Management of infective endocarditis.
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SUBMITTER: Habib G
PROVIDER: S-EPMC1861013 | biostudies-literature | 2006 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundIn their latest guidelines for infective endocarditis (IE) (2015), the European Society of Cardiology (ESC) introduced the implementation of the Endocarditis Team (ET) to facilitate the management of IE. This study presents our experiences and the diagnostic and therapeutic impact of the ET on the management of IE.MethodsFrom 2016-2020, data of all patients with suspected IE referred to the ET were prospectively collected. The final diagnosis was defined by the ET as either rejected, possible or definite IE. Diagnostic impact was scored as any change in initial diagnosis, the frequency of additional diagnostic tests advised by the ET and any change in diagnosis after these tests. Therapeutic impact was scored as any change in antibiotic therapy or change from conservative to invasive therapy or vice versa.ResultsA total of 321 patients (median age 67 [55-77] years, 71% male) were enrolled. The final diagnosis was rejected IE in 47 (15%), possible IE in 34 (11%) and definite IE in 240 (75%) patients. A change of initial diagnosis was seen in 53/321(17%) patients. Additional microbiological tests were advised in 69/321 (21%) patients, and additional imaging tests in 136/321 (42%) patients, which resulted in subsequent change in diagnosis in 23/321 (7%) patients. Any change in antibiotic treatment was advised in 135/321 (42%) patients, and change from initial conservative to additional surgical treatment in 15/321 (5%) patients.ConclusionThe ET had a clear impact on the therapeutic policy for patients with suspected IE and is useful in the management of this life-threatening disease. Broad implementation is warranted.
| S-EPMC9807728 | biostudies-literature
Project description:BackgroundInfective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this "Endocarditis Team" (ET).MethodsWe conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality.ResultsWe analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048).ConclusionsThis multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.
| S-EPMC6735925 | biostudies-literature
Project description:Infective endocarditis (IE) is a rare, life-threatening disease that has long-lasting effects even among patients who survive and are cured. IE disproportionately affects those with underlying structural heart disease and is increasingly associated with health care contact, particularly in patients who have intravascular prosthetic material. In the setting of bacteraemia with a pathogenic organism, an infected vegetation may form as the end result of complex interactions between invading microorganisms and the host immune system. Once established, IE can involve almost any organ system in the body. The diagnosis of IE may be difficult to establish and a strategy that combines clinical, microbiological and echocardiography results has been codified in the modified Duke criteria. In cases of blood culture-negative IE, the diagnosis may be especially challenging, and novel microbiological and imaging techniques have been developed to establish its presence. Once diagnosed, IE is best managed by a multidisciplinary team with expertise in infectious diseases, cardiology and cardiac surgery. Antibiotic prophylaxis for the prevention of IE remains controversial. Efforts to develop a vaccine that targets common bacterial causes of IE are ongoing, but have not yet yielded a commercially available product.
| S-EPMC5240923 | biostudies-literature
Project description:Fungal infective endocarditis (IE) is uncommon in postoperative cardiac surgical patients. The fungal IE accounts for 1.3'-6.8' of all IE cases and is considered the most severe form with a mortality rate as high as 45'-50'. There are various predisposing factors for fungal IE which include congenital heart defects, cardiac interventions like pacemaker insertion, degenerative valvular heart diseases, long-term use of broad-spectrum antimicrobial therapy, and long-term use of central venous. Mortality can reach up to 100' without specific treatment. Definitive therapy necessitates surgical debridement of vegetations/mass/abscess followed by long-term treatment with antifungal agents in patients who have symptoms of heart failure despite optimum medical management. We, hereby, report a case of fungal IE which occurred after the closure of a ventricular septal defect and was treated successfully with liposomal amphotericin B.
| S-EPMC8081123 | biostudies-literature
Project description:IntroductionInfective endocarditis and mycotic tibioperoneal aneurysms are rare complications of COVID-19 infection. Medical therapy may not always be sufficient to reduce the high morbidity and mortality associated with these cardiovascular complications. Surgical treatment may need to be considered in such patients.ReportA 56 year old male patient with diabetes, hypertension, and hyperlipidaemia developed severe pneumonia from COVID-19 infection. He was admitted to the intensive care unit (ICU) at another facility where he was ventilated for a period of six weeks. Blood culture isolated coagulase-negative Staphylococcus and an echocardiogram showed a 1.4 × 1.5 cm mitral valve vegetation. He was treated for a period of 12 weeks with various antibiotic combinations including meropenem, levofloxacin, and teicoplanin with no improvement. On presentation at the current centre, he complained of painful right calf swelling. Computed tomography angiography showed a 7 cm right tibioperoneal trunk aneurysm. He underwent lung and cardiac assessment, following which it was decided to proceed with one stage synchronous surgery. Cardiac surgery was started through a median sternotomy and Guiraudon transeptal approach, with mitral valve replacement using a bioprosthesis (Edwards Magna, size 29). This was immediately followed by a medial lower limb approach with ligation of the aneurysm, followed by arterial reconstruction using a reversed saphenous vein graft from the superficial femoral artery to the posterior tibial artery. He was placed on intravenous vancomycin and ceftriaxone for a period of six weeks. He was discharged home after day 31 on 75 mg aspirin daily. At six month follow up, he was symptom free with a palpable posterior tibial pulse.DiscussionIncreased awareness and close surveillance are necessary for patients with severe COVID-19 infection. In those who develop unusual cardiovascular complications, one stage cardiac and vascular surgery may be feasible, as described in this case.
| S-EPMC10594545 | biostudies-literature
Project description: Not available
| S-EPMC7261229 | biostudies-literature
Project description:Infective endocarditis is a rare condition in humans and is associated with high illness and death rates. We describe a case of infective endocarditis caused by Staphylococcus succinus bacteria in France. We used several techniques for susceptibility testing for this case to determine the oxacillin profile.
| S-EPMC10902547 | biostudies-literature
Project description:Cardiac hemangiomas are rare and often misdiagnosed due to their nonspecific clinical presentations. We report a case of a 70-year-old man presenting with chills and cold sweats, initially suspected of having infective endocarditis based on echocardiographic findings of a mobile mass on the mitral valve. Laboratory results showed leukocytosis and elevated C-reactive protein, but blood cultures were negative. Transesophageal echocardiography later revealed a well-defined mass with characteristics suggestive of a tumor. Surgical excision confirmed the diagnosis of hemangioma. Postoperative recovery was uneventful, with no mitral regurgitation. This case highlights the importance of considering cardiac tumors in the differential diagnosis of intracardiac masses.
| S-EPMC11475683 | biostudies-literature