Risk Factors For Infective Endocarditis Research Articles

Global and Regional Trends and Projections of Infective Endocarditis-Associated Disease Burden and Attributable Risk Factors from 1990 to 2030

Objective To forecast the future burden and its attributable risk factors of infective endocarditis (IE). Method We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model. Results By 2030, the incidence of IE will increase uncontrollably on a global scale, with developed countries having the largest number of cases and developing countries experiencing the fastest growth. The affected population will be predominantly males, but the gender gap will narrow. The elderly in high-income countries will bear the greatest burden, with a gradual shift to middle-income countries. The incidence of IE in countries with middle/high-middle social-demographic indicators (SDI) will surpass that of high SDI countries. In China, the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030, respectively. IE-associated deaths and heart failure will continue to impose a significant burden on society, the burden on women will increase and surpass that on men, and the elderly in high-SDI countries will bear the heaviest burden. High systolic blood pressure has become the primary risk factor for IE-related death. Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade. The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled. Gender, age, regional, and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.

The Evolving Profile of Infective Endocarditis: A Longitudinal Single Centre Study

Infective endocarditis (IE) remains a life-threatening disease with up to 40% lifetime mortality, despite medical and surgical advances. The risk factors of IE are drastically changing from rheumatic heart disease towards prosthetic valves/pacemakers, intravenous drug use, haemodialysis, immunosuppression and hospital-acquired bacteraemia. The shift in predisposing risk factors for IE highlights the increasing change in susceptibility towards causative pathogens.

Percutaneous pulmonary valve implantation: Long term outcomes

Percutaneous pulmonary valve implantation (PPVI) is effective to treat right ventricle outflow (RVOT) dysfunction. Long term results and risk factors of valve dysfunction remain little known. We studied long term results of PPVI. All consecutive patients who had successful PPVI between January 2008 and January 2020 in one tertiary center were prospectively included. Follow-up was updated in 2020. 212 patients were included (Melody Valve, n = 32 (15.1%); Sapien XT Valve, n = 47 (22.2%); Sapien 3 valve, n = 133 (62.7%). Median age was 28 years (range 10-81). Patched native pulmonary artery was the most frequent RVOT type (44.4%). Mean follow-up was 2.8 years (range 3 months to 11.4 years). Pulmonary valve replacement (PVR) was performed in 23 cases (10.8%), related to stenotic degeneration ( n = 22 cases, 95%) and severe regurgitation ( n = 1, 4.3%). PVR was performed in 17 Melody valves (53.1%) and 6 Sapien valves (3.3%), with an incidence of 7.6% per patient-year and 1.3% per patient-year respectively ( P = 0.05). Mean interval between PPVI and PVR was 4.7 years (range 1.1-10.1 year). Infective endocarditis (IE) was reported in 13 patients (Melody valve, n = 12, 37.5%; Sapien valve, n = 1, 0.5%) with an incidence of 5.5% per patient-year and 0.2% per patient-year respectively ( P < 0.0001). In an univariate Cox regression analysis, risk factors of PVR were RV obstruction before PPVI ( P = 0.04), transpulmonary maximal velocity > 2.7 m/s after PPVI ( P = 0.05), tricuspid regurgitation doppler maximal gradient >50 mmHg after PPVI ( P < 0.001), valve diameter < 22 mm ( P < 0.003), IE ( P < 0.0001) and age < 25 ( P = 0.04). Risk factors of IE were Melody valve ( P < 0.0001), RV obstruction before ( P = 0.03) or after PPVI ( P = 0.05), valve diameter < 22 mm ( P < 0.03), and younger age ( P = 0.02). PPVI is effective to treat RVOT dysfunction. Implanted Valve durability is shorter when residual RV obstruction is observed, in smaller RVOT, and when IE occurs.

Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis

The epidemiology of infective endocarditis in Africa is inadequately characterised. We therefore aimed to comprehensively summarise the available data for the incidence, risk factors, clinical pattern, microbiology, and outcomes of infective endocarditis in Africa. We did a systematic review and meta-analysis. We searched PubMed, Embase, African Index Medicus, and African Journals Online for all studies reporting primary data for the epidemiology of infective endocarditis in populations within Africa, published from inception to Jan 14, 2021, irrespective of the language. We used the search terms "endocarditis", "Africa", and the name of all African countries in the search strategy. We excluded articles that did not include primary data, primary studies with a small sample size (<30 participants), and those that report findings from before 1990. We recorded data for study characteristics, sample size, criteria used to define infective endocarditis, risk factors, potential entry site, clinical patterns, microbiology profile, outcomes including complications such as embolic events, heart failure, acute kidney injury, and death, and predictors of death. We used random-effects meta-analysis method to pool estimates. This study is registered with PROSPERO, CRD42021243842. We retrieved 2141 records from the database and bibliographic searches, of which a total of 42 studies were included in this systematic review. Rheumatic heart disease was the most common risk factor for infective endocarditis in adults (52·0% [95% CI 42·4-61·5]), whereas congenital heart disease was the most common risk factor for infective endocarditis in children (44·7% [29·5-60·5]). Microbiological testing (mostly blood cultures) was positive in 48·6% (95% CI 42·2-51·1) of patients with infective endocarditis, with Staphylococcus species (41·3% [95% CI 36·2-46·5]) and Streptococcus species (34·0% [29·0-39·3]) the most commonly identified microorganisms. The pooled rate of surgical treatment of infective endocarditis was 49·1% (95% CI 43·2-55·1). The pooled in-hospital mortality rate was 22·6% (95% CI 19·5-25·9). Other frequent complications included heart failure (47·0% [95% CI 38·2-56·0]), acute kidney injury (22·8% [18·8-27·0]), and embolic events (31·1% [22·2-40·7]). As the most prevalent risk factor in Africa, rheumatic heart disease should be central in interventions to reduce the burden of infective endocarditis on the continent. In tertiary hospitals with good access to cardiac surgery, the outcomes of infective endocarditis seem relatively similar to what has been reported in other parts of the world, especially in high-income countries. None.

685. Evaluating the Role of Medication-assisted Treatment (MAT) in the Management of Infectious Endocarditis in People Who Inject Drugs (PWID)

Abstract Background An estimated 1.29-2.59 million people practice intravenous drug use (IVDU) in the United States making it a growing risk factor for infective endocarditis (IE). In people who inject drugs (PWID), IE accounts for 5-10% of total yearly deaths. IE often requires weeks of intravenous therapy with extensive medical follow-up. The purpose of this study was to evaluate if medication-assisted treatment (MAT) increased treatment retention and survival to optimize addiction assistance and IE treatment efforts. Methods A single-center, retrospective chart review was approved for patients admitted with an ICD-10 code of IE. A multidisciplinary group was created in April, 2019 aimed to improve endocarditis patient outcomes, formed of complex case coordination, infectious disease, cardiology, and pharmacy pain management service members. The historical period was January 1, 2018-March 31, 2019 and the IE pathway (IEP) group was April 1, 2019-June 30, 2020. Patients were excluded if there was no documentation of IVDU (Figure 1). The primary outcome was successful endocarditis therapy, defined per study protocol. Secondary outcomes include: against medical advice (AMA) departures, discharge naloxone prescriptions, clinical opioid withdrawal score (COWS) and patient reported pain. Figure 1. Study Population Methods for study population inclusion and exclusion Results A total of 419 IE patients were evaluated with 166 patients meeting inclusion criteria. The primary outcome was achieved in 51.2% of historical group and 48.8% of the IEP group (p=0.302). AMA departures and inpatient mortality were similar between the two groups. There was increased presence of the pharmacy pain management service with decreased time to consult in the IEP group (Figure 2). Last documented COWS were increased in the IEP group (p=0.002), while last reported patient pain scores decreased (p=0.030). More patients were started on MAT and discharged with naloxone in the IEP group (Table 3). Readmission was found to be higher in the IEP group (p=0.046). Post hoc analysis evaluating outcomes for patients seen by the endocarditis pathway team were similar between the two groups (Table 4). Figure 2. Secondary Outcome (Consult Services) The secondary outcomes of the study population are described comparing the presence and time to various consult services. **P-value indicates statistical significance. Abbreviations: n, number; ID, infectious disease; CT, cardiothoracic Table 3. Secondary Outcomes Table 4. Post Hoc Analysis Conclusion The multidisciplinary group was effective helping to guide the inpatient care of PWID and improve symptom management, but this did not translate to increased successful IE therapy or fewer readmissions. Disclosures All Authors: No reported disclosures

Bloodstream Infection and Endocarditis Caused by Staphylococcus aureus in Patients with Cancer: A Multicenter Cohort Study.

IntroductionIn a large cohort of patients with Staphylococcus aureus bloodstream infection (SABSI), we aimed to analyze the incidence and risk factors for infective endocarditis (IE) among patients with active cancer (PAC) in comparison with those without cancer (PWC).MethodsMulticenter cohort study of patients with SABSI admitted to two tertiary care hospitals, from 2011 to 2019. PAC were defined as those with an active solid organ cancer or hematological malignancies. SABSI and S. aureus IE were compared between PAC and PWC.ResultsAmong 978 episodes of SABSI, 217 (22.2%) occurred in PAC. PAC were younger, had fewer comorbidities, carried cardiac devices less often, and had less community-acquired SABSI than PWC. Compared to PWC, PAC more frequently had catheter-related SABSI, less IE (2.8% vs 10.9%, p < 0.001) and osteoarticular infection (2.3% vs 14.3%, p < 0.001). Independent risk factors for IE were cardiopathy (aOR 4.392, 95% CI 2.719–7.094) and persistent bacteremia (aOR 3.545, 95% CI 2.159–5.820). Thirty-day mortality was high, and similar between groups (24.2% vs 25.5%, p = 0.282).ConclusionsPAC with SABSI developed IE less frequently than PWC did. This finding seems related to the differences in baseline characteristics and may have significant clinical implications, such as transesophageal echocardiography in PAC without cardiopathy or persistent bacteremia.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00575-8.

C54. Infective Endocarditis with Ventricular Septal Defect and Ruptured Sinus of Valsalva: A Case Report

Abstract Background Ventricular Septal Defect (VSD) is the most common congenital heart defect with incidence rate about 50% of all case in children. VSD is often followed by weakness of the wall in the sinus of Valsalva causing aneurysms, where 30-50% of cases of aneurysms in the sinus of Valsalva is associated with VSD. Congenital heart defects also increased risk factors for infective endocarditis (IE) with the risk of infection 15-140 times greater than the general population. Case Description A 7-year-old boy was reported with fever and shortness of breath, echocardiography examination showed subaortic VSD, ruptured sinus of Valsalva, multiple vegetation on left ventricular outflow tract, right coronary cusp, and right ventricle, moderate aortic, pulmonal and tricuspid regurgitation with mild pulmonal hypertension. Although there was no growth of bacteria from blood culture but result from kidney ultrasound showed sign of glomerulonephritis, suggesting additional findings in Duke criteria. The patient was treated with broad spectrum antibiotic and heart failure drugs. Then, Heart Team decided to refer the patient to Cardiac Center Harapan Kita for evacuating vegetations and repairing congenital heart defect. Discussion Infective endocarditis is one of the most arduous complication that must be treated immediately in patients with VSD. Besides reducing the symptoms that arise from heart defects, the clinicians also have to stop the process of infection. Adequate antibiotics and immediate surgery are the best strategy to evacuate the focus of infection as well as to repair congenital defects.

C54. Infective Endocarditis with Ventricular Septal Defect and Ruptured Sinus of Valsalva: A Case Report

Abstract Background Ventricular Septal Defect (VSD) is the most common congenital heart defect with incidence rate about 50% of all case in children. VSD is often followed by weakness of the wall in the sinus of Valsalva causing aneurysms, where 30-50% of cases of aneurysms in the sinus of Valsalva is associated with VSD. Congenital heart defects also increased risk factors for infective endocarditis (IE) with the risk of infection 15-140 times greater than the general population. Case Description A 7-year-old boy was reported with fever and shortness of breath, echocardiography examination showed subaortic VSD, ruptured sinus of Valsalva, multiple vegetation on left ventricular outflow tract, right coronary cusp, and right ventricle, moderate aortic, pulmonal and tricuspid regurgitation with mild pulmonal hypertension. Although there was no growth of bacteria from blood culture but result from kidney ultrasound showed sign of glomerulonephritis, suggesting additional findings in Duke criteria. The patient was treated with broad spectrum antibiotic and heart failure drugs. Then, Heart Team decided to refer the patient to Cardiac Center Harapan Kita for evacuating vegetations and repairing congenital heart defect. Discussion Infective endocarditis is one of the most arduous complication that must be treated immediately in patients with VSD. Besides reducing the symptoms that arise from heart defects, the clinicians also have to stop the process of infection. Adequate antibiotics and immediate surgery are the best strategy to evacuate the focus of infection as well as to repair congenital defects.

Abstract 11705: Comparing Healthcare Utilization and Health Outcomes of Infective Endocarditis Between People Experiencing Homelessness and People With Secure Housing

Introduction: Infective endocarditis (IE) is uniformly fatal if left untreated. Lower socioeconomic status has been shown to increase risk for community-acquired bacteremia, leading to possible IE. People experiencing homelessness (PEH) face risk factors for IE, such as inadequate access to personal hygiene, lack of consistent resting places to prevent skin breakdown, substance use, and inadequately treated comorbidities. This study seeks to compare characteristics of health utilization and outcomes for PEH hospitalized for IE with people with secure housing (PSH). Hypothesis: Mortality rate and healthcare utilization due to IE are higher for PEH compared to PSH. Methods: We used New York Statewide Inpatient Database between 2009 and 2014 to identify patients over 18 years of age admitted with the diagnosis of IE. With homelessness as the exposure variable, outcomes included 1] hospitalization cost per day, 2] length of stay (LOS), and 3] in-hospital mortality. Multivariate regression models, adjusted by patient characteristics, were used to explore the associations between homelessness and outcomes. Results: We identified 809,491 IE hospitalizations (25,968 homeless and 783,523 non-homeless). PEH were significantly more likely to be white (16.9% in PEH and 62.6% in PSH, p&lt; .001). Homelessness was significantly associated with lower odds of in-hospital mortality (adjusted Odds Ratio [aOR] 0.88, p &lt; .001), lower means ratio of cost (Means Ratio 0.99, p &lt; .001), longer LOS (Incidence Rate Ratio=1.03, p &lt; .001), and increased risk for readmission within 30 days of hospital discharge (aOR 1.1, p&lt;.01). Conclusions: The lower risk of hospital mortality for IE amongst PEH is unexpected given the higher burden of comorbidities and risk factors in this vulnerable group. It is possible that a significant proportion of PEH are dying outside hospital walls due to barriers in connecting with medical care. Lower hospitalization cost per day along with longer LOS could also reflect the time intensive but lower cost services required for complex discharge planning efforts for PEH. These results quantify and highlight the need for further study to understand overall mortality in PEH along with effective discharge planning strategies that address these disparities.

Injection drug use infective endocarditis: clinical features and therapeutic challanges

Abstract Introduction Injection drug use (IDU) is a known risk factor for infective endocarditis (IE) and is associated with frequent recurrences, but its prognostic impact is still debated. Moreover, the potential futility of surgery in this population is an unsolved matter. Purpose We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of injection drug use IE (IDUIE). Method We retrospectively included in the analysis 454 consecutive episodes of definite active IE admitted in a single surgical centre from January 2012 to December 2020; 14 out of them where a subsequent infective episode of the same patient. Results IDUIE cases were 63 (13.8%), without significant proportional differences over time. IDUIE patients were significantly younger (43.95±10.12 vs 67.84±13.33, p 0.00) and presented fewer comorbidities (p&amp;lt;0.001). They were admitted with a first episode of IE only in 60.3% of cases vs 92.8% of non-IDU (p&amp;lt;0.001). Embolism was present at admission in a higher percentage (60.3 vs 38.4%, p&amp;lt;0.001). IDUIE was more frequently associated with spondylodiscitis (15.9 vs 7.4%, p=0.026). The infection was less frequently left-sided than in non-IDU patients (57.1 vs 97.2%, p&amp;lt;0.001) and was more often polimicrobic (12.7 vs 4.9%, p=0.015). Most patients were positive for Staphylococcus aureus (54.0 vs 12.8%, p&amp;lt;0.001), while Streptococci were significantly less frequent in patients with IDUIE (11 vs 25%, p=0.015). The proportion of patients undergoing surgery was similar among the two groups (85.5 vs 78.8%, NS). IDUIE patients treated medically for absence of surgical indication had a better survival than patients undergoing surgery for complicated IE (p&amp;lt;0.001). IDUIE was associated with a higher proportion of relapse during follow-up (28.3 vs 3.3%, p&amp;lt;0.001). It was not associated with higher mortality (Figure 1) but was an independent predictor of mortality in multivariable analysis including age (HR per unit 1.048, 95% CI 1.038–1.063, p=0.00) and drug abuse (HR 3.2, 95% CI 1.8–5.6, p=0.00; Figure 2). Among IDUIE patients, we did not find predictors of futility of surgery, not even multiple relapses. Conclusions IDUIE represents a considerable proportion of overall cases of IE, mainly affecting young people. Staphylococcus aureus is the most common microbiologic agent. IDUIE is not associated with higher mortality but drug abuse is an independent predictor of mortality. Considering that patient with uncomplicated IE treated medically have a better prognosis, we should reserve surgery to patients with a strict indication for it. On the other hand, since there are no predictors of futility of surgery, all patients with a complicated IE should undergo surgery without delay. The main determinant of prognosis in these patients is not IE but drug abuse itself. For this reason, increased focus on addiction treatment following hospital discharge is mandatory to improve long term prognosis. Funding Acknowledgement Type of funding sources: None.

AN UNUSUAL CASE OF INFECTIVE ENDOCARDITIS PRESENTING AS MENINGOCOCCAL MENINGITIS IN A YOUNG MALE WITH RECENT DENTAL WORK

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Incidence of infective endocarditis (IE) has been increasing in U.S., likely due to increased age, valvular diseases and cardiac device implantation or valve replacements. Here, we present a case of infective endocarditis with uncommon presentation, unusual risk factors and rapidly progressing course that is important for clinicians to consider in their clinical practice. CASE PRESENTATION: A 39-year-old healthy man, without smoking or drug use, presented for altered mental status and fever for 1-2 days. His initial vitals were significant for a temperature of 103.8˚F. On exam, he was oriented x2, had conjunctival petechiae, a fixed dental expander, a soft systolic murmur and petechial rash over his body. CSF studies suggested bacterial meningitis, but gram stain was negative. CT head showed a subarachnoid hemorrhage. He was started on ceftriaxone, vancomycin and steroids for likely meningococcal meningitis. His blood cultures grew methicillin sensitive Staphylococcus aureus. He developed atrial fibrillation with rapid ventricular response and elevation in troponin to 41.26 ng/dL. A transthoracic echocardiogram showed a stenotic aortic valve suggestive of bicuspid valve without vegetations. CT chest/abdomen/pelvis showed infarcts within the spleen, kidneys and mesentery. His clinical condition further declined and EKG revealed a prolonged P-R interval. A transesophageal echocardiogram showed a large aortic valve vegetation and aortic root abscess. Cardiothoracic surgery was consulted for early surgical intervention with abscess drainage and aortic valve replacement. Patient was successfully discharged home with antibiotics and warfarin. DISCUSSION: The initial presentation of fever, malaise, altered mental status and petechial rash in a young person was suspicion for meningococcal meningitis. One study of patients with IE showed 6% had encephalopathy/meningitis and 4% had hemorrhages. These complications were seen particularly with vegetations ≥3cm and S. aureus infections, similar to this patient. It is imperative to have high suspicion for IE in any infected patient with generalized CNS symptoms. Our patient lacked known risk factors for IE, thus a detailed physical examination is paramount in patients with a high index of suspicion. Presence of a dental implant provided us the initial clue towards this key diagnosis. Few studies show causation of dental procedures and risk of developing IE. This is another rare example. We report successful treatment of a rapidly progressive disease with early diagnosis, appropriate antibiotics and early surgical intervention. CONCLUSIONS: A high index of suspicion is required to quickly diagnosis IE. A detailed physical examination is paramount for correct diagnosis. TEE is superior to bedside TTE in such cases. IE can be complicated with intracardiac abscesses, septic shock, and presence of SAH. REFERENCE #1: Sexton, Daniel, and Vivian Chu. "Native Valve Endocarditis: Epidemiology, Risk Factors, and Microbiology." UpToDate, 7 Oct. 2020, www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology?search=causes+of+enodcarditis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. REFERENCE #2: Thanavaro, Kristin L., and J.V. (Ian) Nixon. "Endocarditis 2014: An Update." Heart & Lung, Mosby, 26 Apr. 2014, www.sciencedirect.com/science/article/pii/S0147956314000788. REFERENCE #3: McDonald, Jay R. "Acute Infective Endocarditis." Infectious Disease Clinics of North America, U.S. National Library of Medicine, Sept. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2726828/. DISCLOSURES: No relevant relationships by Michelle Zur, source=Web Response

Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience

BackgroundIntravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE.MethodsWe retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020.ResultsPatients reporting IDA (N = 54; 12.2%) were significantly younger (p < 0.001) and presented fewer comorbidities (p < 0.001). IDA was associated with a higher proportion of relapses (27.8 vs. 3.3%, p < 0.001) and, at multivariable analysis, was an independent predictor of long-term mortality (HR 2.3, 95%CI 1.1–4.7, p = 0.015). We did not register multiple relapses in non-IDA patients. Among IDA patients, we observed 1 relapse after discharge in 9 patients, 2 relapses in 5 patients and 3 relapses in 1 patient. In IDA patients, neither clinical and laboratory variables nor the occurrence of even multiple relapses emerged as indicators of an adverse risk–benefit ratio of surgery in patients with surgical indication.ConclusionsIE secondary to IDA affects younger patients than those with IE not associated with IDA. Probably due to this difference, IE secondary to IDA is not associated with significantly higher mortality, whereas the negative, long-term prognostic impact of IDA emerges in multivariate analysis. Considering the good prognosis of patients with uncomplicated IE treated medically, surgery should be reserved to patients with a strict- guidelines-based indication. However, since there are no clear predictors of an unfavourable risk–benefit ratio of surgery in patients with surgical indication, all patients with a complicated IE should be operated, irrespective of a history of IDA.

Percutaneous pulmonary valve implantation: Long term outcomes

Percutaneous pulmonary valve implantation (PPVI) is effective to treat right ventricle outflow (RVOT) dysfunction. Long term Results and risk factors of valve dysfunction remain little known. We aimed to study long term Results of PPVI. All consecutive patients who had successful PPVI between January 2008 and January 2020 in one single tertiary center were prospectively included. Follow-up was updated in 2020. Two hundred and twelve patients were included (Melody Valve, n = 32 (15.1%); Sapien XT Valve, n = 47 (22.2%); Sapien 3 valve, n = 133 (62.7%). Median age was 28 years old (range 10-81). Patched native pulmonary artery was the most frequent RVOT type (44.4%). Mean follow-up was 2.8 years (range 3 months to 11.4 years). Pulmonary valve replacement (PVR) was performed in 23 cases (10.8%), related to stenotic degeneration ( n = 22 cases, 95%) and severe regurgitation ( n = 1, 4.3%). PVR was performed in 17 Melody valves (53.1%) and 6 Sapien valves (3.3%), with an incidence of 7.6% per patient-year and 1.3% per patient-year respectively ( P = 0.05). Mean interval between PPVI and PVR was 4.7 years (range 1.1–10.1 year) ( Fig. 1 ). Infective endocarditis (IE) was reported in 13 patients (Melody valve, n = 12, 37.5%; Sapien valve, n = 1, 0.5%) with an incidence of 5.5% per patient-year and 0.2% per patient-year respectively ( P < 0.0001) ( Fig. 2 ). In an univariate Cox regression analysis, risk factors of PVR were RV obstruction before PPVI ( P = 0.04), transpulmonary maximal velocity > 2.7 m/s after PPVI ( P = 0.05), tricuspid regurgitation doppler maximal gradient > 50 mmHg after PPVI ( P < 0.001), valve diameter < 22 mm ( P < 0.003), IE ( P < 0.0001) and age < 25 ( P = 0.04). Risk factors of IE were Melody valve ( P < 0.0001), RV obstruction before ( P = 0.03) or after PPVI ( P = 0.05), valve diameter < 22 mm ( P < 0.03), and younger age ( P = 0.02). PPVI is effective to treat RVOT dysfunction. Implanted Valve durability is shorter when residual RV obstruction is observed, in smaller RVOT, and when IE occurs.

Impact of Chronic Hepatitis C virus co-infection on outcomes of infective endocarditis in people who inject drugs

Injection drug use (IDU) is a risk factor for infective endocarditis (IE) and hepatitis C virus (HCV) infection. This retrospective cohort study assessed HCV's impact on outcomes of adult people who inject drugs (PWID). Those admitted due to IE using modified Duke criteria from January 2012 through May 2018 were identified. The cohort was divided into HCV seropositive and seronegative groups. The seropositive group was further stratified according to HCV viremia. Complications and mortality during the IE hospitalization, at 10 weeks, and 1 year were compared across groups. Clinical factors were similar between the cohorts, except patients without viremia (29, 81%) required more ICU admissions than with viremia (30, 60%) (P < 0.05). There was no difference in mortality at all time periods between the groups. Although several factors affect mortality in PWID with IE, neither HCV antibody positivity nor viremia appear to increase the risk for complications or death.

Infective Endocarditis: A Focus on Oral Microbiota.

Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria entering the bloodstream and settling in the heart lining valves or blood vessels. Despite modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Thus, primary prevention and enhanced diagnosis remain the most important strategies to fight this disease. In this regard, it is worth noting that for over 50 years, oral microbiota has been considered one of the significant risk factors for IE. Indeed, among the disparate recommendations from the American heart association and the European Society of Cardiology, there are good oral hygiene and prophylaxis for high-risk patients undergoing dental procedures. Thus, significant interest has grown in the role of oral microbiota and it continues to be a subject of research interest, especially if we consider that antimicrobial treatments can generate drug-resistant mutant bacteria, becoming a severe social problem. This review will describe the current knowledge about the relationship between oral microbiota, dental procedures, and IE. Further, it will discuss current methods used to prevent IE cases that originate from oral pathogens and how these should be focused on improving oral hygiene, which remains the significant persuasible way to prevent bacteremia and systemic disorders.

Risk Factors and Patient Profile of Infective Endocarditis by &lt;i&gt;Gemella spp.&lt;/i&gt;

Background. The diagnosis of infective endocarditis is difficult, especially when it involves atypical organisms. Therefore, our study identified risk factors of infective endocarditis caused by rare pathogen, Gemella spp. Methods. A systematic review was conducted to investigate characteristics of endocarditis patients infected with Gemella spp. using the search term “Gemella” and “endocarditis.” Case reports were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 83 articles were selected for review. Results. 5 species of Gemella were identified. Typical patient affected were male between 31 and 45 years of age. On admission, patients had fever, tachycardia, and normal blood pressure. Common clinical manifestation other than fever included fatigue and weakness, chills and sweating, and nausea, vomiting, diarrhea, and weight changes. 1 in 4 reported a history of congenital heart disease, and a recent oral infection. 1 in 2 patients underwent surgical procedure. Laboratory tests revealed anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, as well as elevated C-reactive protein in adult and geriatric populations only. Mitral and aortic valves were most commonly infected by Gemella spp.. The most common Gemella spp.-susceptible antibiotics were penicillin, vancomycin, cephalosporin, macrolide, and aminoglycosides. However, antibiotic resistance was observed against penicillin, aminoglycoside, and fluoroquinolone. Antibiotic therapy of at least 6 weeks resulted in superior clinical improvements than durations under 6 weeks. Finally, 1 in 2 patients underwent valve replacement or repair, with common complications affecting the cardiovascular, neurological, and renal systems. Finally, death occurred in 1 in 8 patients, half of which occurred post-surgical procedure, and the majority occurring equal to or greater than 1 week from admission. Conclusion. Our systematic review highlights the importance of considering rare pathogens, particularly in the presence of predisposing risk factors.

Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis

BackgroundAlthough transcatheter pulmonary valve replacement (TPVR) with Melody and Sapien valves has been shown to be safe and effective, infective endocarditis (IE) of the valve remains a significant risk. The goal of this study is to assess how different immunocompromised states influence the likelihood of developing IE in our congenital heart disease population with these valves. MethodsA chart review was conducted of all patient who underwent TPVR at UCLA. Various risk factors including age, transcatheter valve type, and type of immunocompromised state were analyzed as possible risk factors for IE. CART analysis was used to create a visual representation of the interplay of various risk factors. ResultsThe incidence of IE at our institution was approximately 8% (26 events in 339 valve implants), over a median follow up of 2.92 (0.07–9.71) years. All but one event occurred in patients with Melody valves. Patients with any immunocompromised condition were more likely to develop IE (P = 0.01). Presentation severity and outcome of IE was similar for immunocompromised and non-immunocompromised patients. Patients with DiGeorge syndrome and those taking oral immunosuppressants for autoimmune conditions or asthma were at highest risk for developing IE. ConclusionsThe relatively high rate of endocarditis in TPVR patients, particularly in those with Melody valves, is a concerning development. A subset of immunocompromised patients appears to be at higher risk, and it may be beneficial for providers to be especially vigilant with these patients. Further research is needed to assess long-term risk of IE in all TPVR patients.

Infective Endocarditis in Individuals Who Use Intravenous Drugs

Injection drug use (IDU) is a well-established risk factor for infective endocarditis (IE). Most of our evidence base for the epidemiology of

Factors Influencing Oral Health Admissions in Dental Patients With Acute Rheumatic Fever and Rheumatic Heart Disease in a Paediatric Tertiary Hospital

Dental caries has been positively associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) [ [1] Thornley S. Marshall R.J. Bach K. Koopu P. Reynolds G. Sundborn G. et al. Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children. J Epidemiol Community Health. 2017; 71: 364https://doi.org/10.1136/jech-2016-208219 Crossref PubMed Scopus (9) Google Scholar ]. ARF/RHD, a risk factor for infective endocarditis, warrants good dental hygiene, regular dental reviews, and prophylactic antibiotics prior to dental treatment to reduce risk [ [2] Baskerville C.A. Hanrahan B.B. Burke A.J. Holwell A.J. Rémond M.G.W. Maguire G.P. Infective Endocarditis and Rheumatic Heart Disease in the North of Australia. Heart Lung Circ. 2012; 21: 36https://doi.org/10.1016/j.hlc.2011.08.010 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ]. This study assessed the nature and frequency of oral health-related admissions at a tertiary paediatric centre in patients with ARF/RHD.

Infective endocarditis due to Acinetobacter baumannii in an infant with complex congenital heart disease

Infective endocarditis (IE) due to Acinetobacter baumannii is rare in children, however associated with significant morbidity and mortality. Congenital heart diseases are among the major risk factors for IE. We report a case of IE in an infant caused by A. baumannii. The patient is a 2-month-old infant with complaints of recurrent cough and breathlessness since birth which worsened 2 days before admission, associated with fever. There is difficulty in breastfeeding and occasional forehead sweating with associated darkening of the lips, palms and soles. She has been failing to thrive since birth. Significant findings on physical examination include respiratory distress with hypoxia, pyrexia, severe wasting, tachycardia, tachypnea, tender hepatomegaly, widespread coarse crepitation, displaced apex beat and a pan-systolic murmur. Full blood count was suggestive of sepsis, blood culture yielded A. baumannii, chest X-ray revealed dextrocardia with cardiomegaly and increased vascular markings while transthoracic echocardiography showed complex congenital heart disease with vegetation. The patient was commenced on intravenous antibiotics and supportive managements, however died while on admission.