Risk Of Infective Endocarditis Research Articles

Valvular Heart Disease in Patients with Chronic Kidney Disease.

Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.

Determination of Infective Endocarditis Development Risks and Knowledge Levels of Individuals Applying for Dental Treatment

Objective: In the study, it was aimed to determine the risk and level of knowledge of individuals who applied to the clinic for dental treatment. Methods: The research consisted of 713 adult individuals who went to the dental clinic for dental treatment between 01 March and 31 August 2020, who were willing to participate in the study and who met the inclusion criteria. The questionnaires developed by the researchers were used to determine the risks of developing infective endocarditis, and the knowledge levels of Oral and Dental Health and Infective Endocarditis in individuals who attended dental treatment. Descriptive statistical analyzes were made. Results: In the study, the rate of agreeing that "oral and dental health problems are as important as other health problems" (p = 0.005) and that "infective endocarditis disease is an infection of the heart and its valves" (p = 0.009) was found to be significantly higher in females than males. It was determined that the majority of the individuals (38.7%) were indecisive about the idea that “antibiotics should be used before dental treatment”. When the infective endocarditis risk factors were evaluated in the study, it was found that 8.1% had piersing in their body, 28.3% had problems such as gingivitis, bleeding and swelling. Conclusion: The most important issue in preventing the development of infective endocarditis is to increase the awareness of individuals. The society should be made aware of the risk factors that may cause infective endocarditis and their knowledge level should be increased.

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

ObjectiveTo define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsAll patients who underwent first SAVR or TAVI...

Cardioembolic Stroke at Prosthetic Valve Endocarditis

Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. The risk of embolism is very high in IE, with embolic events occurring in 20-50%of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates. Case presentation: A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38 0C). He reported a history of recurrent fever lasting two days. His pre-existing comorbidities included Diabetes Mellitus, Arterial Hypertension and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with a recurrent fever up to 38.8 0C, no significant findings in the transthoracic echocardiogram (TTE), and positive blood cultures for Enterococcus faecalis. It was started an antibiotic therapy. Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke. Conclusion: Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it.

Antibiotic prophylaxis before invasive dental procedures for patients at high risk of infective endocarditis - A systematic review.

Clinical use of antibiotics prophylaxis (AP) for preventing infective endocarditis (IE) after invasive dental procedures is controversial. Expert consensus guidelines are inconsistent, either restricting its use to high-risk individuals or advising its use again. To determine whether there is a genuine need for AP to prevent IE in high-risk patients undergoing invasive dental procedures. Online search was performed on PubMed, Science Direct, British Dental Journal and Cochrane Register of Controlled Trials. The methodological quality of each study was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Seventeen (17) clinical trials were included in the final analysis recruiting 2,410 patients (AP = 1,366; placebo = 1,044). Bacteraemia was detected in 302 AP patients (22.1%) and 362 placebo patients (34.7%). AP reduced the risk of bacteraemia by 49% (risk ratio: 0.51; 95% CI; 0.45 to 0.58; P = 0.0001). Although using AP for IE may be pragmatic and justified for high-risk patients undergoing invasive dental procedures, the evidence is inconclusive because post-procedural bacteraemia may not be a good surrogate marker for IE. Moreover, trials investigating the direct association between AP and IE are lacking due to low disease prevalence and high-cost challenges.

Atendimento odontológico hospitalar de paciente pediátrico com tetralogia de Fallot: relato de caso

ABSTRACT Tetralogy of Fallot is the most prevalent cyanotic congenital heart disease and it has a high mortality rate. The aim of this article was to provide a clinical case, describing the dental treatment of an infant patient with tetralogy of Fallot done at a hospital. The patient was a 7-year-old male, lived in a rural area with no previous diagnosis of this cardiopathy when he was attended to by a multidisciplinary team at University Hospital Ana Bezerra, at Santa Cruz, Northern Rio Grande, Brazil. After his medical appointment, the patient received a visit from the dental resident in Mother-Infant Health in his hospital room. During the dental exam, multiple carious lesions were found and there was an urgent need to reduce the risk of dental infection before the patient underwent heart surgery. The treatment started with a preventive approach, including oral hygiene instruction and behavior management. The treatment was completed using the atraumatic restorative technique, and a root tip was extracted. Antibiotic prophylaxis was administered before the extraction to minimize the risk of infectious endocarditis. After the dental treatment, the multidisciplinary team referred the patient for surgery to address the tetralogy of Fallot. The integration between the multidisciplinary residency and the medical team was important to reduce the risks of infectious endocarditis during the dental treatment, aiming to provide integral care to this patient.

Risk of infective endocarditis after aortic valve neocuspidization (Ozaki procedure): a multiple-center study

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценка частоты и определение факторов риска инфекционного эндокардита (ИЭ) после неокуспидализации аортального клапана. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование был включен 251 пациент (116 мужчин и 135 женщин) с патологией аортального клапана, которым выполняли неокуспидализацию аортального клапана в период с 2016 по 2019 г. в четырех российских центрах. Медиана периода наблюдения составила 24 [17; 32] мес. <h3>РЕЗУЛЬТАТЫ</h3> ИЭ после операции развился у 7 (2,8%) пациентов. По результатам построения кривых Каплана—Мейера ИЭ отсутствовал после неокуспидализации аортального клапана в течение 3 лет в 96,6% случаев, повторные операции в течение 3 лет отсутствовали в 94,6% случаев, а 3-летняя общая выживаемость составила 90,6%. Факторы риска ИЭ включали операцию по поводу активного ИЭ (относительный риск 16,5; 95% ДИ 2,85—95,54; <i>p</i>=0,002) и ишемическую болезнь сердца с чрескожным коронарным вмешательством в анамнезе (относительный риск 11,6; 95% ДИ 2,24—60,14; <i>p</i>=0,003). <h3>ВЫВОД</h3> Потенциально операция неокуспидализации аортального клапана может снизить количество инфекционных осложнений в определенных группах больных. Необходимы дальнейшие проспективные многоцентровые исследования для подтверждения данной гипотезы.

Atrial Septal Defect Patients Have an Elevated Risk for Infective Endocarditis

Atrial Septal Defect Patients Have an Elevated Risk for Infective Endocarditis

Infective endocarditis after surgical aortic or mitral valve replacement: A nationwide population-based study

ObjectiveEvidence regarding the incidence of prosthetic valve endocarditis and its association with the use of mechanical or biologic prosthetic valves is limited. MethodsPatients who underwent aortic or mitral valve replacement in the years 2000 to 2017 were identified from Taiwan's National Health Insurance Research Database and grouped according to the type of prosthesis used (mechanical or biologic). Propensity score matching was performed to reduce confounding. ResultsA total of 22,844 patients were included, with 11,950 (52.2%) and 10,934 (47.8%) in the mechanical prosthesis and biologic prosthesis groups, respectively. After matching, each group contained 5441 patients. During follow-up, patients with a biologic prosthesis had a significantly higher risk of infective endocarditis (IE) than those with a mechanical valve (3.4% vs 1.9%; subdistribution hazard ratio, 1.78; 95% CI, 1.40-2.26). Moreover, biologic prostheses were associated with greater risks of all-cause mortality and redo valve surgery, but lesser risks of ischemic stroke, hemorrhagic stroke, major bleeding, and gastrointestinal bleeding. In subgroup analysis, biologic prostheses were consistently associated with a greater risk of IE in all subgroups, specifically single-valve replacement–aortic, single-valve replacement–mitral, double-valve replacement, active IE (IE diagnosed during index hospitalization), any IE (active or old), and not having a history of IE. ConclusionsIn this nationwide population-based retrospective cohort study, biologic prosthesis use was associated with a greater risk of IE during follow-up compared with mechanical valve use. However, mechanical valve use was associated with a greater risk of ischemic stroke and hemorrhagic complications.

Clinical and echocardiographic characteristics associated with the development of infective endocarditis in patients with significant mitral stenosis.

Infective endocarditis (IE) confers significant mortality and morbidity in patients with underlying mitral stenosis (MS), with both diseased native valves and after valvular procedures. We examined the clinical and echocardiographic parameters in association with the development of IE on patients with significant MS. A total of 478 consecutive patients with index echocardiographic diagnosis of significant mitral stenosis (mitral valve area <1.5cm2 ) were included. Patients were grouped into those with or without IE on at least 5 years of follow-up. Baseline clinical, echocardiographic profile and clinical outcomes were compared. IE was observed in 4.4% (n = 21) of the cohort. These patients were younger (45.3±14.6 vs. 53.2±15.5 years, p = 0.022) at the time of MS diagnosis. NT-proBNP was higher in patients who developed IE (13529 ± 12230 vs. 4381 ± 5875 pg/ml, p < 0.001), with larger left atrial diameter (54.4 ± 10.1 vs. 49.9 ± 9.5 mm, p = 0.040) and elevated pulmonary artery systolic pressure (PASP, 62.3 ± 17.2 vs. 47.2 ± 16.5 mmHg, p = 0.026). There was no significant difference in terms of MS severity, other concomitant valvulopathies, or etiology (rheumatic or degenerative) of MS. Patients who smoked had higher incidence of IE (33.3% vs. 14.2%, log-rank 7.27, p = 0.007). After adjusting for age, valve procedure and PASP, patients who smoked remained at elevated risk of IE (adjusted hazards ratio 2.99, 95% confidence interval 1.18-7.56, p = 0.021). IE occurs in a proportion of patients with MS. Smoking, younger age of diagnosis of MS as well as dilated left atria with elevated PASP may be associated with an elevated risk of this complication.

Clinical Significance of Staphylococcus aureus in a Single Positive Blood Culture Bottle.

Clinical significance of a single positive blood culture bottle (SPBCB) with Staphylococcus aureus is unclear. We aimed to assess the significance of an SPBCB by looking at the associated outcomes. We performed a retrospective, multicenter study of patients with an SPBCB with S aureus using data collected from both electronic health records and the clinical microbiology laboratory. Overall, 534 patients with S aureus bacteremia were identified and 118 (22.1%) had an SPBCB. Among cases with an SPBCB, 106 (89.8%) were classified as clinically significant whereas 12 (10.2%) were considered contaminated or of unclear significance. A majority (92.4%) of patients received antibiotic therapy, but patients with clinically significant bacteremia were treated with longer courses (25.9 vs 5.7 days, P < .001). Significant differences in both frequency of echocardiography (65.1% vs 84.6%, P < .001) and infective endocarditis diagnosis (3.8% vs 14.2%, P = .002) were seen in those with an SPBCB compared to those with multiple positive bottles. A longer hospital length of stay and higher 90-day, 6-month, and 1-year mortality rates were seen in patients with multiple positive blood culture bottles. An SPBCB with S aureus was common among our patients. While this syndrome has a more favorable prognosis as compared to those with multiple positive blood cultures, clinicians should remain concerned as it portends a risk of infective endocarditis and mortality.

Antibiotic prophylaxis with amoxicillin to prevent infective endocarditis in periodontitis patients reconsidered: a narrative review.

To discuss first, the adequacy of the antibiotic prophylaxis regimen currently recommended for the prevention of infective endocarditis in periodontitis patients, and second, preventive measures to decrease the rate of bacteraemia after periodontal treatment. A bibliographic literature search identifying clinical trials between January 1990 and January 2021, focusing on microorganisms in bacteraemia after periodontal treatment and bacteria in infective endocarditis, was performed. Two reviewers independently identified and screened the literature by systematically searching in Medline/Premedline, EMBASE and Cochrane Library. Two hundred and seventy articles were identified, of which twenty-three met the inclusion criteria. Bacteraemia rates after periodontal treatment ranged from 10-94% in the investigated patients. Mainly oral pathogens related to infective endocarditis, such as viridans group streptococci (up to 70%) and HACEK group pathogens (e.g., Aggregatibacter actinomycetemcomitans), were detected. But typical oral and periodontopathogenic species, such as Porphyromonas spp. (P.s gingivalis) (up to 50%), Actinomyces spp. (up to 30%) and Fusobacterium spp. (up to 30%), which do not usually cause infective endocarditis, were also found. Infective endocarditis episodes that might have been in association with a dental treatment were mainly caused by viridans group streptococci. Prophylactic measures like rinse application of chlorhexidine, povidone-iodine or essential oils, diode laser or systemic antibiotic prescription were described as decreasing the bacteraemia rate after periodontal interventions to 5-70%. The currently recommended systemic antibiotic prophylaxis with amoxicillin before periodontal treatment in high-risk cardiovascular patients still covers the most common oral bacteria causing infective endocarditis, namely viridans group streptococci, and therefore seems adequate in this context. Since bacteraemia, not infective endocarditis, is the endpoint in most studies, the causality between bacteraemia after periodontal treatments and infective endocarditis remains difficult to elucidate. Until more evidence is available regarding this, adherence to current guidelines for antibiotic prophylaxis in patients at high risk for infective endocarditis undergoing periodontal treatment remains recommended.

Oral health experiences of Turkish children with acute rheumatic fever or rheumatic heart disease.

Children with acute rheumatic fever (ARF) or using depot-penicillin because of rheumatic heart disease (RHD) are prone to the risk of infective endocarditis (IE) and poor oral hygiene. This cross-sectional study aimed to investigate oral health experiences of a group of healthy children and a group of children with ARF or who were using depot-penicillin because of RHD (study group). Medical and dental data of 86 children aged between 5-12 years were investigated in this study. Medical histories, decayed, missing, and filled teeth, plaque index, gingival index, toothbrushing frequencies, and the study and healthy groups' socioeconomic levels were recruited and examined. The 'dmft' of the study and healthy groups were found to be 5.51±3.81 and 2.37±2.31, respectively, while the 'DMFT' of the study and healthy groups were 1.71±2.28 and 1.06±1.59, respectively. There was no significant difference between the gingival indexes of the study group 0.89±0.39 and the healthy group 0.62± 1.03 (p=0.112). Nevertheless, the groups significantly differed regarding the plaque index, which were 0.87±0.40 and 0.45±0.41, respectively (p<0.001). The tooth brushing frequencies in the study and healthy groups being twice a day or more were 23.3% and 46.5%, respectively. The children with ARF or using depot-penicillin because of RHD had more permanent and primary tooth caries and poorer oral health than the healthy group in this study.

55. Infective Endocarditis After Surgical or Transcatheter Aortic Valve Replacement

BackgroundInfective endocarditis (IE) can complicate both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) with significant morbidity and mortality despite differing pathogenesis. In the presence of limited data from direct comparison studies and recent expansion of TAVI to younger and lower- risk patients, we compared the incidence and timing of IE in TAVI versus SAVR.MethodsUsing data from the TriNetX electronic health records network, we identified (1) a cohort of patients who underwent TAVI between January 2016 and December 2020 (CPT procedure code 1021150) and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1035167 or 1029693, without any associated transcatheter procedure). We examined the incidence of IE (captured with ICD-10 codes I33, I38, or I39) over a 5-year follow up period and matched the cohorts for demographic data and clinically relevant background history. We used Kaplan-Meier estimates and Cox proportional hazards models to compare incidence between matched cohorts.ResultsWe identified 6,302 patients with TAVI and 6,302 matched patients with SAVR. The baseline characteristics of the cohorts were well balanced, Table 1. All standardized mean differences were < 0.05, indicating adequate matching between cohorts. The Kaplan-Meier mortality at 5 years was 38.0% in the TAVI vs. 22.0% in the SAVR cohort (log-rank P < 0.001). There were 290 cases with IE in the TAVI and 604 cases in the SAVR cohort. The corresponding 5-year event rates were 10.0% vs. 16.9% (log-rank P < 0.001), respectively, Figure 1. The risk ratio of TAVI vs. SAVR related IE over the entire 5-year period was 0.48 (95%CI 0.42 — 0.55; P < 0.001). However, the relative risk for IE was non-proportional between groups over the 5-year period, with an early pronounced incidence among SAVR relative to TAVI patients and gradual convergence of the hazard rates over time, Figure 2. Figure 1. Cumulative 5-Year Incidence (Kaplan-Meier Estimates) of Infective Endocarditis Among Matched Transcatheter Aortic Valve Implantation (TAVI) vs. Surgical Aortic Valve Replacement (SAVR) Recipients Figure 2. Risk of Infective Endocarditis in SAVR vs. TAVI Recipients Over Time ConclusionIn this comparative study, the risk for IE was lower among TAVI vs. SAVR recipients, primarily due to the higher risk of IE during the early post-SAVR period. With increasing uptake of TAVI procedures, a better understanding of the temporal occurrence and pathophysiology of IE and application of effective treatment strategies in these patients is required.Disclosures All Authors: No reported disclosures

686. Comparing Treatments of Methicillin-Resistant Staphylococcus aureus Infective Endocarditis by People Who Inject Drugs

Abstract Background People who inject drugs (PWID) are at high risk for infective endocarditis (IE) with high-mortality pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Stigma against PWID may cause differences in treatment and outcomes between these patients infected with MRSA IE. Methods Single center retrospective cohort study from August 2006 to February 2021 that includes adult patients diagnosed with IE. Primary outcomes included 90-day all-cause mortality, 60-day MRSA recurrence, 60-day readmission, and hospital length of stay (LOS). Statistical analysis was performed by chi-square, t-test, and Mann-Whitney-U as appropriate. Results A total of 214 patients were diagnosed with MRSA IE; 89 PWID and 125 non-PWID. The mean (SD) age was 47.4±12.4 years (PWID) vs 59.3 ±16.0 years (non-PWID) (p&amp;lt; 0.001). Patients were primarily male (56%), but differed in terms of race 34% African-American (AA) (PWID) vs 66% AA (non-PWID) (p&amp;lt; 0001). Mean APACHE II scores differed between groups: 16(±9.9) (PWID) vs 19(±8.1) (non-PWID) (p&amp;lt; 0.008). Among patients who cleared bacteremia, mean (SD) duration was 5.7(±3.9) days and was not significant between groups (p&amp;lt; 0.64). Valve-type was 93% native and 7% prosthetic and not different between groups (p&amp;lt; 0.16). Infectious Diseases consult did not differ at 96% overall (p&amp;lt; 0.31), but pursuit of source control nearly reached significance at 27% for PWID vs 41% non-PWID (p&amp;lt; 0.06). Similarly, use of combination therapy daptomycin and ceftaroline was nearly significant: 21% (PWID) vs 12% (non-PWID) (p&amp;lt; 0.09). Odds ratio of PWID and combination therapy remained non-significant after regression: 0.39(0.14-1.1,p&amp;lt; 0.07). Primary 90-day mortality was lower in PWID vs non-PWID (15% vs 30%) respectively (p&amp;lt; 0.01), but did not differ in 60-day MRSA recurrence (p&amp;lt; 1.0) at 9%, 60-day readmission (p&amp;lt; 1.0) at 33%, or median LOS (IQR) (p&amp;lt; 0.46) at 15 (10-24) days overall. Conclusion While PWID are significantly younger, less critically ill, and have lower mortality compared to non-PWID, they have similar LOS, MRSA recurrence, and readmission rates. Analyses suggest a potential difference in the pursuit of source control and combination therapy among PWID, however more studies may be needed to achieve significance. Disclosures Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)

Abstract 13084: Occurrence of Infective Endocarditis After Transcatheter versus Surgical Pulmonary Valve Implantation: Results of a Nationwide Administrative Database

Background: It is unclear if the risk of infective endocarditis (IE) differs between transcatheter (TPVI) and surgical (SPVR) pulmonary valve implantation. We sought to address this question using administrative data including a large nationwide patient population. Methods: All congenital heart disease (CHD) patients ≥4 years of age who underwent isolated pulmonary valve implantation were identified in the BARMER Health Insurance Company database (≈9 million members, representative of the German population). Data from 01/2005 to 12/2018 were analyzed with regard to overall survival and complications particularly focusing on IE. Results: Overall, 461 pulmonary valve implantations were performed in 413 patients (59.4% male, median age 18.6 years (IQR 12.8-31.3)). Of those, 38.4% (n=177) underwent TPVI, while 61.6% (n=284) were treated with SPVR. Overall, IE was diagnosed in 8.0% (n=37) of cases after a median of 1.3 years (IQR 0.2-3.7). In the TPVI cohort, IE occurred in 10.2% (n=18) of cases, while IE was diagnosed in 6.7% (n=19) of cases with SPVR ( p =0.217). Furthermore, 5.0% (n=23) of all patients died during follow-up (of those n=4 within 90 days after diagnosis of IE). On multivariable Cox-regression analysis, previous diagnosis of IE was associated with a higher risk of re-IE ( p =0.025), but no association between IE and age ( p =0.17), sex ( p =0.34) or type of CHD was found ( p =0.71). While the overall rate of IE was not dependent on the treatment modality, there were significant time-dependent differences: Within the first year of follow-up, freedom from IE or death was significantly higher in the TPVI cohort (HR 5.26 [95% CI 1.59-16.67], p =0.006) compared to SPVR), but within the 3-10 year period the probability reversed in favor of the SPVR cohort (HR 10.07 [95% CI 3.41-29.76], p &lt;0.001) compared to TPVI). Conclusion: In a cohort of 413 patients undergoing pulmonary valve implantation, infective endocarditis occurred in 8.0% of cases. The overall rate of infective endocarditis was not significantly different between surgical and interventional pulmonary valve procedures. However, while early endocarditis was more often related to surgical procedures, the mid-term IE risk was significantly lower in surgically treated patients.

Incidence of Infective Endocarditis Among Patients With Tetralogy of Fallot.

BackgroundPatients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple invasive procedures, including pulmonary valve replacement (PVR). Data on the long‐term risk of IE are sparse.Methods and ResultsIn this observational cohort study, all patients with ToF born from 1977 to 2018 were identified using Danish nationwide registries and followed from date of birth until occurrence of first‐time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among patients with ToF versus age‐ and sex‐matched controls from the background population was assessed. Because of rules on anonymity, exact numbers cannot be reported if the number of patients is <4. A total of 1164 patients with ToF were identified and matched with 4656 controls. Among patients with ToF, 851 (73.1%) underwent early surgical intracardiac repair and 276 (23.7%) underwent PVR during follow‐up. During a median follow‐up of 20.3 years, 41 (3.5%) patients with ToF (comprising 24 [8.7%] with PVR and 17 [1.9%] without PVR) and <4 (<0.8%) controls were admitted with IE. The incidence rates of IE per 10 000 person‐years were 22.4 (95% CI, 16.5–30.4) and 0.1 (95% CI, 0.01–0.7) among patients and controls, respectively. Moreover, PVR was associated with a further increased incidence of IE among patients with ToF (incidence rates per 10 000 person‐years with and without PVR were 46.7 [95% CI, 25.1–86.6] and 2.8 [95% CI 2.0–4.0], respectively).ConclusionsPatients with ToF are associated with a substantially higher incidence of IE than the background population. In particular, PVR was associated with an increased incidence of IE. With an increasing life expectancy of these patients, intensified awareness, preventive measures, and surveillance of this patient group are decisive.

An evaluation of prophylactic and therapeutic antibiotic prescribing in Lebanese dental practice

To evaluate antibiotic prescribing patterns and correlates among Lebanese dentists. A descriptive observational study was conducted, from the first of April to the end of May 2017. Dentists who specialized in oral dental surgery or general dental practitioners were eligible to participate in this study. All patients who sought consultation with the selected dentists over a 1 month period were included. A total of 2323 oral and dental procedures were performed by 60 dentists; 553 antibiotic prescriptions were prescribed, representing 23.8% (52.35% for prophylactic purposes and 47.65% for curative purposes). Prophylactic indications were mainly for implant surgery (36.3%) with only 1% appropriate. Curative use was mainly for periodontal abscesses/abscesses (indeterminate) (22.8%), followed by pulpal diseases and periradicular complications (20.5%); it was appropriate in only 1.7 and 1.9% of cases respectively. Amoxicillin-clavulanic acid was the antibiotic that was mostly prescribed for both curative and prophylactic uses (57.6 and 55.9%, respectively), followed by amoxicillin for prophylactic purposes and a combination of spiramycin plus metronidazole for curative purposes. Adherence to guidelines was low for both curative and prophylactic purposes (17.4 and 21.8%, respectively), but was better in patients who were younger [adjusted odds ratio(aOR) = 0.96], male (aOR = 0.40), or had cardiac disease with moderate or high infective endocarditis risk (aOR = 21.72), and when prescribed by oral surgeons (aOR = 0.15). This study showed evidence of the overuse of antibiotics among Lebanese dentists. It can serve as a basis for future studies to optimize antibiotic use among dentists in Lebanon.

The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective study

ObjectiveAntiaggregants (Ag) could prevent infective endocarditis (IE) in preclinical studies. In this study we investigated whether Ag or anticoagulants (Ac) were also protective in humans. MethodsIn part I we determined the incidence of IE of bioprosthetic aortic valves (PVE) in 333 consecutive patients who underwent aortic valve replacement for noninfective aortic insufficiency between 2009 and 2019. In part II we retrospectively analyzed data of 137 patients who had developed IE of the native aortic valve (NVE) between 2007 and 2015. Multivariable Fine–Gray and logistic regression models were used to investigate associations between Ag and Ac therapy and IE. ResultsSixteen of 333 (4.8%) aortic valve replacement recipients developed PVE after a median of 3.72 years. There was no association between Ag and PVE, whereas Ac was associated with a higher IE occurrence (no association for vitamin K antagonists but significant for fondaparinux or low molecular-weight heparins; hazard ratio, 4.61; 95% CI, 1.01-21.9). In contrast, among the 137 patients in part II, vitamin K antagonists (odds ratio [OR], 7.52; 95% CI, 2.51-22.6), double antiplatelet therapy (OR, 44.3; 95% CI, 4.83-407), novel oral Ac (OR, 4.17; 95% CI, 1.15-15.1), and fondaparinux or low molecular-weight heparins (OR, 9.87; 95% CI, 1.81-53.9), but not acetylsalicylic acid, were associated with NVE. ConclusionsAc were associated with IE in both cohorts, whereas Ag were not associated with PVE. This might reflect differences in the studied populations, with Ag and Ac being prescribed for conditions associated with long-term IE risk in the NVE cohort. Therefore, determining the potential protective effect of Ag and Ac will necessitate further well–controlled studies.

Risk of infective endocarditis in patients with Staphylococcus aureus blood stream infection and declining kidney function

Abstract Background Worldwide, Staphylococcus aureus (S.aureus) is one the most common causes of infective endocarditis (IE), particularly in dialysis patients. However, the association between mildly and moderately decreased kidney function and IE in patients with S.aureus blood stream infection (SAB) has not been examined. Purpose In a retrospective nation-wide study, to evaluate the association between IE and declining kidney function in SAB patients. Methods All patients with first-time SAB between January 1st, 1996 to December 31st, 2018 were identified from a national database including &amp;gt;90% of all patients with SAB. By cross-linking with other nationwide databases, co-morbidities were recorded. The population was divided into 4 groups according to eGFR: group 1 (eGFR ≥90), group 2 (eGFR 30–89), group 3 (eGFR &amp;lt;30) and group 4 (Renal Replacement Therapy dependent). Patients were followed until the outcome of IE. Changes in co-morbidities across the eGFR groups were tested with the Cochran-Armitage test. In a multivariable logistic regression analysis, the odds ratio (OR) of IE was calculated for each eGFR group while adjusting for age, sex, hypertension, diabetes, native valve disease (NVD), prosthetic valve, and cardiac implantable electronic device (CIED). Results Among 17,759 SAB patients, 1,098 were diagnosed with IE. The male population accounted for 60–70% of the IE patients in each eGFR group (Table 1). The overall median age of S.aureus IE patients was 61.5 [48–72] with the highest median age in group 2 (67 [57–76]). Across the eGFR groups, there was a significant increase in the prevalence of diabetes (12.6% in group 1 to 47.0% in group 4), hypertension (18.9% in group 1 to 80% in group 4) and native valve disease (18.7% in group 1 to 36.4% in group 4), p&amp;lt;0.0001. In a multivariate analysis with group 1 as reference, the adjusted OR of S.aureus IE increased significantly with OR 1.16 [95% CI 1.01–1.34] in group 2 to OR 1.42 [95% CI 1.07–1.87] in group 3. The increase was not significant in group 4, OR 1.63 [95% CI 0.95–2.53]. The OR of S.aureus IE decreased with increasing age groups and OR was 0.55 [95% CI 0.43–0.71] among patients &amp;gt;80 years as compared to the reference age group, 18–39 years. A significantly increased OR of S.aureus IE was found among patients with NVD (OR 3.25 [95% CI 2.22–4.76]), prosthetic valve (OR 6.31 [95% CI 5.10–7.79] and CIED (OR 2.88 [95% CI 2.35–3.53]). The overall in-hospital mortality was 16.4% (n=181), with the highest mortality in group 3 (n=11, 22.3%). Overall, the one-year mortality was 26.6% (n=292), and the highest mortality was found in group 4 (n=29, 34.1%). When adjusting for age and sex, mortality did not differ significantly with declining eGFR. Conclusion In this study, we found a significant increase in the odds ratio of IE in patients with SAB when kidney function decreased. Both in-hospital and one-year mortality were high, but did not differ significantly across the eGFR groups. Funding Acknowledgement Type of funding sources: None.