Risk Factors For Endocarditis Research Articles

Adults knowledge and perception of their congenital heart disease: a single center cross-sectional study

Abstract Background A great proportion of patients with congenital heart disease (CHD) reach adulthood and face daily challenges living with a chronic illness. Healthcare management of these patients is complex requiring a multidisciplinary approach. To date, few studies have focused on adult patients’ understanding of their CHD. Aim To assess adults’ knowledge of their CHD on 4 domains: (1) disease and treatment, (2) preventive measures, (3) physical activity, (4) reproductive issues. Methods One single center cross-sectional study. Patients were opportunistically recruited to participate in the study at their CHD medical visit, between October 2022 and December 2022. The authors translated Leuven Knowledge Questionnaire for CHD to Portuguese language. Patients that were willing to participate filled the survey before entering the physician’s room. Demographic and clinical variable were gathered during patients’ interview and from clinical records. After run-in period, data were analyzed in SPSS ® for the descriptive analysis. Categorical values were reported as counts and percentages. Results From a total of 344 patients observed during recruitment period, 97 accepted to participate in the study. Demographic and clinical characteristics of the study population are described in Table 1 and 2. Mean age was 41 years, 60% were female, 34% have an education level above 12th grade and 74% are employed. The 3 most prevalent CHD were Tetralogy of Fallot (16%) and atrial septal defect type secundum (13%) and ventricular septal defect (10%). Approximately half of the patients knew the name of their CHD and 41% could describe or locate the lesion on the pictured diagram. 38% could identify at least two symptoms of clinical deterioration. Three-fourths of patients did not know what endocarditis is and only 14% could tell fever was the main symptom of the disease. The majority of patients did not know the risk factors for endocarditis. 73% of patients are aware that they should choose an occupation adequate to their physical status and 75% knew that they are allowed to engage in sexual intercourse if capable of doing so. Only 20% had adequate knowledge about the hereditary nature of their condition. 43% of women knew the risk of clinical deterioration during pregnancy. Conclusion This study showed our patients have high levels of education and employment. Still, large proportions of adults have lack of knowledge about important issues in vary domains. These findings reinforce the need to improve patients’ education about their disease. In addition, it highlights the importance of guideline recommendations on multidisciplinary teams to achieve high quality of care in adults with CHD.

P483 IMPACT OF AN ENDOCARDITIS TEAM ON PROGNOSIS: PRELIMINARY RESULTS

Abstract Infective endocarditis (IE) is a life–threatening microbial infection with high mortality rate (6–50% in–hospital and 19–82% at 5–years)1.Guidelines for management of infective endocarditis underline the importance of multidisciplinary approach with an Endocarditis Team (ET) for the complexity of disease and for prognosis which depends on patients’ characteristics, microorganisms involved and local or systemic complications.ET includes specialists that define multimodality imaging approach to confirm diagnosis and to exclude local or systemic complications, discuss timing of antibiotic therapy, indication and timing of surgical treatments and follow–up. This study was a retrospective analysis based on a population of 86 patients from Infermi Hospital, Rimini, who received a diagnosis of IE from 2019 to 2021 thanks to a multidisciplinary approach. Among 86 patients, 76 (88,4%) had early–diagnosed IE and 10 (11,3%) had late–diagnosed IE.Early–diagnoses IE was defined when diagnoses occurred within 30 days from first symptoms.The aim of this study was to assess the impact of ET on timeliness of diagnosis and prognosis.Comparing the two groups, in the early–diagnosed IE we found higher rate of risk factors for endocarditis and systemic embolisation (27,6% vs. 20%), with Staphylococcus and Streptococcus as the most frequent causative pathogens (43,4% and 31,5%).More frequently the late–diagnosed IE group had mechanical prosthetic valves (20% vs 7,8%) with a higher rate of cardiac surgery (80% vs 35,5%), cardiac valves complications such as abscesses, perforations and pseudo–aneurysms (20% vs 18,4%) and a higher rate of intra–hospital mortality (40% vs 18,4%). Streptococcus and Enterococcus were most involved in the late–diagnosed group.Several trials demonstrated that presence of ET reduces 1–year mortality from 18.5% to 8.2% 2 and in–hospital mortality from 28% to 13% 3. Our preliminary study confirms the importance of ET application to improve early diagnosis (88.4%) and to reduce mortality. Bibliography:1.Kouijzer et al., Native valve, prosthetic valve, and cardiac device–related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies(2022). 2.Botelho–Nevers et al. Dramatic reduction in infective endocarditis–related mortality with a management–based approach(2009). 3.Chirillo,F.et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis(2013).

Answer: Acute dyspnoea with an unusual mass in the right ventricle.

What is the most likely diagnosis? ... Chest computed tomography angiogram showed dense, bilateral pulmonary embolism compatible with cyanoacrylate remnants which is used to obliterate varices. Cyanoacrylate is a monomer, which polymerizes fast when in contact with blood to form a strong glue. There are already clues to the aetiology of the mass on transthoracic echocardiography (Figure 1 and see Supplementary material online, Videos S1–S4). A history of drug abuse is a risk factor for endocarditis of the tricuspid valve, but vegetations tend to be irregular shaped with myocardial like grey scale. Furthermore, they are typically attached on the low-pressure side of atrioventricular valves. A papillary fibroelastoma is mostly localized downstream and would display a well-demarcated border with digitations but will rarely exceed a size of 3 cm as seen in this case (Figure 1A and B and see Supplementary material online, Videos S1 and S2), making it less plausible.1 A thrombus is less likely because it is frequently multi-lobulated and hypoechogenic in the acute phase.

Infective endocarditis in childhood: a single-centre experience of 26 years.

The aim of this study was to present the clinical and microbiological characteristics of patients with infective endocarditis.A retrospective evaluation was made of patients diagnosed with infective endocarditis between 1995 and 2021. The clinical and laboratory characteristics of the patients were recorded together with conditions constituting a risk for the development of endocarditis, treatment, and surgical outcomes.Evaluation was made of 68 patients with a mean age of 7.3 years (3 months-17 years), diagnosed with infective endocarditis. An underlying cause of CHD was determined in 47 (69%) patients and rheumatic valve disease in 3 (4.4%). There was no structural heart disease in 18 (26%) patients of whom 13 of them had other risk factors. A causative organism was found in 41 (60%) cases, and the microorganism most often determined was viridans group streptococcus. No difference was determined between the patients diagnosed before and after 2007 in respect of the frequency of viridans streptococcus (p > 0.05). Septic emboli were seen in 18 (26%) patients, of which 17 required surgical treatments. In 5 of 11 (16.6%) patients with mortality, the agent was S. aureus. Of the total 28 (41%) patients were evaluated as hospital-acquired endocarditis. The most frequently determined agents in this group were staphylococcus epidermidis and S. aureus.Although CHDs continue to be the greatest risk factor for endocarditis, there is an increasing frequency of endocarditis in patients with no structural heart disease. Mortality rates are still high in infective endocarditis, especially in S. aureus endocarditis.

Multicenter Study of Endocarditis After Transcatheter Pulmonary Valve Replacement

BackgroundEndocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. ObjectivesThe purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. MethodsThe authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. ResultsInvestigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. ConclusionsThe incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.

Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: a population-based retrospective study

The objective was to describe the epidemiology, bacteriology, clinical presentation, risk factors for endocarditis (IE), diagnostic workup, and outcome of patients with bacteremia caused by the non-influenzae Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella genera (HACEK). A retrospective population-based cohort of patients with bacteremia collected from 2012 to 2017 was identified. Clinical data from identified patients were collected from medical records to classify patients, calculate incidences, analyze risk factors of IE, and describe the management and outcome of the cohort. A total of 118 episodes of HACEK bacteremia were identified, of which 27 were definite IE. The incidence of HACEK bacteremia was 5.2 and of HACEK IE 1.2 episodes per 1,000,000 inhabitants per year. Other focal infections were identified in 55 of 118 of the episodes, most commonly within the abdomen (26 episodes). The propensity to cause IE ranged from 62 in Aggregatibacter actinomycetemcomitans to 6% in Eikenella. Risk factors for IE were cardiac implantable electronical device, predisposing cardiac conditions, community acquisition, long duration of symptoms, multiple positive blood cultures, fever, heart murmur, embolization, and unknown origin of infection. The scoring system DENOVA developed to predict IE in bacteremia with Enterococcus faecalis also had a high sensitivity and specificity for predicting IE in HACEK bacteremia. The 30-day mortality was 4% in IE and 15% in non-IE bacteremia, and only one case of relapse was found. IE is common in bacteremia with Aggregatibacter, Cardiobacterium, and Kingella but relatively rare in Haemophilus and Eikenella. Treatment failures are very rare, and DENOVA can be used to evaluate the need for transesophageal echocardiography.

A Scenario-Based Survey of Expert Echocardiography Recommendations for Patients With Staphylococcus aureus Bacteremia at Varying Risk for Endocarditis

Echocardiography to detect infective endocarditis is regarded as a key quality indicator in the care of patients with Staphylococcus aureus bacteremia, but its application varies markedly between reported series. Understanding the reasons for this variation in practice is important to improve the use of this investigation. To identify expert clinicians' preferred echocardiography strategy for a variety of S aureus bacteremia scenarios in a hypothetical setting free from extrinsic constraints. Anonymous web-based survey study comprising 50 text-based scenarios describing patients with S aureus bacteremia and various combinations of risk factors for endocarditis. Other variables included patient age and the presence of an extracardiac focus of infection warranting prolonged treatment. The survey was emailed to participants between September 2018 and March 2019. Each respondent was asked to recommend 1 of 6 echocardiography strategies for up to 8 randomly selected scenarios. Respondents were primarily infectious diseases physicians, and more than half reported an annual caseload of more than 20 cases of S aureus bacteremia. The proportion of respondents selecting each of the 6 echocardiography strategies was calculated alongside Wilson score confidence intervals. Modified Fleiss κ statistics were used to described interrespondent variability. Generalized estimating equations were used to assess the associations between respondent- and scenario-level variables and the recommendation of an echocardiography strategy with a low negative likelihood ratio for infective endocarditis (ie, a highly exclusionary strategy). A total of 656 respondents from 24 countries provided 4837 echocardiography recommendations across the 50 scenarios. Echocardiography recommendations were associated with scenarios' burden of endocarditis risk (multivariate odds ratio per point of the VIRSTA score, 1.4; 95% CI, 1.4-1.5; P < .001). Poor interrespondent agreement was seen across all scenarios (modified Fleiss κ, 0.06; 95% CI, 0.05-0.07) but was most notable for scenarios with a lower risk of endocarditis (modified Fleiss κ, 0.04; 95% CI, 0.03-0.05). The presence of an extracardiac focus of infection was also associated with the choice of echocardiography strategy (odds ratio for highly exclusionary strategy, 0.51; 95% CI, 0.45-0.58). Respondent location in continental Europe was associated with recommendations in favor of a highly exclusionary strategy (odds ratio, 1.8; 95% CI, 1.3-2.5) compared with location in Australia or New Zealand. In this study, expert clinicians demonstrated active stratification by risk of endocarditis when making echocardiography recommendations for hypothetical patients with S aureus bacteremia. Substantial disagreement existed as to whether patients at lower risk of endocarditis should undergo transesophageal echocardiography-based echocardiography strategies.

Endocardite infecciosa associada à doença periodontal e Diabetes Mellitus

Foi atendido um paciente canino, fêmea, apresentando endocardite da válvula mitral, doença periodontal severa e diabetes mellitus. A endocardite infecciosa é uma doença com baixa taxa de morbidade, porém, com alta taxa de mortalidade. É uma infecção do endocárdio que surge como consequência de uma bacteremia transitória ou permanente. A doença periodontal tem sido incriminada como responsável por bacteremia e fator de risco para a endocardite e resistência à insulina. O estado diabético é considerado um fator agravante para a endocardite e para a doença periodontal pelo comprometimento de várias funções do organismo, inclusive a resposta imune e integridade vascular. O diagnóstico da endocardite geralmente é realizado na necropsia e quando feito na clínica médica, o tratamento é bastante agressivo, prolongado e muitas vezes frustrante. O objetivo do presente trabalho é de relatar o diagnóstico e o sucesso do tratamento de um paciente com endocardite de mitral.

Trends and Outcomes of Infective Endocarditis in Adults With Tetralogy of Fallot: A Review of the National Inpatient Sample Database

BackgroundLesion complexity and prosthetic valves are known risk factors for infective endocarditis in patients with congenital heart disease. Tetralogy of Fallot (TOF) is the most common complex/cyanotic congenital heart disease and often requires prosthetic valve implantation. Population-based risk of endocarditis in TOF patients is unknown. MethodsWe reviewed the National Inpatient Sample (NIS) and identified admissions in TOF patients (>18 years), 2000 to 2014. The primary outcome was to describe incidence of endocarditis-related admissions. To assess trends, we divided the study period into tertiles: early (2000 to 2004), mid (2005 to 2009) and late (2010 to 2014) eras. The secondary outcome was to compare in-hospital mortality, complications, and health care resource utilization between admissions with and without endocarditis. ResultsThere were 393 (2.1%) endocarditis-related admissions among 18,353 admissions, and the incidence of endocarditis-related admissions increased over time: 1.9% (early era) vs 2.2% (mid-era) vs 2.4% (late era), P < 0.001. Overall in-hospital mortality was 6%. In addition to previously described risk factors for endocarditis, such as previous pacemaker/defibrillator or prosthetic valve implantation, we observed an association between endocarditis-related admissions and male gender, black race, and lower socioeconomic class. In comparison with admissions without endocarditis, the endocarditis-related admissions had higher in-hospital mortality, complications, and health care resource utilization measured by length of stay, inflation-adjusted hospitalization cost, and type of hospital discharge. ConclusionsIncidence of endocarditis-related admissions increased over time and was associated with higher mortality, complications, and health care resource utilization. Further studies are required to investigate the observed temporal increase in incidence of endocarditis and explore new strategies to improve outcomes.

Endocarditis After Transcatheter Pulmonary Valve Replacement

BackgroundEndocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and prosthetic valves. ObjectivesThe aim of this study was to evaluate rates and potential risk factors for endocarditis after transcatheter pulmonary valve replacement in the prospective Melody valve trials. MethodsAll patients in whom a transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3 prospective multicenter studies comprised the analytic cohort. The diagnosis of endocarditis and involvement of the TPV were determined by the implanting investigator. ResultsA total of 309 patients underwent transcatheter pulmonary valve replacement (TPVR) and were discharged with a valve in place. The median follow-up duration was 5.1 years, and total observation until study exit was 1,660.3 patient-years. Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR), and a total of 35 patients were reported to have TPV-related endocarditis (34 at the initial diagnosis, 1 with a second episode). The annualized incidence rate of endocarditis was 3.1% per patient-year and of TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR, freedom from a diagnosis of endocarditis was 89% and freedom from TPV-related endocarditis was 92%. By multivariable analysis, age ≤12 years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4; p = 0.011) and immediate post-implant peak gradient ≥15 mm Hg (2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002) were associated with development of endocarditis and with development of TPV-related endocarditis (age ≤12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p = 0.006; gradient ≥15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p = 0.008). ConclusionsEndocarditis is an important adverse outcome following TVPR in children and adults with post-operative congenital heart disease involving the RVOT. Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study: Post Approval Study of the Original Investigational Device Exemption [IDE] Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV] Post-Market Surveillance Study; NCT00688571)

Infective Endocarditis: Update on Epidemiology, Outcomes, and Management.

Infective endocarditis remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. The spectrum of patients presenting with endocarditis is shifting with different risk factors, predisposing patient characteristics, and treatment recommendations than in the past. This review addresses changes in the epidemiology of infective endocarditis, along with current diagnostic imaging modalities, treatment recommendations, and mortality trends. Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. Although transthoracic and transesophageal echocardiography are essential for diagnosis, additional testing (nuclear, computed tomographic, and magnetic resonance imaging) is helpful in selected patients. Early surgical management, even in high-risk patients, has a mortality benefit because eradication of infection with antibiotics alone is difficult and because valve destruction often results in hemodynamic compromise. As part of a broad differential diagnosis, clinicians should consider the diagnosis of endocarditis in patients with risk factors, even when the clinical presentation is nonspecific. Blood cultures and echocardiography are the first steps for diagnosis. Other imaging modalities can enhance diagnosis, particularly in patients with intracardiac devices or prosthetic material. Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition.

Primary percutaneous coronary intervention during ST elevation myocardial infarction in prosthetic valve endocarditis: a case report

BackgroundInfective endocarditis (IE) is still a condition with high mortality and morbidity, especially in the elderly, and in patients with prosthetic valves. The concept of “time-to-therapy” plays a key role for the prompt management of IE and related complications, and the currently available multimodality imaging may play a key role in this setting. Myocardial ischemia due to extrinsic coronary compression from an aortic abscess is an extremely rare condition where the optimal therapeutic strategy has not been defined yet. We present herein the first case of a patient with ST elevation myocardial infarction caused by an aortic root abscess treated with percutaneous stent implantation.Case presentationAn 82-year-old woman with a history of atrial fibrillation, chronic renal failure, anemia and a bioprosthetic aortic valve replacement performed in 2014, was admitted to hospital with profound asthenia and a pyrexia of unknown origin. Because of high clinical suspicion of endocarditis, a trans-esophageal echocardiogram was performed. Empirical broad-spectrum antimicrobial therapy was initiated, followed by targeted treatment based on the results of blood cultures (Staphylococcus aureus). The echocardiogram did not show vegetations and the patient was managed conservatively. She suddenly deteriorated, due to an acute coronary syndrome (ACS) with anterior ST segment elevation. An urgent angiogram was performed, and extrinsic compression of the left coronary system, due to an aortic root abscess, was suspected. After discussion with the surgical team, percutaneous revascularization was attempted, aiming to restore satisfactory hemodynamics, in order to plan surgery. Unfortunately, the patient rapidly developed cardiogenic shock, with multi organ failure, and died in less than 24 h.ConclusionsPatients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography. At present, the specific timing of echocardiographic follow-up and surgical intervention is still a matter of debate, and our case aims to highlight the importance of this aspect in the management of endocarditis, in order to avoid severe complications that adversely affect patient prognosis.

Corynebacterium striatum as an Unusual Case of Endocarditis in an Intravenous Drug User: Case Report and Review of the Literature

Abstract A 59-year-old man, with a history of intravenous drug use, was admitted for 1 week of intermittent fever after a year of recurrent bouts of cellulitis. He quickly defervesced on empiric antibiotic therapy. Admission blood cultures were positive for Corynebacterium striatum as were wound cultures, which also grew methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus. A holosystolic murmur was heard. His transthoracic echocardiogram showed mitral valve prolapse, regurgitation, and a flail leaflet. The transesophageal echocardiogram revealed small perforations and a vegetation of the mitral valve. The endocarditis was successfully treated with surgical repair of the mitral valve and 6 weeks of intravenous vancomycin. Corynebacterium striatum is an unusual cause of endocarditis. It should not be dismissed as a contaminant in patients with risk factors for endocarditis.

Risk factors for pneumococcal endocarditis.

Bacteremia is one of the most common manifestations of invasive pneumococcal disease (IPD). One complication of bacteremia is endocarditis; yet, few studies have evaluated the overall incidence and risk factors for IPD-associated endocarditis. Thus, we evaluated the overall incidence and risk factors of endocarditis compared to those without endocarditis in a large population of IPD patients. We prospectively collected all IPD cases from 2000 to 2014 in Northern Alberta, Canada. Descriptive statistics were used to compare sociodemographic variables, clinical characteristics, and IPD-related outcomes between patients with and without endocarditis. Endocarditis complicated the course of only 28 (0.3%) of 3251 adult patients with IPD. Endocarditis patients were more likely to use illicit drugs and have a higher severity of illness at presentation (i.e., higher rate of altered mental status and rate of intensive care unit [ICU] utilization, p<0.05); however, no other major risk factors were identified. New murmur development among endocarditis patients was common: 39.3% compared to 2.2% of non-endocarditis patients (p<0.001). The mortality rate of 39.3% was more than twice that of the rate of 14.7% for the patients with IPD but without endocarditis. There was no pneumococcal serotype predilection for endocarditis. Endocarditis is an uncommon complication of IPD, but, when present, is associated with a significantly increased risk of mortality. Overall, few specific risk factors were identified for IPD-related endocarditis, with the exception of illicit drug use.

Risk of Infective Endocarditis in Patients with End Stage Renal Disease.

Endocarditis is a serious complication in patients treated with RRT. The study aimed to examine incidence and risk factors of endocarditis in patients with ESRD. The Danish National Registry on Regular Dialysis and Transplantation contains data on all Danish patients receiving renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD. Incidence of endocarditis was estimated for each RRT modality. Independent risk factors of endocarditis were identified in multivariable Cox regression models. From January 1st, 1996 to December 31st, 2012, 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation). Endocarditis developed in 267 (2.5%); of these 31 (12%) underwent valve surgery. The overall incidence of endocarditis was 627 per 100,000 person-years in patients receiving RRT. Incidence was higher in patients receiving hemodialysis compared with those receiving peritoneal dialysis or kidney transplantation (1092 per 100,000 person-years, 212 per 100,000 person-years, and 85 per 100,000 person-years, respectively). Adjusted hazard ratios for endocarditis in patients receiving hemodialysis were 5.46 (95% confidence interval [95% CI], 3.28 to 9.10) and 0.41 (95% CI, 0.18 to 0.91) for kidney-transplanted recipients, respectively, as compared with patients in peritoneal dialysis. The incidence of endocarditis in hemodialysis recipients with central venous catheters was more than two-fold higher as compared with those with arteriovenous fistulas. Overall mortality, subsequent to endocarditis, was 22% in-hospital and 51% at 1 year. The first 6 months in RRT, aortic valve disease, and previous endocarditis were identified as significant risk factors of endocarditis. Patients receiving RRT have a high incidence of endocarditis, in particular during hemodialysis treatment using central venous catheters. The first 6 months in RRT, aortic valve disease, and previous endocarditis are significant risk factors for developing endocarditis.

Risks and Challenges of Surgery for Aortic Prosthetic Valve Endocarditis

Prosthetic valve endocarditis is the most severe form of infective endocarditis. This study assessed the risks and challenges of surgery for aortic prosthetic valve endocarditis. In total, 116 consecutive patients (98 males, age 65.2±12.7years), who underwent redo-surgery for active aortic prosthetic valve endocarditis between 2000 and 2014, were reviewed. Cox regression analysis was used to identify factors for aortic root destructions as well as for morbidity and mortality. Median follow-up was 3.8 years (0-13.9 years). Aortic root destructions (42 limited and 29 multiple lesions) were associated with early prosthetic valve endocarditis and delayed diagnosis (≥14 d), but not with mortality. There were 16 (13.8%) early (≤30 d) and 32 (27.6%) late (>30 days) deaths. Survival at 1, 5, and 10 years was 72±4.3%, 56±5.4%, and 46±6.4%, respectively. The cumulative incidence of death, reinfection, and reoperation was 19.0% at 30days and 36.2% at 1year. Delayed diagnosis, concomitant procedures, and EuroSCORE II >20% were predictors for early mortality and need for mechanical circulatory support, age >70years, and critical preoperative state were predictors for late mortality. In their absence, survival at 10 years was 70±8.4%. Reinfections and reoperations occurred more frequently if ≥1 risk factor for endocarditis and aortic root destructions were present. At 10 years, freedom from reinfection and reoperation was 89±4.2% and 91±4.0%. The risks of death, reinfection, and reoperation are significant within the first year after surgery for aortic prosthetic valve endocarditis. Early diagnosis and aortic root destructions are the most important challenges, but advanced age, critical preoperative state, and the need for mechanical circulatory support determine long-term survival.

Haemophilus parainfluenzae Mural Endocarditis: Case Report and Review of the Literature.

Haemophilus parainfluenzae, which uncommonly causes endocarditis, has never been documented to cause mural involvement. A 62-year-old immunocompetent female without predisposing risk factors for endocarditis except for poor dentition presented with fever, emesis, and dysmetria. Echocardiography found a mass attached to the left ventricular wall with finger-like projections. Computed tomography showed evidence of embolic phenomena to the brain, kidneys, spleen, and colon. Cardiac MRI revealed involvement of the chordae tendineae of the anterior papillary muscles. Blood cultures grew Haemophilus parainfluenzae. The patient was treated successfully with ceftriaxone with resolution of symptoms, including neurologic deficits. After eleven days of antibiotics a worsening holosystolic murmur was discovered. Worsening mitral regurgitation on echocardiography was only found three weeks later. Nine weeks after presentation, intraoperative evaluation revealed chord rupture but no residual vegetation and mitral repair was performed. Four weeks after surgery, the patient was back to her baseline. This case illustrates the ability of Haemophilus parainfluenzae to form large mural vegetations with high propensity of embolization in otherwise normal cardiac tissue among patients with dental risk factors. It also underscores the importance of physical examination in establishing a diagnosis of endocarditis and monitoring for progression of disease.

Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement

ObjectiveTo determine the incidence and risk factors for endocarditis and reintervention in patients undergoing placement of right ventricle-to-pulmonary artery valve conduits. MethodsAll right ventricle–to–pulmonary artery valved conduits placed between 1995 and 2014 were included. Freedom from endocarditis, reintervention, and replacement were analyzed using the Kaplan-Meier method and parametric survival regression models. ResultsA total of 586 patients underwent placement of a total of 792 valved conduits, including 289 (36%) pulmonary homografts, 121 (15%) aortic homografts, 245 (31%) bovine jugular grafts, and 137 (17%) porcine heterografts. There were 474 (60%) primary placements and 318 (40%) replacements. The median duration of conduit follow-up was 7 years; 23 conduits developed endocarditis at a median of 5 years after surgery. The use of bovine jugular grafts was the sole significant risk factor associated with endocarditis (hazard ratio, 9.05; 95% confidence interval, 2.6–31.8 compared with homografts). The hazard was greater for bovine jugular grafts compared with the other conduit types and increased with time; however, bovine jugular grafts were associated with a lower risk for reintervention (P < .0001) and replacement (P = .0002). Factors associated with greater risk of both reintervention and replacement were younger age and smaller conduit size. In addition, a diagnosis of truncus arteriosus was associated with a greater risk for replacement (P = .03). ConclusionsBovine jugular grafts are associated with a significantly greater risk of late endocarditis but with lower reintervention rates compared with other valved conduits. The risk of endocarditis and durability must be balanced during conduit selection. Antibiotic prophylaxis and a high index of suspicion for endocarditis are warranted in patients with bovine jugular grafts.

Bacterial colonization of central venous catheters after heart valve surgery: a risk factor study

In the presence of a prosthetic heart valve, the colonization of a central venous catheter (CVC) has been implicated as a risk factor for endocarditis. Avoiding bacterial colonization of Central Venous Catheters (CVCs) is an everyday challenge for clinicians

Recent advances in the study of Q fever epidemiology, diagnosis and management

Q fever is a worldwide zoonotic infection with an epidemiological pattern consisting of sporadic cases, endemic situations and outbreaks of unsuspected magnitude, as occurred in Holland. This event highlighted the fact that the term "chronic Q fever" is misleading and should be avoided. Here, we review recent advances in the understanding and management of this disease. There have been clonal outbreaks of confirmed "geotypes," such as the outbreaks in French Guiana, where a very high incidence was restricted to one city, with a specific clinical expression, an unusual serological response and a putative common reservoir. The advent of positron emission tomography has improved the diagnosis of endocarditis, vascular and osteoarticular infections. Molecular tests, including fluorescent in situ hybridization, may be included in the diagnostic strategy using the new criteria for endocarditis, vascular and osteoarticular infections. Q fever during pregnancy is challenging because pregnant women are less symptomatic, but infection is associated with a poor fetal outcome, including malformations that are preventable by antibiotics. Male patients over 40 years old with a valvulopathy are at the highest risk for progression to endocarditis. Antibiotic prophylaxis prevents endocarditis in 100% of at-risk patients. Finally, IgG anticardiolipin antibodies, part of the auto-immune response during acute Q fever, were recently added to the risk factors for endocarditis, due to their ability to promote acute valvular lesions and endocarditis.