Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms: A Nationwide Analysis.

Antithrombotic agents: Do they protect from infective endocarditis? A retrospective observational study using TriNetx

Enterococcus faecalis Bacteremia Following Transurethral Resection of the Prostate (TURP): Urinary Sepsis or Infective Endocarditis?

Infective endocarditis presents unique challenges, particularly in individuals with congenital heart diseases, such as this case, where the patient had tetralogy of Fallot physiology secondary to double outlet right ventricle, and Fanconi anemia. This case describes how the combination of multiple factors necessitated multidisciplinary management. A 45-year-old South Asian male patient with a known history of tetralogy of Fallot physiology secondary to double outlet right ventricle presented to our emergency department with fatigue, fever, and neurological deficits suggestive of an embolic stroke. Transthoracic echocardiography revealed severe pulmonary stenosis and a significant subaortic ventricular septal defect with vegetations, indicative of infective endocarditis. Magnetic resonance imaging of the brain demonstrated multiple infarcts, suggestive of an embolic event. Blood cultures grew Streptococcus mitis. The patient was admitted to the intensive care unit and treated with aggressive antibiotic therapy. However, his clinical course was complicated by disseminated intravascular coagulation and acute kidney injury, requiring hemodialysis and transfusion support. Despite interventions, his condition deteriorated further. Genetic consultation indicated Fanconi anemia, adding complexity to his clinical management. This case is remarkable because the patient survived up into adulthood with double outlet right ventricle and tetralogy of Fallot physiology without prior corrective surgery, which is a rare occurrence. The embolic stroke, likely resulting from a septic embolus, and the presence of Fanconi anemia further complicated the clinical scenario. Despite aggressive treatment, the patient's progression to refractory sepsis and disseminated intravascular coagulation ultimately resulted in cardiac arrest. This case underscores the importance of early recognition, multidisciplinary collaboration, and tailored therapeutic strategies in managing complex congenital heart diseases with infective endocarditis and other comorbidities.

Infective endocarditis (IE) remains a serious condition with a high mortality rate, even with recent improvements in its diagnosis and management. HACEK organisms, which include Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae, are gram-negative bacteria naturally found in the human mouth and upper respiratory tract. Despite their limited pathogenic potential, HACEK organisms account for 1-3% of all cases of infective endocarditis. This form of endocarditis primarily affects individuals with pre-existing heart conditions or prosthetic heart valves. The disease typically progresses slowly, with an average diagnostic delay ranging from one month for Haemophilus spp. to three months for Aggregatibacter and Cardiobacterium spp. We present a case of a 40-year-old previously healthy man who has been managed for HACEK-IE in native valves without a pre-existing cardiac disease. His blood cultures yielded a gram-negative bacillus which was identified as Cardiobacterium hominis. He was managed with third generation cephalosporin for six weeks with a good clinical outcome. This case highlights the importance of considering HACEK-IE in a patient with native heart valves.

Given the diverse technical challenges associated with transcatheter valve-in-transcatheter valve procedures, the treatment strategy for each clinical case must be tailored to the individual patient.We present the case of a man in his late 70s with a complex clinical history, including two prior transcatheter aortic valve implantation (TAVI) procedures and infective endocarditis, who later developed severe degeneration of the aortic prosthesis requiring a third transcatheter intervention.Initially treated with a Lotus valve in 2014, the patient underwent a TAV-in-TAV with an Evolut prosthesis in 2022, followed by endocarditis-related degeneration and severe restenosis. In 2024, a third prosthetic valve (Acurate neo2) was implanted using the TAV-in-TAV-in-TAV technique.With expanding indications for TAVI and increasing longevity among treated patients, complex multi-prosthesis interventions may become more frequent, highlighting the need for improved procedural planning, imaging strategies and long-term surveillance. At 1-year follow-up, the patient remains asymptomatic with preserved valve function.This case illustrates the feasibility of a third TAVI after treated prosthetic valve endocarditis, supported by CT-guided procedural planning and 1-year follow-up, which remains scarcely reported in the literature.

Intracranial mycotic aneurysms are rare, representing only 0.7%-5.4% of all intracranial aneurysms, and typically arise from septic emboli secondary to infective endocarditis. Large-vessel occlusion due to a septic embolus is exceedingly uncommon and carries high morbidity. A 29-year-old man with methicillin-resistant Staphylococcus aureus endocarditis and intravenous drug use presented with intracerebral and subarachnoid hemorrhage. CT angiography revealed a left parieto-occipital hematoma with midline shift. An emergency craniotomy for hematoma evacuation exposed a ruptured distal middle cerebral artery (MCA) mycotic aneurysm, which was clipped, and pathological analysis confirmed abscess formation within the aneurysm wall. Despite antibiotic therapy, a new distal MCA aneurysm developed within an abscess cavity. Cerebral angiography later demonstrated M1 occlusion requiring mechanical thrombectomy, achieving partial reperfusion consistent with Thrombolysis in Cerebral Infarction grade 2a. The persistent abscess and aneurysm required Onyx embolization and abscess drainage in a hybrid operating room. Sequential mycotic aneurysms with concurrent large-vessel occlusion and abscess formation represent a rare and aggressive manifestation of septic emboli. Successful management depends on coordinated microsurgical clipping, endovascular embolization, thrombectomy, and abscess evacuation. Early recognition of evolving vascular pathology and combined surgical-endovascular approaches improve outcomes in infective mycotic aneurysm-related cerebrovascular disease. https://thejns.org/doi/10.3171/CASE25902.

Candida endocarditis (CE) is a rare but highly lethal complication of candidemia, comprising 1-2% of infective endocarditis cases, yet associated with disproportionately high mortality. Large-scale contemporary data on predictors of in-hospital death remain limited. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult CE hospitalizations. Weighted descriptive statistics described the cohort, and multivariable logistic regression identified predictors of in-hospital mortality. Secondary outcomes included length of stay (LOS) and hospitalization costs. Among 1280 CE hospitalizations, in-hospital mortality was 18.8%. Predictors of higher mortality included age 45-64years (aOR 2.61; 95% CI 1.57-4.41) and ≥ 75years (aOR 2.11; 95% CI 1.06-4.19), hematologic malignancy (aOR 33.5; 95% CI 12.3-101), surgical ventricular assist devices (aOR 45.7; 95% CI 8.25-284), femoral (aOR 12.9; 95% CI 4.78-36.0) or subclavian (aOR 22.4; 95% CI 5.65-82.7) central venous catheters, septic shock (aOR 9.47; 95% CI 6.21-14.8), embolic stroke (aOR 10.5; 95% CI 4.72-23.9), cardiogenic shock (aOR 3.69; 95% CI 1.61-8.51), and acute kidney injury (aOR 1.64; 95% CI 1.04-2.60). Valve intervention significantly reduced mortality (aOR 0.04; 95% CI 0.01-0.09). Non-survivors had longer hospital stays (median 24 vs. 19days) and nearly double the hospitalization costs ($117,808 vs. $61,178). In this nationally representative cohort, CE remained highly lethal, with age, malignancy, invasive devices, and critical complications driving mortality. Valve intervention conferred substantial survival benefit, underscoring the importance of early recognition, multidisciplinary care, and timely surgical evaluation.

Echocardiography is crucial in the diagnosis of infectious endocarditis (IE). We assessed the correlation between transesophageal echocardiography (TEE) and surgical findings. A retrospective study of IE patients who underwent surgery. Discrepancies between TEE and surgical findings were defined as ≥ 1 infected valves, vegetations and abscess, and vegetations size ≥5 mm. Descriptive statistics and regression analysis were performed. Eighty patients were included. Mean age was 55.03 years, 26.3% had prosthetic valves. S. aureus and S. viridans spp were identified in 22.5% and 20% of cases, respectfully. On TEE, 84% had vegetations, and 31.2% had abscesses. Mitral and aortic valves were affected in 51%, and 40%, respectfully. TEE and surgical findings highly correlated regarding abscess count, valve involvement, and vegetation size. Significantly, more vegetations were observed during surgery compared to TEE (19% vs. 11%). In 46 patients (57.5%) (Group 1) no discrepancies were found. In 34 patients (42.5%) ≥ 1 discrepancy was found (Group 2). Patients in Group 1 vs. 2 presented with significantly more weakness (80.4% vs. 52.9%) and confusion (21.2% vs. 2.9%). Mitral valve involvement [21 (45.7%) and 24 (70.6%)], and larger vegetations on TEE (15.17 mm vs. 20 mm) were significantly more common in Group 2. S. viridans was linked to more discrepancies (p = 0.07). In a multivariate model Charlson index and vegetation size were associated with discordant findings. Discrepancies were observed between TEE and surgical findings, especially in patients with S. viridans IE or mitral valve involvement. These differences did not affect surgery appropriateness.

Percutaneous mechanical aspiration as a bridging strategy for massive ICD lead-associated vegetations in cardiac device-related infective endocarditis.

The management of complicated Gram-positive bloodstream infections (cBSI) and infective endocarditis (IE) often requires prolonged intravenous therapy. Transition to oral therapy is frequently unfeasible because of resistance, drug interactions, or adherence concerns, increasing the risk of intravenous-related complications and healthcare burden. The pharmacokinetic profile and spectrum of oritavancin may enable effective treatment and early discharge. This study evaluated its effectiveness, safety, and impact on hospital resource use in patients with cBSI or IE. We conducted a multicenter, retrospective, observational study across eight hospitals in Italy and Spain (April 2023-February 2025). Adult patients with Gram-positive cBSI (persistent/refractory BSI or prosthetic material) or IE (2023 modified Duke criteria) treated with ≥ 1 dose of oritavancin were included. Dosing was determined by the treating physicians. Data on outcomes, adverse events (AEs) and healthcare use were collected from medical records. Patients were followed for at least 6months. Twenty-seven patients were included: 13 (48.1%) cBSI and 14 (51.9%) IE. Median age was73years (IQR 65-81); 18 out of 27 (66.7%) were male; Charlson Comorbidity Index 6 (IQR 4-7). In cBSI, oritavancin was first-line in 6/13 (46.2%) and given in multiple doses in 8/13 (61.6%), median of 2 doses (IQR 2-2.5). Clinical success was 100%, with no recurrence or BSI-related mortality. In IE, Staphylococcus aureus was identified in 5 of 14 cases (35.7%), of which 40% were methicillin-resistant. Native valves were involved in 6/14 (42.8%), prosthetic valves in 6/14 (42.8%), cardiac devices in 2/14 (14.3%). Clinical success wasachieved in 85.7% of patients with IE (12/14). Two AEs occurred: nausea and a non-fatal acute coronary syndrome in a patient with pre-existing ischemic heart disease. Oritavancin use reduced 369hospital days with potential savings of approximately €4235 per patient. Oritavancin may represent a safe, effective treatment option for selected patients with cBSI or IE, with advantages in outcomes, reduced hospital stay, and cost containment.

Giants in infectious diseases: Prof. Jose M. Miró's translational research in infective endocarditis.

Comparative risk of infections with GLP-1 receptor agonists versus SGLT2 inhibitors in patients with advanced chronic kidney disease and type 2 diabetes.

Perivalvular abscess is a life-threatening complication of infective endocarditis. Early recognition using transesophageal echocardiography (TEE), including advanced three-dimensional (3D) imaging, is crucial for diagnosis, surgical planning, and timely intervention. This case highlights the value of 3D TEE in defining peri-annular extension and guiding complex procedures, such as the Commando surgery.

Quercetin and its derivatives as potent inhibitors of PilA protein of Streptococcus sanguinis: An in silico approach to combat infective endocarditis

Genomic insights into clinical Teichococcus aerofrigidensis: acquisition of aminoglycoside phosphotransferase resistance genes via Tn6082 transposon.

There has been a notable increase in hospitalizations due to Right-Sided Infective Endocarditis (RSIE), affecting the endocardium and right chambers. With a rising incidence, ranging between 5-10%, and an approximate mortality rate of 6%, (RSIE) poses specific challenges in terms of diagnosis and treatment. Its atypical clinical presentation compared to left endocarditis and its therapeutic particularities underline the need for greater understanding. In this series of cases, we proposed to highlight crucial data to suspect and guide the diagnosis and timely treatment to avoid complications.

Background and Objectives: Catheter-related bloodstream infections (CRBSIs) and infective endocarditis (IE) lead to substantial morbidity, prolonged hospitalizations, and increased mortality. This study aimed to determine the incidence of IE among hospitalized catheter-dependent HD patients with CRBSI and identify risk factors associated with 90-day all-cause mortality. Materials and Methods: We conducted a retrospective analysis of patients diagnosed with CRBSI. Clinical, microbiological, and accessible echocardiographic data were evaluated. Risk factors for 90-day mortality were analyzed using univariate analysis and multivariable binary logistic regression analysis models. Results: A total of 85 hospitalized catheter-dependent HD patients with CRBSI were included. Gram-positive organisms were the predominant pathogens (70.6%), with Staphylococcus aureus identified in 35.3% (30/85) of all CRBSI cases. Gram-negative bacteria accounted for 29.4% of all CRBSIs. IE was identified in 9.4% (n = 8) of patients diagnosed with CRBSI. Significant differences were observed between the IE and non-IE groups regarding the need for length of hospital stay, vegetation, embolism (p < 0.05). The 90-day all-cause mortality rate was 14.1% (n = 12). Univariate analysis identified that older age and female gender were associated with increased mortality (p < 0.05). In the multivariable binary logistic regression, only age (OR: 1.055, 95% CI: 1.005-1.107, p = 0.029) remained an independent predictor of 90-day mortality. Conclusions: In catheter-dependent HD patients, Staphylococcus aureus is the predominant organism associated with both CRBSI and IE. With an observed IE occurring in 9.4% hospitalized catheter-dependent HD patients with CRBSI, consistent compliance with prevention bundles must be prioritized as a standard of care for catheter management.

The prognostic impact of vegetation size in infective endocarditis (IE) remains unclear. Our aim was to evaluate the relation between vegetation size and outcome. Our data come from the Spanish IE registry between 2008 and 2024. From 6525 IE patients, 5,000 (76.6%) had vegetations, and 3,592 (55.1%) had documented vegetation size measurements. Patients were categorized into two groups based on maximum vegetation diameter: <10 mm (1,319 - 36.7%) and ≥10 mm (2,273 - 63.3%). Compared to patients with small vegetations, patients with vegetations ≥10 mm were younger (68 vs. 70 years, p<0.001), had more frequent right-sided IE (8.0% vs. 4.1%, p<0.001), less prosthetic valve IE (23.9% vs. 29.9%, p<0.001), higher surgical rates (55.9% vs. 40.1%, p<0.001), more embolic events (28.0% vs. 21.4%, p<0.001), higher in-hospital (28.3% vs. 19.6%, p<0.001) and one-year mortalities (35.6% vs. 27.5%, p<0.001). Large vegetation size was an independent predictor of in-hospital mortality (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9, p<0.001), embolic events (OR 1.34, 95% CI 1.15-1.55, p<0.001), and one-year mortality (hazard ratio 1.32, 95% CI 1.17-1.50, p<0.001). Vegetation size was an independent predictor of inhospital mortality in left-sided IE (OR 1.7, 95% CI 1.4-2.1, p<0.001) but not in right-sided IE (OR 1.2, 95% CI 0.7-2.3, p = 0.50). In patients with IE, large vegetation size is independently associated with embolic events and increased mortality particularly in those with left-sided IE, suggesting the need for more aggressive management in these patients.

Infective endocarditis (IE) is a rare but potentially life-threatening condition with a wide spectrum of clinical presentations, often leading to diagnostic delay. The COVID-19 pandemic has added further complexity by overlapping clinical features and imposing constraints on diagnostic pathways. We report the case of a 48-year-old male who presented with prolonged non-specific symptoms following a recent COVID-19 infection. Multiple emergency department visits resulted in an initial diagnosis of viral illness. Subsequent clinical deterioration prompted further evaluation, which revealed severe aortic regurgitation due to a large aortic valve vegetation on transthoracic echocardiography. Blood cultures grew α-haemolytic Streptococcus mitis fulfilling the modified Duke criteria for IE. The patient developed complications, including heart failure and peripheral arterial embolisation, necessitating urgent surgical aortic valve replacement. This case highlights the diagnostic challenges of IE in the context of recent COVID-19 infection, where overlapping symptoms and altered healthcare pathways may contribute to delayed recognition. Clinicians should maintain a high index of suspicion for IE in patients presenting with persistent or atypical symptoms following COVID-19 infection. Early recognition and prompt intervention are essential to prevent serious complications.