Prosthetic Valve Infective Endocarditis Research Articles

Epidemiological and microbiological characteristics and complications of infective endocarditis in children

Despite the progress in diagnostic modalities and therapeutic strategies, Infective endocarditis remains a lethal disease especially in children. We aimed to update current characteristics of infective endocarditis in children and to identify complications. We carried out in our department a retrospective study including 40 children diagnosed with infective endocarditis (IE) between 1983 and 2017. Forty children with IE were diagnosed by using modified Ducke criteria. There were 19 boys and 21 girls aged between 1 to 18 years. Sixteen children (40%) had congenital heart disease including inter ventricular septal defect, tetralogy of Fallot, patent ductus arteriosis. Left-side IE occurred in 33 patients (82.5%). There was no case of IE of prosthetic valve. Streptococcus viridans were identified in 4 patients and Staphylococcus aureus in 5 patients. Blood culture-negative IE was concluded in the other cases. Neurological complications occurred in 9 patients, including 5 with cerebral infarction and 3 with intra cerebral bleeding. Clinical signs of cerebral stroke were hemiparesis (63%), facial paralysis (18%) and speech disorder (27%). One case of pulmonary embolism was identified and 3 cases of splenic infraction. The mortality in children with IE was important (50%). The mortality rate in patients who had cerebral stroke was significantly higher than those who had not (75% versus 35%, P < 0.05). In our study, IE in child has various characteristics compared to IE in adult. IE complication increases the risk of death.

P1694 Prosthetic mitral valve infective endocarditis complicated by left ventricle to right atrial fistula

Abstract Left ventricle (LV) to right atrial (RA) shunt is a rare type of ventricular septal defect. Acquired LV-RA shunt is rare and may occur as complication of cardiac surgery, endocarditis, thoracic trauma or myocardial infarction. Infective endocarditis is the second most important cause of this type of shunt. Case presentation A 44 year old female patient presented to our hospital complaining of progressive exertional dyspnea and palpitations for 6 months, and high grade fever for 2 weeks. The patient had history of mitral valve replacement with mechanical prosthesis 16 years ago. The patient had no history of recent invasive procedures or dental interventions. General examination revealed an irregular pulse at rate of 100 beats per minute (bpm), blood pressure of 100/60 mmHg, temperature of 38.5 ͦ C and congested neck veins. Cardiac examination revealed an audible prosthetic mitral click with a harsh pansystolic murmur heard on the apex and left sternal border, and an accentuated P2 over the pulmonary area. Her resting electrocardiogram (ECG) showed atrial fibrillation with ventricular response of 110 bpm. Her laboratory investigations revealed normochromic normocytic anemia with Hemoglobin level of 8 g/dl (13-16), and leucocytosis with white blood cell count of 16.24 103 cell/ ul (4.00-11.00); as well as elevated C-reactive protein (CRP) level of 73 (0-3). Her international normalized ratio (INR) was 3 (1-1.3) on warfarin 5 mg. Transthoracic echocardiography (TTE) revealed a dehiscent prosthetic mitral valve with severe paravalvular regurgitation, severe tricuspid valve regurgitation and pulmonary hypertension with predicted resting pulmonary artery systolic pressure of 60 mmHg. It also showed an abnormal jet passing from the LV into the RA above the tricuspid valve during systole, both right and left ventricular systolic functions were preserved. Subsequent 2D/3D transoesophageal echocardiography (TEE) confirmed the TTE findings with detection of LV-RA fistula with significant left to right shunt; it also visualized multiple vegetations attached to the mitral annulus at the site of the valve dehiscence. The patient was diagnosed with prosthetic mitral valve infective endocarditis, empirical antibiotics were started and the patient was referred for another center for urgent surgery. Redo mitral valve replacement, tricuspid valve repair and closure of the defect were done; the patient developed complete heart block postoperatively and permanent pacemaker was inserted. Conclusion Infective endocarditis remains a major health problem with high mortality and severe complications. It is important to keep high index of suspicion in high risk patients for infective endocarditis as delayed diagnosis increases the risk of serious complications and mortality, and makes surgical intervention, if indicated, more demanding with increased incidence of perioperative complications. Abstract P1694 Figure. TTE&amp;TEE of prosthetic mitral IE

P202 Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves

Abstract Purpose The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves. Methods Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography. Results In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p = 0.002), 84% and 82% and 89% and 95% (p = 0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p = 0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve. Conclusions Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.

Infective endocarditis: A changing epidemiological profile over the years: A prospective cohort study

Epidemiological features of infective endocarditis (IE) have changed during the last decades because of an increase in degenerative valvular disease in the elderly, placement of prosthetic valves, and exposure to invasive procedures. Although lower mortality rates have been observed, overall mortality remains high. The aim of this study was to analyse epidemiology, and predictors of 6-month mortality in IE. This was a prospective study that enrolled 240 patients admitted for IE in the cardiology department of Monastir hospital between 1983 and 2017. Included Patients had definite IE according to the modified Ducke criteria. Thirty-two percent of episodes involved prosthetic valves. Thirty percent of episodes were nosocomial. Thirty-three percent included staphylococci, 22% streptococci, and 10% enterococci. At least one complication occurred in 59% of the episodes and 43% had surgical intervention. Six-month mortality was 20%: 29% for staphylococci, 19% for enterococci, and 9% for streptococci. Seventy-one percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 13% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age ( P = 0.04), the causative microorganism ( P = 0.03), and treatment group ( P = 0.03). Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus was the predominant microorganism. Age, staphylococci, and the contraindication to surgery were the main predictors of 6-month mortality.

P1247 Bilateral endogenous endophthalmitis as the initial presentation of hacek prosthetic valve infective endocarditis

Abstract Summary A 75 year old lady with a prosthetic aortic valve (St Jude mechanical AVR) presented to ophthalmology with a one month history of black spots in the vision of her left eye with a further episode in her right eye two weeks later, leading to a diagnosis of bilateral endogenous endopthalmitis and was admitted to hospital. There was no history of trauma and the chest and abdominal examination was normal. The erythrocyte sedimentation rate (40) and C reactive protein (45.8) were elevated. She had several sets of blood cultures, which were positive for Aggregatibacter actinomycetemcomitans, a HACEK organism and was started on empirical Ceftriaxone. The transthoracic echocardiography was normal. However, the suspicion of Infective Endocarditis (IE) was high, therefore a transoesophageal echocardiography was performed and showed an aortic root abscess (Image 1). An urgent computerised aortogram was performed. Following a planned two week period of intravenous antibiotics the patient was taken to theatre to have a redo AV valve replacement and root repair. Following a prolonged period on intensive care and a six week course of pathogen directed antibiotic therapy she was then fit enough to be discharged. Conclusion We present the first case in the literature of a HACEK Prosthetic Valve endocarditis presenting with bilateral endogenous endophthalmitis. Abstract P1247 Figure. TOE image of Absess

Predictive model of in-hospital mortality in left-sided infective endocarditis

Introduction and objectivesInfective endocarditis (IE) is a complex disease with high in-hospital mortality. Prognostic assessment is essential to select the most appropriate therapeutic approach; however, international IE guidelines do not provide objective assessment of the individual risk in each patient. We aimed to design a predictive model of in-hospital mortality in left-sided IE combining the prognostic variables proposed by the European guidelines. MethodsTwo prospective cohorts of consecutive patients with left-sided IE were used. Cohort 1 (n=1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment sample to derive the model (n=688), and a validation sample for internal validation (n=314). Cohort 2 (n=133) was used for external validation. ResultsThe model included age, prosthetic valve IE, comorbidities, heart failure, renal failure, septic shock, Staphylococcus aureus, fungi, periannular complications, ventricular dysfunction, and vegetations as independent predictors of in-hospital mortality. The model showed good discrimination (area under the ROC curve=0.855; 95%CI, 0.825-0.885) and calibration (P value in Hosmer-Lemeshow test=0.409), which were ratified in the internal (area under the ROC curve=0.823; 95%CI, 0.774-0.873) and external validations (area under the ROC curve=0.753; 95%CI, 0.659-0.847). For the internal validation sample (observed mortality: 29.9%) the model predicted an in-hospital mortality of 30.7% (95%CI, 27.7-33.7), and for the external validation cohort (observed mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5). ConclusionsA predictive model of in-hospital mortality in left-sided IE based on the prognostic variables proposed by the European Society of Cardiology IE guidelines has high discriminatory ability.

Long-term Outcome of Patients With Nonoperated Prosthetic Valve Infective Endocarditis: Is Relapse the Main Issue?

In nonoperated prosthetic valve endocarditis (PVE), long-term outcome is largely unknown. We report the follow-up of 129 nonoperated patients with PVE alive at discharge. At 1 year, the mortality rate was 24%; relapses and reinfection were rare (5% each). Enterococcal PVE was associated with a higher risk of relapse.

Association between biomass formation and the prognosis of infective endocarditis due to Staphylococcus aureus

IntroductionThe aim of this study was to evaluate the association between biomass formation and the clinical characteristics and prognosis of Staphylococcus aureus infective endocarditis (IE). MethodsWe prospectively studied 209 S. aureus strains causing IE. Biomass formation was examined using the crystal violet assay and quantified spectrophotometrically. The average (SD) optical density of the biomass was compared for each clinical, microbiological (methicillin-resistance, vancomycin MIC≥1.5μg/ml) and molecular (clonal complex, agr type and agr dysfunction) variable according to their presence or absence. The primary clinical endpoints studied were in-hospital death, severe sepsis, persistent bacteraemia, symptomatic peripheral embolisms and prosthetic valve IE. ResultsMean age was 66.1 years, 61.5% of patients were male and the median age-adjusted Charlson comorbidity index was 5 points (IQR 3–8). In-hospital mortality was 37.3%. Strains belonging to CC5 and CC22 had optical biomass densities [mean (SD) 1.573 (1.14) vs 0.942 (0.98) p<0.001 and 1.720 (0.94) vs 1.028 (1.04) p=0.001, respectively]. Strains belonging to CC5 and CC22 had significantly higher optical biomass densities [1.369 (1.18) vs 0.920 (0.93) p=0.008]. No statistically significant differences were found in the clinical endpoints studied. ConclusionsHigh biomass production was associated with CC5 and CC22 but not with higher hospital mortality, septic complications, type of endocarditis, methicillin-resistance, elevated vancomycin MIC or agr dysfunction.

Cumulative incidence and mortality of infective endocarditis in Siriraj hospital\u2013Thailand: a 10-year retrospective study

BackgroundTo investigate the cumulative incidence of and factors associated with mortality among patients with infective endocarditis (IE) at Thailand’s largest national tertiary referral center.MethodsMedical charts of adult patients diagnosed with IE by Duke criteria at Siriraj Hospital during January 2005 to May 2015 were retrospectively reviewed.ResultsOf 380 patients, 66.3% had definite IE, and 81.3% had native valve IE (NVE). Cumulative IE incidence was 5.67/1000 admissions. The most common pathogens were viridans group streptococci (VGS) (39.7%), methicillin-sensitive Staphylococcus aureus (MSSA) (13.1%), and beta-hemolytic streptococci (11.5%) in NVE; and, MSSA (20.3%), VGS (20.3%), and Enterococcus spp. (16.9%) in prosthetic valve (PVE) or device-related IE (DRIE). Overall in-hospital mortality was 18.4%. Mortality was significantly higher in PVE/DRIE than in NVE (26.8% vs. 16.5%, p = 0.047). End-stage renal disease (ESRD) (aOR: 9.43, 95% CI: 2.36–37.70), diabetes mellitus (DM) (aOR: 2.81, 95% CI: 1.06–7.49), neurological complication (aOR: 14.16, 95% CI: 5.11–39.22), congestive heart failure (aOR: 4.32, 95% CI: 1.91–9.75), hospital-acquired infection (aOR: 3.78, 95% CI: 1.66–8.57), renal complication (aOR: 3.12, 95%CI: 1.32–7.37), and other complication during admission (aOR: 3.28, 95% CI: 1.41–7.61) were independently associated with mortality.ConclusionsThe incidence of IE, and the mortality rate among those diagnosed with IE are both increasing in Thailand – particularly among those with PVE or DRIE. End-stage renal disease, diabetes mellitus, and development of IE-related complications during admission were found to be independent predictors of mortality.

Multimodality Imaging in Infective Endocarditis: An Imaging Team Within the Endocarditis Team.

Infective endocarditis (IE) is a complex disease with cardiac involvement and multiorgan complications. Its prognosis depends on prompt diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. However, IE diagnosis always poses a challenge, and echocardiography remains diagnostically imperfect in cases of prosthetic valve IE or cardiac implantable electronic device infection. In recent years, other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) have experienced significant technical improvements, and their application to the detection of cardiac and extracardiac IE-related lesions seems to be a strategic way forward in the management of patients with suspected IE. However, the scientific evidence in the literature remains limited; current guidelines address the use of the multimodality imaging in the field of IE with caution; the incremental value of each technique and their combinations is debated; and their use varies across countries. Despite these limitations, healthcare providers and surgeons should be aware of the possibilities offered by the multimodal imaging approach when appropriate. Here, we emphasize the value of a multidisciplinary heart valve team, the endocarditis team, underlining the importance of cardiac and extracardiac imaging experts in playing a key role in informing the diagnosis and management of patients with IE. Illustrative cases, critical appraisal of contemporary data, and conceptual and practical suggestions for clinicians that may help to improve the prognosis of patients with IE are provided in this review article.

DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci

ObjectivesTo analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact.MethodsA multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year.ResultsEighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20€) and 557 days for IE (283,187.45€).ConclusionsDBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.

333018F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (PET/CT) for the diagnosis of prosthetic valve infective endocarditis (PVIE): a prospective multicenter study

Abstract Background and objectives 18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the value of this new diagnostic algorithm has never been prospectively assessed. Purposes 1. Primary objective: to assess the value of the new ESC criteria including 18F-FDG PET/CT in prosthetic valve infective endocarditis (PVIE). 2. Secondary objectives: to determine the reproducibility of 18F-FDG PET/CT; to assess its ability to predict embolic events. Methods Between 2014 and 2017, 175 patients with suspected PVIE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable or not feasible PET/CT,115 patients were finally included in the analysis, including 91 definite IE and 24 rejected IE, as defined by an expert Consensus of Endocarditis Team after 3-month follow-up as Gold Standard Nuclear data were blindly analyzed by two independent nuclear medicine physicians. Patients follow-up was scheduled at one and three months after hospitalization Results Significant cardiac uptake by PET/CT (major criterion) was observed in 67 among 91 patients with definite PVIE and 6 patients with rejected IE (sensitivity 73.6%, specificity 75%, positive predictive value 91%, negative predictive value 42%). Considering cardiac uptake as a major criterion, the ESC 2015 classification increased the sensitivity of Duke criteria from 57 to 84% (p&lt;0.001) but decreased its specificity from 84 to 70% (p&lt;0.001). Intraobserver reproducibility of cardiac uptake evaluation was good (kappa = 0.84) but inter observer reproductibility was less satisfactory (kappa = 0.63). Embolic events occurred in 31 patients (27%) and were correlated with vegetation size by ECHO (p&lt;0.001), Staphylococcus infection (p=0.003), and PET/CT cardiac uptake (p=0.02). Conclusion 1. the value of PET CT and ESC criteria is confirmed and may allow earlier diagnosis of PVIE 2. PET CT is associated with an increased risk of false positive results probably related to the technical improvements 3. Reproducibility of nuclear measurements seems unsatisfactory, justifying efforts to standardize PET studies interpretation 4. Our study describes for the first time a positive correlation between a positive PET/Ct and occurrence of embolic events, warranting additional studies.

Long-term Outcomes of Surgery for Invasive Valvular Endocarditis Involving the Aortomitral Fibrosa

Reconstruction of the intervalvular fibrosa (IVF) for invasive double-valve infective endocarditis (IE) is a technically challenging operation. This study presents the long-term outcomes of two surgical techniques for IVF reconstruction. From 1988 to 2017, 138 patients with invasive double-valve IE underwent surgical reconstruction of the IVF, along with double-valve replacement (Commando procedure, n= 86) or aortic valve replacement with mitral valve repair (hemi-Commando procedure, n= 52). Mean follow-up was 41 ± 5.9 months. Reoperation was required in 82% of patients, and 34% underwent emergency surgery. Pathologic features included positive blood cultures (90%), prosthetic valve IE (75%), aortic root abscess (78%), mitral annular abscess (24%), and intracardiac fistula (12%). There were 28 hospital deaths: 21 (24%) in the Commando group and 7 (14%) in the hemi-Commando group (P= .12). Overall survival at 1, 5, and 10 years was 67%, 48%, and 37%, respectively. Coronary artery disease, native valve IE, and causative organism (Staphylococcus aureus, coagulase-negative Staphylococcus, and viridans streptococci) were risk factors for late mortality. Freedom from reoperation at 1, 5, and 8 years was 87%, 74%, and 55%, respectively. Freedom from recurrent IE at 1, 5, and 8 years was 90%, 78%, and 67%, respectively. Although it is technically demanding, surgery for invasive IE involving IVF, which provides the only chance for cure, can be performed with reasonable clinical outcomes. In cases of IE invading the IVF and limited to the anterior mitral valve leaflet, a hemi-Commando procedure that includes mitral valve repair has improved early outcomes.

Outcomes of surgery for infective endocarditis in children: A 30-year experience

BackgroundInfective endocarditis (IE) is rare in children. Limited data have been reported on long-term outcomes of children who undergo surgery for IE. MethodsData were retrospectively obtained from medical records for all children who underwent surgery for IE. ResultsBetween 1987 and 2017, 138 children with IE required surgery (mean age, 8.3 ± 6.5 years). The majority of children (80.4% [111 out of 138]) had underlying cardiac structural anomalies. Prior heart surgery was performed in 50.7% of patients (70 out of 138), including 19.6% (27 out of 138) who had valve replacement. Operative mortality was 5.8% (8 out of 138). Mean follow-up time was 9.7 ± 7.6 years. Long-term survival at 5 and 25 years was 91.5% (95% confidence interval, 85.1%-95.2%) and 79.1% (95% confidence interval, 66.3%-87.5%), respectively. Risk factors associated with death were: age (hazard ratio [HR], 0.88; P = .015), prosthetic valve IE (HR, 3.86; P = .02), coagulase-negative staphylococci (HR, 4.52; P = .015), increased duration of preoperative antibiotic therapy (HR, 1.02; P = .009), shock (HR, 3.68; P = .028), and aortic valve replacement (HR, 3.22; P = .044). In patients with left-sided IE, risk factors independently associated with death were heart failure (HR, 18.8; P = .025) and vegetation size adjusted to body surface area (HR, 1.06; P = .008). Freedom from recurrent endocarditis was 94.7% (95% confidence interval, 87.7%-97.8%) at 25 years. ConclusionsChildren undergoing surgery for IE had good long-term survival and recurrence of IE was uncommon. Surgery during the active phase of endocarditis did not increase risk of mortality or reoperation. In patients with left-sided IE, vegetation size adjusted for patient body surface area was identified as a risk factor for death, and a useful indicator of prognosis.

FDG PET/CT in a case of suspected infective endocarditis of prosthetic valve

FDG PET/CT in a case of suspected infective endocarditis of prosthetic valve

19718F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve infective endocarditis over the modified Duke"s criteria

19718F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve infective endocarditis over the modified Duke"s criteria

Infective endocarditis: A changing epidemiological profile over the years: A prospective cohort study

Epidemiological features of infective endocarditis have changed during the last decades because of an increase in degenerative valvular disease in the elderly, placement of prosthetic valves, and exposure to invasive procedures. Although lower mortality rates have been observed over the last decades, overall mortality remains high. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. And the aim was to analyse epidemiology, and predictors of 6-month mortality in infective endocarditis. A prospective observational cohort study included 240 patients with definite IE. Thirty-two percent of episodes involved prosthetic valves. Thirty percent of episodes were nosocomial. Thirty-three percent included staphylococci, 22% streptococci, and 10% enterococci. At least one complication occurred in 59% of the episodes and 43% had surgical intervention. Six-month mortality was 20%: 29% for staphylococci, 19% for enterococci, and 9% for streptococci. Seventy-one percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 13% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age ( P = 0.04), the causative microorganism ( P = 0.03), and treatment group ( P = 0.03). Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus was the predominant microorganism. Age, staphylococci, and the contraindication to surgery were the main predictors of 6-month mortality.

First reported detection of biofilm formation by Campylobacter fetus during investigation of a case of prosthetic valve endocarditis

AimsCampylobacter fetus subsp fetus (CFF) can cause intestinal illness, particularly in immunocompromised humans, with the potential to cause severe systemic infections. CFF is a zoonotic pathogen with a broad host...

Endocardites infectieuses : formes particulières (coeur droit, prothèse valvulaire, dispositif électronique intracardiaque)

Right-sided infective endocarditis (IE) represents 5-10% of IE. It may occur in patients with electronic intracardiac device, central venous catheter or congenital heart disease, but the most frequent situation is intravenous drug use. Prosthetic valve IE is the most severe form of IE. The diagnosis is more challenging than that of native valve IE, as is treatment, both antibiotic treatment and surgical indications. The infection of an electronic intracardiac device is a severe disease. Both diagnostic and therapeutic strategies are difficult.

Acute kidney injury in infective endocarditis: A retrospective analysis

BackgroundAcute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria. MethodsUsing the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015. ResultsSeventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n=29, 37.7% vs. n=4, 1.4%, P<0.0005), cardiac failure (n=29, 36.7% vs. n=1, 2.9%, P<0.0005), diabetes mellitus (n=14, 18.2% vs. n=1, 0.9%, P=0.034), and prosthetic valve IEs (n=24, 31.2% vs. n=4, 11.4%). No differences were observed for gentamicin exposure (n=57, 64% vs. n=32, 86.5%, P=0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92–17.9), 4.37 (95% CI 4.37–465.7), and 1.084 (1.084–16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4±22.1 days vs. 39.6±12.6, P<0.005). ConclusionAKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.