Onset Of Infective Endocarditis Research Articles

Surgical repair of tetralogy of Fallot in a 78-year-old woman: a case report

BackgroundTetralogy of Fallot is a congenital heart disease mostly diagnosed and treated in early childhood. However, there are some adult cases receiving treatment.Case presentationWe describe a 78-year-old Japanese woman who presented with severely hypertrophic right ventricle, ventricular septum defect, overriding aorta, and severe infundibular stenosis in the right ventricular outflow tract. As hypoxemia was mild and daily exertion was sufficiently possible, home oxygen therapy was introduced. After 1 month, she was referred because of a positive blood culture. The blood culture test was positive four times, therefore, the antibacterial drug was administered according to active infective endocarditis. SpO2 repeatedly decreased during hospitalization, thus oxygen was needed. As there were infective endocarditis onset and progressive hypoxemia, we planned a surgical correction.ConclusionTetralogy of Fallot was diagnosed and successfully treated with complete surgical correction, and the development of infective endocarditis was the definitive indication for surgery at this late age.

Evaluation of epidemiological and microbiological characteristics, clinical features, and outcomes of adult patients with infective endocarditis in Mashhad, Iran.

Infective endocarditis (IE) is a serious problem with high morbidity and mortality. However, there is a paucity of data regarding its epidemiology in non-high-income settings. Here, we described the characteristics of patients with IE. Between March 2012 to March 2020, all adults (≥ 16 years) with a diagnosis of IE who were admitted to a university hospital in Mashhad, Iran, were included in the study. We evaluated 46 cases of IE with a median age of 42 years (interquartile range 31 to 58.3 years), of whom 21 (46%) had a definite diagnosis. The presence of a prosthetic valve or intracardiac device was the leading predisposing factor (N = 14, 30%). The etiology of IE in 22 subjects (48%) remained unknown. Staphylococcus aureus (N = 12, 26%) was the most common causative pathogen. Echocardiography revealed the mitral valve as the most affected valve (N = 18, 39%). Intravenous drug users (IVDU) had a higher chance of right-sided IE, as compared to no IVDU patients (odds ratio: 35, 95% CI: 3.7 to 425.0). The most prevalent complications were lung infarction, acute heart failure, and neurologic involvement (N = 5, 11% for each), and 15 patients (33%) died because of IE. In our study, the median age of IE onset was relatively low. The most frequent predisposing factor was a prosthetic valve or intracardiac device. The proportion of negative blood cultures was unacceptably high. Thus, our findings emphasize promoting laboratory infrastructure, developing a national protocol for early initiation of appropriate treatment, and eliminating predisposing factors.

High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers.

Kidney transplant recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation, and outcome. While infective endocarditis (IE) is among such complications in KTRs, the literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria) in adult KTRs from January 2010 to December 2018 were included, as well as two controls per case, and followed until 31 December 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan–Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus, and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated, age, vascular nephropathy, and elevated calcineurin inhibitor through levels were significantly associated with the occurrence of IE in our study. Patient and death-censored graft survival were greatly diminished five years after IE, compared to controls being 50.3% vs. 80.6% (p < 0.003) and 29.7% vs. 87.5% (p < 0.002), respectively. IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant.

Implications of Infective Endocarditis by Probiotic Microorganisms: A Systematic Review of Case Reports

ObjectivesRecent growth in the commercial use of probiotic supplementation has led to an increased demand for investigation behind complications secondary to probiotic use. Of note, there is a vast amount of literature documenting a relationship between onset of infective endocarditis and probiotic supplementation, but the symptomology and treatment interventions can vary. The purpose of this study is to perform a review of recently reported cases of infective endocarditis secondary to probiotic microorganisms for epidemiology and treatment interventions. MethodsA systematic review of literature was performed on MEDLINE for infective endocarditis secondary to probiotic microorganism case studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Statistical significance was set at P < 0.05. ResultsEach case was reviewed for the inclusion criteria, which were the following: English language, case reports, full-text, publication within 6 years, pertained to probiotic-related endocarditis, and peer-reviewed. To further ensure that all appropriate studies were identified, the reference list of each identified study was also reviewed, and no further articles met the inclusion criteria. The final analysis included in the qualitative synthesis was 6 patients. Patient cases of infective endocarditis were between 2018 to 2020. Among the adult cohort, the average age of patients was 53.2 ± 17. The most prevalent bacterial culture among the adult cohort was Lactobacillus rhamnoses (80%). The onset of patient symptoms ranged among the adult cohort between 6 months to <1 month. Past medical histories were significant for various comorbidities unique to each patient including diabetes and heritable genetic mutations. Among the patients which underwent aortic valve replacement, there was variable improvement in ejection fraction. ConclusionsHealthcare providers ought to be aware to screen for Lactobacillus rhamnoses as a common pathogen of probiotic infective endocarditis. This study has inconclusive evidence to suggest that decreased ejection fraction in probiotic infective endocarditis is different from other primary causes. Funding SourcesNo funding to disclose. This study was supported by the QUICK Research Institute (Kansas City, MO).

Clinical analysis of Staphylococcus aureus infective endocarditis in children

Objective To describe the clinical characteristics, treatment and outcomes of Staphylococcus aureus infective endocarditis (SAIE) in children. Methods One hundred and fifty-one children with infective endocarditis (IE) and treated in Shanghai Children′s Medical Center of Shanghai Jiaotong University School of Medicine were retrospectively analyzed, from January 2007 to December 2017.There were 88 boys and 63 girls, the age of IE onset ranged from 1 month to 17 years [(6.27±4.80) years]. There were 23 cases (15.2%) with infection of staphyloco-ccus aureus, 128 cases with non-Staphylococcus aureus infective endocarditis (NSAIE). The clinical characteristics, treatment and prognosis of patients between the SAIE group and the NSAIE group were analyzed and compared. Results Among the SAIE group, there were 15 boys and 8 girls, the age of IE onset ranged from 3 months to 16 years [(6.2±5.6) years]; 10 cases of them had no underlying heart disease.There was no significant difference in gender, age and previous cardiac surgery between the SAIE group and the NSAIE group (all P>0.05). The number of patients without underlying heart disease in the SAIE group was more than that in the NSAIE group, and the difference was statistically significant[43.5%(10/23 cases) vs.20.3%(26/128 cases), χ2=5.762, P=0.016]. Compared with the NSAIE group, the SAIE group was associated with significantly higher levels of C-reactive protein [60.0(128.0) mg/L vs.25.0(58.0) mg/L, Z=-2.033, P=0.042], higher erythrocyte sedimentation rate [(59.3±43.2) mm/h vs.(39.4±31.5) mm/h, t=-2.283, P=0.024], and lower levels of serum albumin [30.1(12.7) g/L vs.34.3(8.4) g/L, Z=-2.282, P=0.022]. The proportion of severe sepsis in the SAIE group was also significantly higher than that in the NSAIE group [21.7%(5/23 cases) vs.7.0%(9/128 cases), Z=5.014, P=0.045]. Twelve cases (52.2%) of the SAIE group had systemic embolic events, including cerebral events (6 cases), pulmonary (2 cases), limbs (1 case), splenic (1 case), limbs and mesenteric (1 case), limbs and cerebral events (1 case). Eighteen cases in the SAIE group were treated with antibiotics combined with surgery and 1 case died, while 5 cases were treated with antibiotics alone, 4 cases died and 1 case abandoned.The SAIE patients had a significantly higher systemic embolic rate [52.2%(12/23 cases) vs.20.3%(26/128 cases), χ2=7.978, P=0.016], neurological events rate [30.4%(7/23 cases) vs.10.9%(14/128 cases), χ2=4.669, P=0.031] and in-hospital mortality [21.7%(5/23 cases) vs.6.3%(8/128 cases), χ2=4.139, P=0.042] than those in the NSAIE group. Conclusions SAIE was most common in those without heart disease.Compared with NSAIE, SAIE is characterized by a higher prevalence of severe sepsis, major neurological events, and inpatient mortality.Timely surgery is recommended in these cases, when possible, before the occurrence of complications. Key words: Infective endocarditis; Staphylococcus aureus; Child

National Temporal Trend Analysis of Infective Endocarditis among Patients Infected with HIV in Spain (1997-2014): A Retrospective Study.

Background: People living with human immunodeficiency virus (HIV) (PLWH) form a vulnerable population for the onset of infective endocarditis (IE). We aimed to analyze the epidemiological trend of IE, as well as its microbiological characteristics, in PLWH during the combined antiretroviral therapy era in Spain. Methods: We performed a retrospective study (1997–2014) in PLWH with data obtained from the Spanish Minimum Basic Data Set. We selected 1800 hospital admissions with an IE diagnosis, which corresponded to 1439 patients. Results: We found significant downward trends in the periods 1997–1999 and 2008–2014 in the rate of hospital admissions with an IE diagnosis (from 21.8 to 3.8 events per 10,000 patients/year; p < 0.001), IE incidence (from 18.2 to 2.9 events per 10,000 patients/year; p < 0.001), and IE mortality (from 23.9 to 5.5 deaths per 100,000 patient-years; p < 0.001). The most frequent microorganisms involved were staphylococci (50%; 42.7% Staphylococcus aureus and 7.3% coagulase-negative staphylococci (CoNS)), followed by streptococci (9.3%), Gram-negative bacilli (8.3%), enterococci (3%), and fungus (1.4%). During the study period, we found a downward trend in the rates of CoNS (p < 0.001) and an upward trends in streptococci (p = 0.001), Gram-negative bacilli (p < 0.001), enterococci (p = 0.003), and fungus (p < 0.001) related to IE, mainly in 2008–2014. The rate of community-acquired IE showed a significant upward trend (p = 0.001), while the rate of health care-associated IE showed a significant downward trend (p < 0.001). Conclusions: The rates of hospital admissions, incidence, and mortality related to IE diagnosis in PLWH in Spain decreased from 1997 to 2014, while other changes in clinical characteristics, mode of acquisition, and pathogens occurred over this time.

Report of Two Cases of Colon Cancer Diagnosed after Onset of Infective Endocarditis

Report of Two Cases of Colon Cancer Diagnosed after Onset of Infective Endocarditis

Current knowledge among pediatric dentistry specialists in Japan regarding prevention of infective endocarditis

Infective endocarditis (IE) is a life-threatening disease, with dental procedures known to produce bacteremia considered to be major factors in its development. Thus, prevention of IE onset with antibiotics given prior to performing dental treatments is widely recommended. However, few studies have been conducted to determine the general knowledge of pediatric dentists regarding IE prevention. Members of the Japanese Society of Pediatric Dentistry were invited to participate in a survey in order to elucidate common knowledge among pediatric dentists for prevention of IE. A total of 118 answered the questionnaire, most of whom had experience with prescribing antibiotics for IE prevention. Approximately 80% of those answered that they administer antibiotics only to patients at high risk for IE, though they also noted difficulties understanding which heart diseases are defined as high risk for the disease. As for dental procedures associated with an increased risk for IE, most of the respondents answered dental treatments conducted as surgical procedures, while less invasive procedures were thought to be low risk for IE. More than 80% of the queried pediatric dentists selected oral amoxicillin at a dose of 50 mg/kg of body weight for child patients. Among those, over 50% prescribed antibiotics only prior to performing dental treatment. We found that pediatric dentists in Japan tend to prescribe antibiotics in accordance with the guidelines, though they expressed difficulty with understanding which heart diseases are at high risk of IE, likely due to lack of training in cardiology.

Neurologic Complications of Infective Endocarditis: Recent Findings.

The purpose of this paper is to provide recent insights in management of neurologic complications of left-sided infective endocarditis (IE). Cerebral lesions observed in IE patients are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis, and small-vessel cerebral vasculitis. Brain MRI represents a major tool for the detection of asymptomatic events occurring in the majority of patients. The latter can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, surgery could be safely performed earlier than previously thought. Symptomatic cerebral ischemic or hemorrhagic events occur in 20-55% of IE patients, whereas asymptomatic events are detected in 60-80% of patients undergoing systematic brain MRI. Management of such patients requires an experienced multidisciplinary team. Recent studies suggest that early cardiac surgery, when indicated, can be performed safely in patients with cerebral ischemic events. Other important issues include the appropriate use of anti-infective and anti-thrombotic agents, and endovascular treatment for mycotic aneurysms. Altered mental status at IE onset, which is associated with brain injury, is a major determinant of short-term outcome.

Treatment of infective endocarditis in 29 children with Linezolid

Objective To explore the effectiveness and safety of Linezolid (LIZ) in treating children with infective endocarditis (IE). Methods The clinical data of 112 children with IE and treated in the Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from August 2008 to September 2015 were retrospectively analyzed.There were 64 boys and 48 girls, and the age of IE onset ranged from 1 month to 17 years [(6.0±4.8) years]. Twenty-nine patients received LIZ treatment >7 days (LIZ treatment group), including 21 males and 8 females, and the age ranged from 5 months to 15 years [(6.9±5.2) years]. The remaining 83 patients were identified without LIZ treatment(non-LIZ treatment group), including 43 boys and 40 girls, and the age ranged from 1 month to 17 years [(5.7±4.7) years]. The etiological results, curative effect and adverse reactions of the LIZ treatment group were observed. Results Among the LIZ treatment group, 22 cases had congenital heart disease and 1 case had intravenous catheter.There were 10 cases with infection of staphylococcus aureus, 6 cases with coagulase negative staphylococcus, 5 cases with oral streptococci and Streptococcus bovis group, 3 cases with streptococcus pneumonia, 2 cases with enterococcus faecium and 3 cases with negative blood culture results.All cases of the LIZ treatment group received Vancomycin therapy at first, LIZ was given when the Vancomycin therapy failed(16 cases with temperature reiteration, 1 case inadequate microbiological response), Vancomycin intolerance (6 neutropenia, 2 renal toxicity, 2 allergy), and oral maintenance therapy (2 cases). The duration of LIZ treatment ranged from 9 to 135 days [(39.2±27.2) days]. Three patients (10.3%) had adverse effects during LIZ treatment, 1 case with severe digestive symptoms after treatment, 1 case with teeth discoloration, 1 case with the indicators decreasing by 2 routine blood test.Meanwhile, 16 cases of 85 patients (18.8%) had side effects during Vancomycin treatment, in which 7 cases with neutropenia, 6 cases with rash and 3 cases with renal insufficiency.But there were no significant differences in adverse effects between LIZ and Vancomycin treatment (χ2=1.119, P>0.05). Twenty-five cases were cured (86.2%) and 2 cases dead (6.9%) in the LIZ treatment group.And no significant difference was found in cure rate, or mortality between LIZ treatment group and non-LIZ treatment group (86.2% vs.77.1%, χ2=1.090; 6.9% vs.8.4%, χ2=0.069, all P>0.05) at 6 to 84(23.9±19.1) months follow-ups. Conclusions LIZ can be used to deal with Vancomycin failure and IE caused by gram positive coccus.LIZ was generally well tolerated in patients with IE.It may be useful in cases of IE complicated by brain abscesses for the good distribution.It is 100% orally bioavailable, allowing oral administration for outpatients. Key words: Linezolid; Infective endocarditis; Vancomycin; Multi-drug resistant bacteria; Child

The onset of infectious endocarditis with neurological symptoms

Despite the well known clinical and laboratory signs of infectious endocarditis, it remains one of the most difficult conditions in terms of diagnostics. A cause of its late diagnostics is polymorphism of the clinical picture accompanied, especially at early stages, by clinical “masks” (cardiac, pulmonary, renal, cerebral, etc.). We report a case of atypical onset of the disease with multiple thromboembolism of cerebral arteries, minimal clinical manifestations, and rapid destruction of the mitral valve that required surgical intervention.

The increasing incidence of infective endocarditis in Denmark, 1994–2011

BackgroundLittle updated population-based evidence exists of temporal trends in infective endocarditis (IE). MethodsFor the 1994–2011 period, we used Danish nationwide registries to identify cases with first-time IE and to estimate the population size. We calculated the incidence rate of IE in 3-year intervals. To evaluate time trends in incidence, we used the 1994–1996 period as reference and computed incidence ratios and 95% confidence intervals (CI) as the incidence in each of the subsequent 3-year intervals divided by the incidence in the reference period. ResultsWe identified 5486 incident IE patients (65% men) and the mean age at diagnosis was 63years. Men tended to be younger at diagnosis than women; 62years vs. 65years. Mean age at IE diagnosis steadily increased from 57years in 1994–1996 to 65years in 2009–2011. The IE incidence rate increased from 3.93 per 100,000 person-years in 1994–1996 to 7.55 per 100,000 person-years in 2009–2011, corresponding to an incidence ratio of 1.92 (95% CI: 1.74–2.12). The increase in incidence over time was more pronounced in men (2.28, 95% CI: 2.02–2.59) than in women (1.39, 95% CI: 1.18–1.64). We observed no increase in incidence over time for subjects younger than 50years, whereas the incidence increased substantially over time for elderly patients, with the highest incidence ratio of 3.38 (95% CI: 2.55–4.52) for patients more than 80years at IE onset. ConclusionThe incidence of IE increased over time particularly among men and for the older age groups.

The role of hemostasis in infective endocarditis.

Infective endocarditis (IE) is a thromboinflammatory disease of the endocardium, with pathophysiology mostly the result of the interplay between microorganisms and modifiers of the hemostasis system. In this setting, the evidence gathered so far warrants a more systematic appraisal. In this review article, experimental and clinical data on the role of hemostasis in IE are summarized. Starting from the current pathogenetic model of IE, we discuss the dual role of platelets in this condition, the microbial interaction with the hemostasis system, also describing nonspecific hemostasis changes during sepsis. We finally propose our hypothesis of thrombophilia as a possible trigger of IE, highlighting the challenges that the study of hemostasis in IE presents. The role of hemostasis in IE appears to be an exciting field of research. The activity of the hemostasis system is highly relevant in terms of susceptibility, progression, and treatment of IE. Pharmacologic modulation of hemostasis before and after IE onset is possible and represents still a largely unexplored area of study.

Implication of the oral bacteria on the onset of infective endocarditis

Implication of the oral bacteria on the onset of infective endocarditis

Device-related infective endocarditis, with special consideration of implanted intravascular and cardiac devices in a predominantly male population

The relationship between invasive medical devices and infective endocarditis (IE) has not been comprehensively assessed. We describe our experience of patients with IE, with particular attention to the role of pre-existing intravascular catheters and implanted cardiac devices in the pathogenesis. We performed a retrospective review of hospital records over a 10-y period (1997-2007), and included patients with 'definite' or 'possible' IE as per the modified Duke criteria. The complete electronic medical record was reviewed for the presence of intravascular devices prior to the onset of IE, including intravascular catheters and implanted cardiac devices (defibrillators and pacemakers). We identified 155 patients with IE. Infection involved a native valve in 124 (80%) patients and a prosthetic valve in 15 (9.7%). In the remaining 16 (10.3%) patients, infection was attributed to an implanted cardiac device. The most commonly identified source of infection was a central venous catheter, accounting for 17.4% of patients, followed by an implanted cardiac device in 10.3% of patients. Staphylococcus aureus was the most commonly isolated organism in catheter-associated IE and cardiac device-associated IE (31.9% and 62.5%, respectively). Thirty-five (22.5%) patients died within 90 days. Mortality was 31.9% in patients with IE caused by methicillin-resistant S. aureus (MRSA). Intravascular catheters and cardiac implantable devices are common sources of infection leading to IE, and the intracardiac devices themselves often become infected, with MRSA as the predominant pathogen.

Identification and characterization of a collagen‐binding protein, Cbm, in Streptococcus mutans

Streptococcus mutans, a major pathogen of dental caries, is occasionally isolated from the blood of patients with infective endocarditis. Bacterial attachment of exposed collagen tissue in the impaired endothelium is an important step in the onset of infective endocarditis. In our previous studies, some S. mutans strains were shown to possess collagen-binding activities and most of them had an approximately 120-kDa cell-surface collagen-binding protein called Cnm. However, several strains without Cnm proteins show collagen-binding properties. In the present study, another collagen-binding protein, Cbm, was characterized and its coding gene cbm was sequenced in these strains. The amino acid alignment in the putative collagen-binding domain of Cbm was shown to have approximately 80% identity and 90% similarity to the comparable region of Cnm. Cbm-deficient isogenic mutant strains constructed by insertional inactivation of the cbm gene, lacked collagen-binding properties, which were recovered in the complemented mutant. Analyses of a large number of clinical isolates from Japan, Thailand and Finland revealed that cbm-positive strains were present in all of these countries and that cnm-positive and cbm-positive strains were detected in the oral cavity of approximately 10 and 2% of systemically healthy subjects, respectively. In addition, cnm-positive strains were predominantly identified in the serotype f group, whereas cbm-positive strains were frequently detected in serotype k. These results suggest that Cbm as well as Cnm are major cell surface proteins of S. mutans associated with binding to type I collagen and predominantly identified in serotype k strains.

Left ventricle outflow tract vegetation, embolism and troponin rise: an infective endocarditis case report

Infective endocarditis (IE) incidence increases with advancing age [1], and recently has often shown atypical onset and poor prognosis. The clinical history varies greatly in relation to the different initial clinical manifestations, possible underlying heart disease, the microorganisms involved, the presence of complications and patient characteristics. Nowadays, the ‘‘classic textbook signs’’ [2] may be found almost exclusively in developing countries. In general, the most common expression of IE (20–50% of patients [2]) is often an embolic phenomenon. However, acute coronary syndrome (ACS) is an unusual IE onset form, and, as our case seems to describe, is associated with other particular features in the potential clinical evolution of IE.

Modifiers of Symptomatic Embolic Risk in Infective Endocarditis

To ascertain the impact of prior antiplatelet and statin therapy on symptomatic embolic events in [corrected] infective endocarditis (IE). We studied a retrospective cohort of adult patients with a diagnosis of IE who presented to Mayo Clinic (Rochester, MN) from January 1, 2003, to December 31, 2006. Patients were grouped into those who received treatment before infection or controls who did not receive treatment for both antiplatelet therapy and, separately, statin therapy. Because of the retrospective study design and thus the nonrandomized treatment groups, a propensity score approach was used to account for the confounding factors that may have influenced treatment allocation. Antiplatelet therapy included aspirin, dipyridamole, clopidogrel, ticlopidine or any combination of these agents. Statin therapy included atorvastatin, simvastatin, pravastatin, lovastatin, rosuvastatin, or fluvastatin. The primary end point was a symptomatic embolic event that occurred before or during hospitalization. Multivariable logistic regression was used to assess the propensity-adjusted effects of continuous daily therapy with antiplatelet and statin agents on risk of symptomatic emboli. Likewise, Cox proportional hazards regression was used to test for an independent association with 6-month mortality for each of the treatments. The study cohort comprised 283 patients with [corrected] IE. Twenty-eight patients (24.1%) who received prior continuous antiplatelet therapy developed a symptomatic embolic event compared with 66 (39.5%) who did not receive such treatment. After adjusting for propensity to treat, the effect of antiplatelet therapy on embolic risk was not statistically significant (odds ratio, 0.71; 95% confidence interval [CI], 0.37-1.36; P=.30). Only 14 patients (18.2%) who received prior continuous statin therapy developed a symptomatic embolic event compared with 80 (39.4%) of the 203 patients who did not. After adjusting for propensity to treat with statin therapy, the benefit attributable to statins was significant (odds ratio, 0.30; 95% CI, 0.14-0.62; P=.001). The 6-month mortality rate of the entire cohort was 28% (95% CI, 23%-34%). No significant difference was found in the propensity-adjusted rate of 6-month mortality between patients who had and had not undergone prior antiplatelet therapy (P=.91) or those who had and had not undergone prior statin therapy (P=.87). The rate of symptomatic emboli associated with IE was reduced in patients who received continuous daily statin therapy before onset of IE. Despite fewer embolic events observed in patients who received antiplatelet agents, a significant association was not found after adjusting for propensity factors. A continued evaluation of these drugs and their potential impact on subsequent embolism among IE patients is warranted.

Anticoagulation Should Not Be Used in Most Patients With Stroke With Infective Endocarditis

One of the most worrisome consults to the stroke service is the patient with neurological symptoms in the setting of infective endocarditis (IE). Stroke is the main neurological complication of IE and in 50% to 75% is the presenting feature. The most effective strategy for the prevention of a first or recurrent stroke is the prompt institution of appropriate antibiotic therapy, which reduces the risk to 1% to 3% within the first week.1 Ischemic stroke is 3-fold more common than hemorrhagic stroke. Embolic patterns are seen on diffusion-weighted MR in 92% of patients with stroke or encephalopathy. Initiating anticoagulation may seem reasonable to prevent embolization of infected or bland platelet–fibrin valvular vegetations—perhaps enhanced in the presence of antiphospholipid antibodies—and it is the standard of care for most cardioembolic stroke; however, the stroke risk is similar in the presence or absence of anticoagulants at onset of IE. The most compelling reason to avoid anticoagulation in Staphylococcus aureus IE is the predominance of early …

Factors associated with surgery for active endocarditis in congenital heart disease

BackgroundDespite the recent progress of cardiac surgery, the indications for surgical intervention during the active phase of infective endocarditis have not yet been established in patients with congenital heart diseases due to the limited number of such patients. The present study aims to determine the surgical indications for active infective endocarditis in congenital heart diseases. MethodsA retrospective observational cohort multi-center study on infective endocarditis with congenital heart diseases was conducted from January 1997 to December 2001 in Japan and 239 patients were registered. Sixty-one (26%) of the 239 patients had undergone surgical therapy for active infective endocarditis, which was defined as cardiac surgery during administration of intravenous antibiotics. ResultsThere were 7 deaths (11%). A univariate regression analysis revealed that the factors significantly associated with the need for surgical intervention for active IE were the lack of diagnosis of cardiac disorders before the onset of infective endocarditis, aortic valve infective endocarditis, perivalvular abscess, presence of heart failure, and change of antibiotics. A stepwise logistic regression analysis revealed that the presence of a perivalvular abscess, heart failure and a change in the antibiotics were independent determinant factors for the need for surgical treatment of active infective endocarditis in patients with congenital heart diseases. ConclusionsSurgery should therefore be considered even during the active phase in patients with congenital heart diseases and infective endocarditis, when they develop associated with heart failure, a perivalvular abscess, or the need for a change in antibiotics.