Treatment Of Bacterial Endocarditis Research Articles

Mitral valve chordal rupture against the background of cardiac SARS-CoV-2 infection. Cases series

In an ever-changing information flow on coronavirus disease 2019 (COVID-19) pandemic, we describe a case series of mitral valve chordal rupture (MVCR) in non-comorbid middle-aged men that occurred over a period of 3 to 5 weeks after Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection. With significant advances in the prevention of acute rheumatic fever, the treatment of bacterial endocarditis and acute coronary syndrome, acute mitral regurgitation has become a relatively rare diagnosis. During the pandemic, there has been a surge in the incidence of spontaneous MVCR, and new data on the problem are accumulating. The presented case series are united by the fact that the infection symptoms were mild, followed by signs of probable endomyocarditis, unrecognized in time, and acute mitral valve regurgitation developed against the background of physical provocation (exercise and cough). Two patients had previously been diagnosed with mitral valve prolapse (myxomatous degeneration and connective tissue disease). Two patients were successfully operated on in different clinics. The described cases emphasize that the consequences of inflammation persistence may be more severe than the primary viral damage, which determines the importance of a comprehensive examination and long-term follow-up. To date, the differential diagnosis of patients with sudden onset of dyspnea and chest pain associated with an infectious process should include MVCR.

Infective endocarditis in dogs and cats

Infective endocarditis is an uncommon cardiac disease, caused by microbial invasion of the endocardium or heart valves. It presents many challenges with respect to diagnosis and effective treatment. This article reviews the pathogenesis, clinical presentation, methods of diagnosis and treatment of bacterial endocarditis in dogs and cats.

Risk factors for acute kidney injury associated with the treatment of bacterial endocarditis at a tertiary academic medical center

Background: Acute kidney injury (AKI) is a common complication of endocarditis.Objective: To determine risk factors for the development of AKI in patients treated for endocarditis.Methods: This single centre, retrospective univariate and multivariate analysis to determine risk factors for the development of AKI included patients diagnosed with endocarditis between January 2009 and October 2013.Results: Of 211 included patients, a total of 84 (39.8%) patients developed AKI. We identified multiple independent variables associated with the development of AKI, including: age ≥ 65 years, presence of hardware, chronic kidney disease, AKI on admission, infection with Staphylococcus spp, receipt of nafcillin or oxacillin or aminoglycoside and nafcillin or oxacillin or aminoglycoside and vancomycin, vancomycin trough level ≥ 20.0 mcg/ml, aminoglycoside total daily dose reduction, duration of vancomycin exceeding three days, receipt of loop diuretic or more than three concomitant nephrotoxins and duration of loop diuretic or non-steroidal anti-inflammatory drug therapy exceeding seven days.Conclusions: In patients treated for endocarditis, multiple risk factors for AKI were identified. Prospective studies are needed to evaluate these variables for causation of AKI in patients treated for endocarditis.

Myocardial Infarction in a Hospitalized Patient with Chronic Renal Failure

Introduction Patients hospitalized with renal failure who have a myocardial infarction are a specific group at risk for worse outcomes. One of the major challenges is the choice to use contrast angiography and the fear of contrast induced nephropathy. Another challenge is the treatment regimen patients should receive at discharge and weighing the risk vs benefit ratio concerning the increased mortality rates seen in this specific subset of patients. Case Presentation The case being presented is of an 82 year old male patient diagnosed with stage 4 chronic renal failure who suffered an in hospital myocardial infarction while undergoing treatment for bacterial endocarditis and a suspected GI bleed. The patient has several other diagnoses including severe aortic stenosis, CLL and orthostatic pneumonia. The purpose of this case report is to outline the challenges and considerations clinicians must make when treating patients with chronic renal failure who suffer a myocardial infarction while hospitalized. The patient’s presentation, workup, diagnostic tests, and treatment are discussed in detail. Conclusion The present case poses numerous challenges for the care team. Angiography was not performed on this patient due to the risk of exacerbating the patient’s renal failure with the use of IV contrast angiography. The decision to forgo angiography was also made as the patient would not be a candidate for open heart bypass surgery. Anticoagulation with IV heparin and IV Rosufen was the treatment in this case. It is important to stress the importance of aggressive treatment post discharge in patients with chronic renal failure who suffer a myocardial infarction, as the greatest risk for mortality is in the first 6 months post discharge (7). Clinicians may also be reluctant to aggressively treat such patients post discharge due to the risks of adverse medication effects, potentially leading to a higher mortality rates in this subset of patients (7).

Circulation: Clinical Summaries.

Circulation: Clinical Summaries.

Actualización en cardiología pediátrica y cardiopatías congénitas

The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.

Clinical Update on the Diagnosis and Treatment of Bacterial Endocarditis

Infective endocarditis (IE) represents the top of the pyramid of the relationship between humans and bacteria in that it is a less common form of infection than other localized infections in specific organ systems, but it may carry considerable morbidity and mortality. In a time when the practice of medicine is performed at the organ-system level through subspecialists, systemic diseases causing dysfunction in multiple organ systems like IE may be difficult to diagnose. The salient features of IE may present atypically or be obscured by the presence of preexisting and coexisting diseases. Early diagnosis of IE is important because of its high risk of morbidity and mortality. Management of the patient with IE is complex and requires interventions by internists, infectious disease specialists, cardiologists, and cardiothoracic surgeons. It represents one of only a few situations where bactericidal therapy is important to treatment efficacy. As such, the development of antimicrobial resistance in bacteria has the potential to impact the management of endocarditis most significantly. This review will touch on several aspects of endocarditis, including pathogenesis and treatment.

Canine Bacterial Endocarditis: A Review

Bacterial endocarditis is a disease of primarily middle-aged to older, large-breed dogs that is associated with high morbidity and mortality. It presents many challenges with respect to diagnosis and effective treatment. This paper reviews the pathogenesis, clinical presentation, progression, methods of diagnosis, and treatment of bacterial endocarditis in dogs. Methods for proper diagnosis, including echocardiographic findings and blood culture techniques, and recommendations for effective antimicrobial therapy are also provided.

Comment on: The role of aminoglycosides in combination with a -lactam for the treatment of bacterial endocarditis: a meta-analysis of comparative trials

Sir, Falagas and colleagues performed a meta-analysis of comparative trials to determine the role, if any, of aminoglycosides in combination with a b-lactam antibiotic for the treatment of infective endocarditis caused by Gram-positive cocci. 1 They are to be congratulated on their thorough analysis and their many fine contributions to the literature. One point in the Discussion section of the article 1 deserves further clarification. The authors state that ‘the addition of gentamicin to penicillin G or ceftriaxone is highly recommended by the AHA for the first 2 weeks of treatment’ in the latest published statement 2 and that findings from their meta-analysis did not support this position. As outlined in their review, only one trial 3 that pertained to streptococci was included in the analysis and that investigation examined monotherapy versus dual therapy for native valve endocarditis caused by either viridans group streptococci or Streptococcus bovis. It is noteworthy that only patients who had streptococcal isolates that were susceptible to penicillin, ceftriaxone and gentamicin were included in the study; ‘resistance’ to penicillin of the initial blood culture isolate was an exclusion criterion. The authors did not, however, provide the specific in vitro susceptibility data (MIC) for the isolates. Due to the success of b-lactam monotherapy in this trial 3 and other investigations, both the current 2 and previous 4 versions of the AHA ‘treatment guidelines’ listed only b-lactam monotherapy as a 4 week treatment option for native valve endocarditis caused by penicillin-susceptible (MIC £ 0.12 mg/L) viridans group streptococci and S. bovis. The current guidelines do recommend that the first 2 weeks of treatment of native valve endocarditis caused by streptococci that have higher (>0.12 to £0.5 mg/L) MICs of penicillin receive combination therapy with gentamicin.

Aminoglycosides in combination with a -lactam for the treatment of bacterial endocarditis: authors' response

Aminoglycosides in combination with a -lactam for the treatment of bacterial endocarditis: authors' response

Mycotic Aneurysm of the Ulnar Artery Presenting as a Late Complication of Fulminant Infective Endocarditis

We present a case of a mycotic ulnar artery aneurysm presenting after treatment for bacterial endocarditis. An 82-year man presented with back pain, a new heart murmur and hepatomegaly. A diagnosis of discitis and bacterial endocarditis was made. The patient was treated with benzylpenicillin and gentamycin. Two weeks after starting antibiotics he developed a fever and tenderness in his right forearm. The pain and fever resolved. A week later the pain returned, he became generally unwell and a pulsatile swelling developed in his right forearm. Ultrasound showed a 3 cm aneurysm of the ulnar artery. No other aneurysms were found. The aneurysm was resected and the inflow ligated. Despite appropriate antibiotic therapy, mycotic aneurysms may still develop secondary to fulminant infective endocarditis even after blood cultures have been sterile.

Mycotic Aneurysm of the Ulnar Artery Presenting as a Late Complication of Fulminant Infective Endocarditis

We present a case of a mycotic ulnar artery aneurysm presenting after treatment for bacterial endocarditis. An 82-year man presented with back pain, a new heart murmur and hepatomegaly. A diagnosis of discitis and bacterial endocarditis was made. The patient was treated with benzylpenicillin and gentamycin. Two weeks after starting antibiotics he developed a fever and tenderness in his right forearm. The pain and fever resolved. A week later the pain returned, he became generally unwell and a pulsatile swelling developed in his right forearm. Ultrasound showed a 3cm aneurysm of the ulnar artery. No other aneurysms were found. The aneurysm was resected and the inflow ligated. Despite appropriate antibiotic therapy, mycotic aneurysms may still develop secondary to fulminant infective endocarditis even after blood cultures have been sterile.

Argatroban for anticoagulation during cardiopulmonary bypass in an infant

Heparin induced thrombocytopenia (HIT) is a rare, but potentially life-threatening complication of heparin therapy. In patients with HIT, alternative means of anticoagulation are necessary. The authors present an infant with HIT who required anticoagulation during cardiopulmonary bypass for tricuspid valve excision in the treatment of bacterial endocarditis. The direct thrombin inhibitor, argatroban, was successfully used. Previous reports regarding the use of argatroban and other nonheparin anticoagulants for anticoagulation are reviewed and suggestions regarding argatroban dosing in infants are presented.

Antibacterials for the prophylaxis and treatment of bacterial endocarditis in children.

Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children. This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management. The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci. There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae. The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology. The therapeutic goal is to achieve sterilisation of the cardiac vegetations. The choice of antibacterial is dependent upon the susceptibility profile of the causative organism. Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association. For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice. In the case of endocarditis caused by methicillin-resistant S. aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material. Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci. While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis. Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis. These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures. Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy. Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures. In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended. The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, and in fact propagates bacterial resistance.

Optimisation of the prevention and treatment of bacterial endocarditis.

This paper reviews currently established guidelines for the prevention and treatment of bacterial endocarditis. Endocarditis remains a life-threatening disease with substantial morbidity and mortality. Primary prevention of endocarditis, whenever possible, is therefore very important. In an individual with endocarditis, rapid diagnosis and effective treatment are essential to good patient outcome. The guidelines discussed here are largely based on those issued by the American Heart Association. While most cases of endocarditis are not attributable to an invasive procedure, certain procedures are associated with bacteraemia by organisms commonly associated with endocarditis, and antibacterial prophylaxis is recommended before such procedures. Patient cardiac conditions are stratified into high, moderate and negligible risk categories based on potential outcome if endocarditis develops. For oral, dental, respiratory tract, and oesophageal procedures (most often associated with viridans streptococci) the standard antibacterial regimen is oral amoxicillin. For gastrointestinal and genitourinary procedures (most often associated with enterococci), parenteral antibacterials are most often recommended. For high-risk patients, intramuscular or intravenous ampicillin and gentamicin (or vancomycin and gentamicin in penicillin-allergic individuals) is recommended. For moderate risk patients, an option of oral amoxicillin or parenteral ampicillin is offered. Treatment of bacterial endocarditis is guided by identification of the causative micro-organism. Approximately 80% of cases of endocarditis are due to the gram-positive cocci: streptococci and staphylococci. Other gram-positive organisms include enterococci (predominantly Enterococcusfaecalis and E. faecium) and the HACEK group of organisms (Haemophilus parainfluenzae, H. aphrophilus, Actinobacillus [Haemophilus] actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). In general, for uncomplicated cases of endocarditis due to penicillin-susceptible viridans streptococci or Streptococcus bovis 4 weeks of benzylpenicillin (or ceftriaxone) is the preferred regimen for most patients aged >65 years. A 2-week course of treatment can be used when gentamicin is added, in patients at low risk for adverse events caused by gentamicin therapy. When endocarditis is caused by strains of viridans streptococci or S. bovis relatively resistant to penicillin, or by enterococci, both benzylpenicillin and gentamicin are recommended. For staphylococcal endocarditis on native heart valves, nafcillin or oxacillin with or without gentamicin is the preferred regimen. In prosthetic valve staphylococcal endocarditis, nafcillin (or oxacillin) with rifampicin and gentamicin is recommended. For all of the above situations, vancomycin is recommended for the patient allergic to penicillin (or methicillin). Finally, consideration of out-of-hospital therapy in selected patients is discussed.

Diagnosis and treatment of bacterial endocarditis in cattle

Diagnosis and treatment of bacterial endocarditis in cattle

Teicoplanin pharmacokinetics in intravenous drug abusers being treated for bacterial endocarditis

The pharmacokinetics of teicoplanin were determined after multiple 30-min intravenous infusions of 10 to 15 mg/kg every 12 to 24 h in 11 intravenous drug abuse (IVDA) patients being treated for bacterial endocarditis. Multiple serum samples were obtained over 7 to 14 days. Twenty-four-hour urine collections were obtained on days 1 and 5. Serum concentration-time data were analyzed by using multiple-dose pharmacokinetic analysis (NONLIN84). Results were compared with pharmacokinetic parameters derived from previous studies in normal healthy volunteers following multiple intravenous infusions of teicoplanin (3 to 6 mg/kg/day). Total and renal clearances of teicoplanin in IVDA patients were found to be significantly greater and more highly variable than those observed previously in normal healthy volunteers. As a result, predicted steady-state trough concentrations in serum may vary up to fivefold. The mechanism responsible for this variation appears to be related to the glomerular filtration rate. In IVDA patients, individualized teicoplanin dosage may be required in the treatment of bacterial endocarditis.

Treatment of bacterial endocarditis in a Shire mare

Treatment of bacterial endocarditis in a Shire mare

Recommended treatment for bacterial endocarditis

Recommended treatment for bacterial endocarditis

Effects of tissue-type plasminogen activator (t-PA) on Streptococcus sanguis-infected endocardial vegetations in vitro.

The effects were studied of in-vitro exposure to tissue-type plasminogen activator (t-PA) on endocardial vegetations isolated from rabbits with Streptococcus sanguis endocarditis as well as on Str. sanguis-infected plasma clots. For both vegetations and clots t-PA induced lysis of the infected fibrin matrix, demonstrated by a release of streptococci into the incubation medium and by an increase in the concentration of fibrin degradation products. The clots decreased in weight, whereas only partial lysis of the vegetations was obtained. Addition of plasminogen to the incubation medium did not enhance the effect of t-PA on vegetations. Fibrinolysis by t-PA did not interfere with the antimicrobial action of benzylpenicillin on the bacteria in a fibrin matrix. It is concluded that t-PA can degrade the fibrin matrices of infected endocardial vegetations and plasma clots. Reduction of vegetation size by t-PA may prove to be useful in the treatment of bacterial endocarditis.