L. Strom , Elias Abrutyn , Jesse A. Berlin , Judith L. Kinman , Roy S. Feldman , Paul D. Stolley , Matthew E. Levison , Oksana M. Korzeniowski , and Donald Kaye Risk Factors for Infective Endocarditis Michael Jacobson Risk Factors for Infective Endocarditis R. Paul Adams Risk Factors for Infective Endocarditis Peter Collignon Metrics 20 July 1999Volume 131, Issue 2Page: 155KeywordsAntibiotic prophylaxisEndocarditisMedical risk factorsMitral valve prolapseOdds ratioPrevention, policy, and public healthProphylaxis ePublished: 15 August 2000 Issue Published: 20 July 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

C-Reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis

The objective of this study was to evaluate the sensitivity of C-reactive protein (CRP) elevation compared to erythrocyte sedimentation rate (ESR), leucocyte count and thrombocyte count in the diagnosis of infective endocarditis (IE). It was designed as a prospective study of suspected episodes of IE in adults in tertiary care at a university-affiliated department of infectious diseases. In 89 episodes of IE, CRP was available from the start of treatment. Median age was 66 years, 45 were men and 44 women. Median CRP concentration was found to be 90 (range 0-357) mg/l with only 4% normal values. Episodes involving native valves had higher CRP than episodes occurring with prosthetic valves. Staphylococcal origin, short duration of symptoms, short duration of fever and highest recorded temperature all correlated to higher CRP levels. The CRP response was also prominent among patients > 70 years old. Among non-responders, a few cases with simultaneous cirrhosis were noted. ESR was less sensitive than CRP, with a normal level in 28% of the episodes. It was concluded that CRP determination is superior to erythrocyte sedimentation rate, leucocyte count and thrombocyte count in the diagnosis of infective endocarditis.

Infective endocarditis: review of 135 cases over 9 years.

One hundred thirty-five cases of infective endocarditis in adults at the University of Alberta Hospital from 1985 to 1993 were reviewed and the von Reyn and Duke criteria were compared. There were 80 cases of native valve endocarditis, 15 cases of endocarditis in intravenous drug users, 7 cases of early prosthetic valve endocarditis, and 33 cases of late prosthetic valve endocarditis. Valve replacement or repair was performed in 33% of all cases. The overall mortality was 19%. The mortality among patients treated surgically was significantly lower than that among those treated medically (9% vs. 24%, respectively; P = .037). However, when patients who were too medically unstable for surgery or who refused surgery were excluded, the mortality among the medically treated group decreased to 15%, which was not significantly different from that among the surgically treated group. The 33 patients transferred from other hospitals were infected with similar pathogens; however, the rate of surgical intervention among these patients was much higher than that among other patients (64% vs. 24%, respectively; P < .0001), and the mortality was slightly lower (12.1% vs. 21.6%, respectively; P = .31). The 54 surgical and autopsy-proven cases were classified by the von Reyn and the Duke criteria without knowledge of the operative and autopsy results: 15% of these cases were rejected by the von Reyn criteria, and none were rejected by the Duke criteria.

Tricuspid Valve Aneursym Formation in a Child with Suspected Endocarditis

Aneurysms of the aortic and mitral valve are a known complication of infective endocarditis in adults. We report an unusual case of tricuspid valve endocarditis in a child with resultant aneurysm formation as its presenting finding after a brief clinical course. (ECHOCARDIOGRAPHY, Volume 13, January 1996)

Procedures associated with infective endocarditis in adults

To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study. Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models. Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule. Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6; 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7; 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant. Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis,it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.

Native valve infective endocarditis in adults. Analysis of 32 consecutive cases over a ten-year period from 1980 to 1989.

Thirty-two patients with native valve infective endocarditis who presented over a 10-year period at our hospital were analyzed retrospectively. The presenting symptom was a persistent fever in 22 patients. In 30 patients, the New York Heart Association functional class was less than II before the development of endocarditis. Blood cultures were positive on all occasions in 24 out of 29 culture-positive patients. All of the viridans streptococci, accounting for 79% of the isolated pathogens, were highly susceptible to ampicillin. Treatment consisted of a 6 week course of antibiotics, usually ampicillin, at a dose of 12 grams/day. In 9 cases, we had to change or stop the antibiotics because of severe side effects. The longer the period before making a diagnosis, the more severe were the symptoms of congestive heart failure and the more frequent was the incidence of cerebral hemorrhage. To initiate treatment as early as possible, in order to minimize valve destruction and to reduce the risk of cerebral hemorrhage, serial blood cultures are recommended in patients with valvular heart disease or congenital heart disease and a persistent fever, with minimal cardiac symptoms.

Infective endocarditis in adults

Infective endocarditis in adults

Infective endocarditis in adults in Glasgow, 1976-81

Seventy-one cases of endocarditis in adults, defined on strict clinical criteria over a period of 5 years were studied. The demographic profile was similar to other published studies except that no bimodal peak in age distribution was detected. The major presenting features were infection, cardiac failure and embolism. Rheumatic valvular disease (44%) was the most common predisposing condition. Twenty percent of our patients developed endocarditis on an apparently normal valve and 28% presented with prosthetic valve infection. M-mode echocardiography was carried out in only 44% of cases and with a low rate of detection of vegetations. Streptococcus viridans was the most common causal organism. The mortality for the total series (45%) was considerably greater than that in other recent reports. Our study confirmed that failure to show early response to appropriate antimicrobial therapy was an indication to consider immediate valve replacement.