Risk Of Infective Endocarditis Research Articles

AN UNUSUAL CASE OF TRICUSPID VALVE INFECTIVE ENDOCARDITIS CAUSED BY ERYSIPELOTHRIX RHUSIOPATHIAE

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Erysipelothrix rhusiopathiae is an uncommon cause of endocarditis. We present a case of Erysipelothrix rhusiopathiae in a patient with tricuspid valve involvement. CASE PRESENTATION: This is a 47-year-old male with a history of hypertension who presented with a four-week history of bilateral lower extremity edema. The patient is a lumberjack by occupation and was having difficulty working. His swelling extended to his knees, prompting a visit to his primary physician. The patient was started on oral furosemide but reported no improvement. On admission, the patient was afebrile. The patient was fluid overloaded with bibasilar lung crackles and 3+ pitting edema in bilateral lower extremities. Labs revealed leucocytosis, creatinine of 3.8, and an NT-pro-BNP level of 29,959. CT of the chest revealed pulmonary edema. The patient was started on intravenous diuretic therapy and oral beta-blockers in view of his acute decompensated heart failure. The patient's blood cultures were positive for gram-positive rods and started on empiric treatment with intravenous vancomycin. Echocardiogram revealed severe tricuspid regurgitation and multiple tricuspid valve vegetations. The most significant vegetation was noted to be 2.6 cm x 1.6 cm in size. A trans-esophageal echocardiogram revealed severe tricuspid regurgitation with significant vegetations visible on all three leaflets of the tricuspid valve. After 6 days, repeat blood cultures showed gram-positive rods with sensitivities revealing Erysipelothrix rhusiopathiae as the causative agent. The patient's antibiotic regimen was converted to intravenous Penicillin G. DISCUSSION: Erysipelothrix rhusiopathiae is a gram-positive, rod-shaped, non-sporing bacillus. It is a zoonotic disease known for its association with occupations involving close exposure to animals [1]. Patients who are diagnosed with this infection manifest with skin infections or systemic organ involvement. Our patient presented with systemic bacteremia, with common involvement of the aortic valve [1]. The clinical presentation of our patient was unique, given that in the absence of heart disease, he presented with overt volume overload and acute renal failure. He lacked the more classic symptoms of infective endocarditis, including fever, chills, and skin lesions. Our patient did not have any significant past medical conditions increasing his risk for infective endocarditis. In past literature, reported cases of Erysipelothrix rhusiopathiae and endocarditis had shown a proclivity towards the aortic valve [1,2]. In our case, we felt the most astonishing feature was the isolated involvement of the tricuspid valve. Its mortality rate is higher when compared to the more common etiological pathogens of infective endocarditis [1]. CONCLUSIONS: Physicians should not only observe clinical symptoms but aim to holistically assess the patient to reach a timely diagnosis and initiate appropriate therapy. Reference #1: Reboli, A.C. and W. Farrar, Erysipelothrix rhusiopathiae. Principles and practice of infectious diseases, 2010. 5: p. 2226-7. Reference #2: Veraldi, S., et al., Erysipeloid: a review. Clinical and Experimental Dermatology: Clinical dermatology, 2009. 34(8): p. 859-862. DISCLOSURES: No relevant relationships by Karthik Gonuguntla, source=Web Response No relevant relationships by Pranav Karambelkar, source=Web Response No relevant relationships by Shivaraj Patil, source=Web Response No relevant relationships by Chaitanya Rojulpote, source=Web Response

A RARE CASE OF NATIVE TRIPLE-VALVE INFECTIVE ENDOCARDITIS

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Infective endocarditis (IE) is a life-threatening infection. Despite medical advances, mortality from IE remains high. Enterococcal IE is becoming more prevalent in elderly patients with degenerative valvular disease and bloodstream infections from gastrointestinal (GI) or genitourinary (GU) tracts. We present a rare case of native triple-valve infective endocarditis. CASE PRESENTATION: A 58-year-old man with a history of squamous cell carcinoma of tongue post hemiglossectomy with chemoradiation therapy and small bowel obstruction post open laparotomy a month earlier presented for altered mental status. Initial vitals showed tachycardia and was otherwise normal. Positive examination findings were cachexia, a healed partial tongue resection, decreased air entry over lung bases and left upper abdominal tenderness without peritonitis. The rest of the physical exam was unremarkable. Initial lab results were significant for leukocytosis, mild anemia, elevated BUN and creatinine. Computed tomography (CT) of chest and abdomen showed a large left lower lobe consolidation, right lower lobe patchy parenchymal disease and gastric wall thickening. He was started empirically on Zosyn, vancomycin and fluconazole. Blood cultures grew Enterococcus faecalis and transthoracic echocardiogram (echo) showed an acute-on-subacute endocarditis with vegetations on the tricuspid, mitral and aortic valves with ejection fraction 65-70%. Bronchoscopy with bronchoalveolar lavage (BAL) culture was positive for Candida Glabrata 3 days after his death. He later developed septic shock with multiorgan failure and was considered ineligible for surgery. Despite optimal medical therapy and no worsening of echo findings, he ultimately died. DISCUSSION: Multivalvular IE increases the likelihood of complications from congestive heart failure, acute renal failure, embolic events, disseminated intravascular anticoagulation and death (1). Enterococcus faecalis is an opportunistic pathogen in oral cavity, the GI and GU tracts. Manipulation of the GI and GU tracts, cancer and previous treatment with antibiotics increase the risk of enterococcal bacteremia. Our patient’s overall immunocompromised state and recent surgical intervention placed him at higher risk of Enterococcus faecalis infection. Enterococcus faecalis bacteremia is a common cause of IE that has had no survival improvement in the past decade (2). Ultimately, his BAL culture was positive for Candida glabrata, which if resulted in fungemia, could be complicated by a rare but aggressive form of IE with a mortality rate of 80% requiring both medical and early surgical intervention (3). CONCLUSIONS: Triple valve endocarditis is rare with few studies in literature to guide the best management. Further research is necessary to identify patients at increased risk of multivalve IE, in regards to optimal screening methods to facilitate early detection and therapy. Reference #1: Kim, N., Lazar, J., Cunha, B., Liao, W., & Minnaganti, V. (2000). Multi-valvular endocarditis. Clinical Microbiology and Infection, 6(4), 207–212. doi: 10.1046/j.1469- 0691.2000.00065.x Reference #2: Dahl, A., Rasmussen, R. V., Bundgaard, H., et al. (2013). Enterococcus faecalis Infective Endocarditis. Circulation, 127(17), 1810–1817. doi: 10.1161/circulationaha.112.001170 Reference #3: Baddley, J. W., Benjamin, D. K., et al. (2008). Candida infective endocarditis. European Journal of Clinical Microbiology & Infectious Diseases, 27(7), 519–529. doi: 10.1007/s10096-008-0466-x DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Lamiaa Rougui, source=Web Response

Point-of-care Ultrasound in the Evaluation of Mitral Valve Regurgitation and Mitral Annular Calcification.

Case PresentationA 77-year-old female presented to the emergency department (ED) with chest pain. Cardiac point-of-care ultrasound (POCUS) was performed and demonstrated a hyperechoic structure on the posterior leaflet of the mitral valve. Admission to cardiology and echocardiogram revealed moderately decreased mobility of the posterior leaflet, mitral annular calcification, and severe mitral regurgitation.DiscussionThese findings highlight the role of POCUS in identifying mitral valve pathology in the ED, ultimately leading to appropriate disposition and management. Mitral annular calcification can lead to significant manifestations including mitral stenosis or regurgitation, and advanced cases have been associated with an increased risk of infective endocarditis, thrombosis, and arrhythmia.

Risk for infective endocarditis in bacteremia with Gram positive cocci.

Infective endocarditis (IE) is a serious complication of bacteremia and is most often caused by Gram positive cocci. We investigated the prevalence of IE in patients where echocardiography was encouraged when bacteremia with Gram positive cocci was present. The study included patients with Gram positive cocci bacteremia hospitalized at two Danish hospitalsbetweenMarchandDecember 2016. Information concerning echocardiography, demographics and bacterialspecieswas collected from thepatients'medicalfiles. Patients without echocardiography were followed for 6months in order to confirm orrejectpossible IE. The study included 585 patients with Gram positive cocci bacteremia, and echocardiography was performed in 414 (71%) of them. The prevalence of IE in patients with high risk bacteremia, i.e. Staphylococcus aureus, non-beta-hemolytic streptococci, Enterococcus faecalis, and coagulase-negative staphylococci was 16%. Patients with Enterococcus faecalis had the highest prevalence of IE (33%) followed by non-beta-hemolytic streptococci (23%) and Staphylococcus aureus (12%). Among low risk bacteremia the prevalence of IE was 1%. The mean age of patients with IE was 74years (SD 12.9) and 71% were male. These findings strongly support routine echocardiography in patients with high risk bacteremia and non-performance of echocardiography in patients with low risk bacteremia.

Risk for Endocarditis with

The Streptococcus genus comprises >50 species that cause a wide range of human infections. Although the variable risk for infective endocarditis (IE)

Impact of Chronic Renal Failure on Surgical Outcomes in Patients With Infective Endocarditis

Patients with chronic renal failure (CRF) who are undergoing hemodialysis are at increased risk for infective endocarditis (IE). However, outcomes of surgical treatment for IE in these patients have not been well studied. Between 1997 and 2017, 539 patients underwent surgical treatment for IE. Of these patients, 125 were undergoing hemodialysis for end-stage renal disease (ESRD), and 414 had no history of CRF. Primary end points compared in this study were short-term survival and long-term survival. Preoperatively, dialysis-treated patients had higher incidences of diabetes (43% vs 18%), hypertension (79% vs 49%), congestive heart failure (63% vs 48%), cardiogenic shock (13% vs 5.3), and sepsis (29% vs 18%) (all P < .05). Postoperatively, they experienced higher rates of prolonged mechanical ventilation (54% vs 22%), pneumonia (17% vs 5.6%), sepsis (6.4% vs 1.0%), cardiac arrest (7.2% vs 1.7%), gastrointestinal events (14% vs 5.1%), and operative mortality (14% vs 5.8%) (all P < .05). The 5- and 10-year survival rates were significantly worse in the dialysis-treated group at 29% and 16%, respectively, compared with 72% and 53% in the patients who did not have CRF (P < .001). ESRD was a risk factor for both short-term mortality (odds ratio, 2.0) and long-term mortality (hazard ratio, 2.7). Rates of reoperation in dialysis-treated patients were very low: 5- and 10-year incidences were 0% and 2.0%, respectively. In patients with ESRD and IE, poor postoperative outcomes emphasized the importance of prevention and raised the question whether indications for surgical treatment in the general population are appropriate for patients who are dialysis dependent. Additionally, low rates of reoperation supported the use of bioprosthetic valves in these patients.

Novel loss of function mutation in NOTCH1 in a family with bicuspid aortic valve, ventricular septal defect, thoracic aortic aneurysm, and aortic valve stenosis

BackgroundBicuspid aortic valve is the most common congenital valvular heart defect in the general population. BAV is associated with significant morbidity due to valve failure, formation of thoracic aortic aneurysm, and increased risk of infective endocarditis and aortic dissection. Loss of function mutations in NOTCH1 (OMIM 190198) has previously been associated with congenital heart disease involving the aortic valve, left ventricle outflow tract, and mitral valve that segregates in affected pedigrees as an autosomal dominant trait with variable expressivity.MethodsWe performed whole‐exome sequencing in four members of a three‐generational family (three affected and one unaffected subject) with clinical phenotypes including aortic valve stenosis, thoracic aortic aneurysm, and ventricular septal defect.ResultsWe identified 16 potentially damaging genetic variants (one stop variant, one splice variant, and 14 missense variants) cosegregating with the phenotype. Of these variants, the nonsense mutation (p.Tyr291*) in NOTCH1 was the most deleterious variant identified and the most likely variant causing the disease.ConclusionInactivating NOTCH1 mutations are a rare cause of familial heart disease involving predominantly left ventricular outflow tract lesions and characterized by the heterogeneity of clinical phenotype.

Teledentistry and Interprofessional Care: Oral Health Within a Medical Clinic

Background: In 2000, the first Surgeon General’s Report on Oral Health was published and one of the major themes in the report was that oral health is important for overall health. Nowhere is this more true than in individuals with complex medical conditions. Poor oral health can lead to increased risk of infective endocarditis and poorly controlled diabetes. People who take multiple medications are at risk for more dental caries due to serious side effects, including dry mouth. And individuals with movement disorders may have trouble brushing their …

Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species.

Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. We aimed to investigate the prevalence of IE at species level in patients with streptococcal BSIs. We investigated all patients with streptococcal BSIs, from 2008 to 2017, in the Capital Region of Denmark. Data were crosslinked with Danish nationwide registries for identification of concomitant hospitalization with IE. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species adjusted for age, sex, ≥3 positive blood culture bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Among 6506 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men) the IE prevalence was 7.1% (95% CI, 6.5-7.8). The lowest IE prevalence was found with Streptococcus pneumoniae (S pneumoniae) 1.2% (0.8-1.6) and Spyogenes 1.9% (0.9-3.3). An intermediary IE prevalence was found with Sanginosus 4.8% (3.0-7.3), Ssalivarius 5.8% (2.9-10.1), and Sagalactiae 9.1% (6.6-12.1). The highest IE prevalence was found with Smitis/oralis 19.4% (15.6-23.5), Sgallolyticus (formerly Sbovis) 30.2% (24.3-36.7), Ssanguinis 34.6% (26.6-43.3), Sgordonii 44.2% (34.0-54.8), and Smutans 47.9% (33.3-62.8). In multivariable analysis using S pneumoniae as reference, all species except S pyogenes were associated with significantly higher IE risk, with the highest risk found with S gallolyticus odds ratio (OR) 31.0 (18.8-51.1), S mitis/oralis OR 31.6 (19.8-50.5), S sanguinis OR 59.1 (32.6-107), S gordonii OR 80.8 (43.9-149), and S mutans OR 81.3 (37.6-176). The prevalence of IE in streptococcal BSIs is species dependent with S mutans, S gordonii, S sanguinis, S gallolyticus, and S mitis/oralis having the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.

Infective endocarditis: An Orthodontist’s perspective

Infective endocarditis associated with orthodontic treatment is a rare occurrence. Unfortunately, many orthodontic practitioners do not treat patients potentially at risk of developing endocarditis due to the lack of practical guidelines and fear of precipitating the infection. Additionally, many patients that undergo orthodontic treatment are inappropriately prescribed antibiotic cover for procedures that have a minimal bacteraemia risk. In this paper the literature linking orthodontic treatment and infective endocarditis was examined. The appropriate management were recommended for patients with risk of infective endocarditis during orthodontic procedures.

Risk factors of infective endocarditis in persons who inject drugs

BackgroundThe rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature.MethodsA case–control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario.ResultsThirty three cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p = 0.001) and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p < 0.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls; p = 0.197).DiscussionOur study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature.

Transcranial Doppler Emboli Monitoring for Infective Endocarditis.

Ischemic stroke can occur in 20-55% of patients with infective endocarditis (IE) with 75% occurring during the first 2 weeks of treatment. CT or MRI brain can diagnose the sequelae of stroke but transcranial Doppler (TCD) can document active embolization. We undertook a retrospective review of our patient cohort and a systematic review of literature to assess the role of TCD in early diagnosis and management of ischemic stroke in IE. Retrospective chart review and literature review. We found 89 patients with stroke caused by IE at our institution from December 2011 to April 2018. TCDs were obtained on 26 patients; 16 were abnormal for cerebrovascular abnormalities. Only 4 patients had 30-minute emboli monitoring performed, of which one revealed emboli. We found 3 studies investigating the role of TCDs in IE that showed promise in its use as a predictive tool in stroke risk stratification. Presence of embolization in the form of high-intensity transient signals (HITS) detected on TCDs can be used for early diagnosis of IE, assessing efficacy of antibiotic therapy, and stratification of stroke risk in IE. This can aid further research into testing preventative interventions for reducing stroke burden in IE such as earlier valvular surgery or vacuum-assisted vegetation extraction.

Clinical Significance of the Controlling Nutritional Status (CONUT) Score in Patients with Infective Endocarditis.

Risk stratification of patients with infective endocarditis (IE) is difficult. The Controlling Nutritional Status (CONUT) score is an index of immune function and nutritional status. We investigated the prognostic value of the CONUT score in IE and whether its prognostic value differed between IE patients with and without indications for surgery.Clinical records were retrospectively evaluated for 92 patients with IE treated at Nihon University Itabashi Hospital and Nihon University Hospital between January 2014 and May 2019. The CONUT score was determined upon admission, and patients were divided into two groups at the median score (≤ 7 [n = 50] and ≥ 8 [n = 42]). The primary outcome was all-cause mortality at 90 days after admission.The high CONUT group had significantly higher C-reactive protein and N-terminal pro-brain natriuretic peptide levels, as well as a significantly lower hemoglobin and estimated glomerular filtration rate (all P < 0.05), and considerably more valve perforation (26% versus 8%, P < 0.05). Kaplan-Meier analysis revealed that mortality was significantly higher in the high CONUT group (P < 0.001). Even after adjusting for the propensity score based on IE risk factors, a higher CONUT score was still associated with mortality. A receiver-operating characteristic analysis revealed that a CONUT score ≥ 8 had a sensitivity of 86% and specificity of 76% for predicting all-cause mortality. A CONUT score ≥ 8 was most strongly associated with mortality in patients with surgical indications (P < 0.001).In patients with IE, a higher CONUT score was significantly associated with inflammation, heart failure, renal dysfunction, anemia, valve dysfunction, and short-term mortality, especially in patients with surgical indications.

Endocarditis risk with bioprosthetic and mechanical valves: systematic review and meta-analysis

ObjectiveBioprosthetic valves are being used with increased frequency for valve replacement, with controversy regarding risk:benefit ratio compared with mechanical valves in younger patients. However, prior studies have been too small...

Comparison of infective endocarditis risk between balloon and self-expandable valves following transcatheter aortic valve replacement: systematic review and meta-analysis.

This study aimed to compare incidence of IE between BE and SE valves by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2019. Included studies were published observational studies that compared the risk of IE among patients undergoing TAVR employing BE versus SE valves, using the random-effects to calculate risk ratios and 95% confidence intervals (CIs).Ten cohort studies from April 2013 to November 2019 were included in this meta-analysis involving 13,478 subjects (6289 SE and 7189 BE types). Our study showed no statistical difference in IE rates between each type of valves (pooled OR 0.96, 95% CI: 0.68-1.35, p = 0.801 with I2 = 14.7%).There was no difference in IE rate between BE and SE valves following TAVR. Further studies are warranted to confirm our findings.

Infective Endocarditis in Patients With Intestinal Failure: Experience From a National Referral Center.

Infective endocarditis (IE) is a recognized complication of central line-associated bloodstream infection (CLABSI). Central venous access devices (CVADs) are essential for the delivery of long-term parenteral nutrition (PN), yet there are no published data as to the prevalence, characteristics and outcomes of IE in this population. A prospectively maintained database of patients with intestinal failure (IF) types 2 and 3, managed by a national intestinal failure center between January 2010 and December 2018, was analyzed retrospectively and relevant factors extracted from case records. A total of 745 patients with IF and CVADs in situ on admission, or placed during their stay, were admitted over the duration of this study, 640 with type 2 IF and 105 with type 3 IF. Two hundred eighty-two echocardiograms were performed to investigate potential IE associated with a CLABSI event. Four cases of IE were identified in the entire cohort of 782,666 catheter days (IE incidence rate: 0.005 per 1000 catheter days and 187 per 100,000 person-years for the entire cohort; 0.048 per 1000 inpatient catheter days for acute type 2 IF, 0.0026 per 1000 outpatient catheter days [ie, 99 per 100,000 person-years for outpatients with type 3 IF]). IE is rare in the type 3 IF population and a rare consequence of CLABSI in inpatient acute type 2 IF. However, mortality and morbidity are high. Routine echocardiography may not be warranted for investigation of CLABSI unless there is a high risk of IE or a virulent organism is involved.

Cardiovascular infections - recent progress and future challenges

Patients with previous endocarditis are at highest risk of infective endocarditis (266-fold compared to the general population) - preventive strategies are of particular importance in this patient subgroup. Patients with community-acquired E. faecalis bacteremia should undergo transesophageal echocardiography - according to a recent study the prevalence of endocarditis may be ≥ 20 % in this setting. Several smaller observational studies suggest an association between E. faecalis endocarditis and colorectal neoplasias - colonoscopy should therefore be offered to patients with newly diagnosed E. faecalis endocarditis (particularly in patients with unknown portal of entry). The non-inferiority of partial oral endocarditis treatment has been demonstrated in a selected subgroup of patients characterized by a stable condition/course, small vegetations and the absence of perivalvular complications. Uncritical and early oralisation of endocarditis treatment in patients not fulfilling these criteria may lead to adverse treatment outcomes. Approximately one out three patients with a left ventricular assist device (LVAD) will suffer from LVAD-related infections during the first year after implantation. Appropriate antibiotic treatment and adequate surgical debridement are essential management strategies.

Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery.

Infective endocarditis (IE) may require heart valve surgery. It is well known that heart valve surgery itself and previous IE predispose to IE. However, data are sparse on whether the risk of IE is different among patients undergoing valve surgery due to IE and other causes (i.e. recurrent vs. first-time IE). Using Danish nationwide registries, patients undergoing left-sided heart valve surgery in the course of an IE hospitalization (1996-2017) were identified and matched with controls undergoing left-sided heart valve surgery due to another cause than IE in a 1:1 ratio. Patients were stratified according to type of surgical valve intervention and affected valve. The comparative risk of recurrent vs. first-time IE was assessed by cumulative incidence curves and multivariable Cox regression analyses. The study population comprised 971 patients with a first-time admission for IE requiring heart valve surgery matched with 971 controls undergoing heart valve surgery due to other causes than IE. The risk of recurrent IE was significantly higher than the risk of first-time IE following heart valve surgery (5.5% and 3.0% by 10years, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.02-2.70). The risk of IE recurrence was not significantly different comparing valve replacement and valve repair (5.5% and 5.3%, respectively, HR 1.60, 95% CI 0.71-3.60). Yet, the risk of IE recurrence was significantly higher among patients with biological versus mechanical prostheses (6.3% and 4.6%, respectively, HR 2.00, 95% CI 1.02-3.70). Following heart valve surgery, the risk of recurrent IE was significantly higher than the risk of first-time IE.

ASSOCIATION OF DIABETES MELLITUS WITH POOR OUTCOMES IN PATIENTS WITH INFECTIVE ENDOCARDITIS

While studies have demonstrated an increased risk for infective endocarditis (IE) in patients with diabetes mellitus (DM), it is unclear if the coexistence of DM and IE portends a higher risk of cardiovascular outcomes. We reviewed the records of 11,955 patients from the National Inpatient Sample (

Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement

ObjectivesTranscatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level. MethodsBased on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018. ResultsA total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1–3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78–2.00) and 1.40 (95% CI 1.34–1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensity-matched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70–2.04) %/year vs 1.71 (95% CI 1.58–1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96–1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3–49.3) than in SAVR patients with IE (32.8% 95% CI 28.6–37.3; RR 1.32, 95% CI 1.08–1.60). DiscussionIn a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.