RESUMEN
Streptococcus mitis is a leading cause of infective endocarditis (IE). However, our understanding of the genomic epidemiology and pathogenicity of IE-associated S. mitis is hampered by low IE incidence. Here we use whole genome sequencing of 129 S. mitis bloodstream infection (BSI) isolates collected between 2001-2016 from clinically diagnosed IE cases in the UK to investigate genetic diversity, antimicrobial resistance, and pathogenicity. We show high genetic diversity of IE-associated S. mitis with virtually all isolates belonging to distinct lineages indicating no predominance of specific lineages. Additionally, we find a highly variable distribution of known pneumococcal virulence genes among the isolates, some of which are overrepresented in disease when compared to carriage strains. Our findings suggest that S. mitis in patients with clinically diagnosed IE is not primarily caused by specific hypervirulent or antimicrobial resistant lineages, highlighting the accidental pathogenic nature of S. mitis in patients with clinically diagnosed IE.
Asunto(s)
Bacteriemia , Infecciones Estreptocócicas , Streptococcus mitis , Humanos , Streptococcus mitis/genética , Streptococcus mitis/aislamiento & purificación , Reino Unido/epidemiología , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/epidemiología , Irlanda/epidemiología , Bacteriemia/microbiología , Bacteriemia/epidemiología , Endocarditis/microbiología , Endocarditis/epidemiología , Genoma Bacteriano/genética , Secuenciación Completa del Genoma , Masculino , Femenino , Variación Genética , Genómica , Anciano , Filogenia , Persona de Mediana Edad , Farmacorresistencia Bacteriana/genética , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/epidemiología , Adulto , Factores de Virulencia/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Virulencia/genéticaRESUMEN
OBJECTIVES: This study aimed to analyse the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis undergoing valve surgery. METHODS: Retrospective multicentric study based on the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry comprising patients with infective endocarditis who underwent valve surgery between 1994 and 2018 at 6 German centres. Patients were divided into 2 groups for statistical comparison according to the presence or absence of preoperative septic cerebral embolism. Propensity score matching was performed for adjusted comparisons of postoperative outcomes. Primary outcomes were 30-day mortality and estimated 5-year survival. RESULTS: A total of 4917 patients were included in the analysis, 3909 (79.5%) patients without and 1008 (20.5%) patients with preoperative septic cerebral embolism. Patients with preoperative septic cerebral embolism had more baseline comorbidities. Mitral valve endocarditis (44.1% vs 33.0% P < 0.001), large vegetations >10 mm (43.1% vs 30.0%, P < 0.001), and Staphylococcus species infection (42.3% vs 21.3%, P < 0.001) were more frequent in the cerebral embolism group. Among patients with preoperative cerebral embolism, 286 (28.4%) patients had no stroke signs (silent stroke). After matching (1008 matched pairs), there was no statistically significant difference in 30-day mortality (20.1% vs 22.8%; P = 0.14) and 5-year survival (47.8% vs 49.1%; stratified log-rank P = 0.77) in patients with and without preoperative cerebral embolism, respectively. CONCLUSIONS: Preoperative septic cerebral embolism in patients with infective endocarditis requiring valve surgery does not negatively affect early or late mortality; therefore, it should not play a major role in deciding if surgery is to be performed.
Asunto(s)
Embolia Intracraneal , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Embolia Intracraneal/mortalidad , Embolia Intracraneal/epidemiología , Anciano , Endocarditis/cirugía , Endocarditis/mortalidad , Endocarditis/complicaciones , Alemania/epidemiología , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Sistema de Registros , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Válvulas Cardíacas/cirugía , Factores de RiesgoRESUMEN
BACKGROUND: When to perform echocardiography to rule out infective endocarditis (IE) in patients with viridans group streptococci (VGS) bloodstream infections (BSIs) is unclear. OBJECTIVES: We aimed to identify independent risk factors for IE in patients with VGS BSI. METHODS: This retrospective study conducted at Seoul National University Hospital from January 2013 to December 2022 involved patients with VGS and nutritionally variant streptococcal BSI, excluding single positive blood cultures and polymicrobial BSI cases. Independent risk factors were identified by multivariate logistic regression and sensitivity analyses according to echocardiography results, VGS species or the inclusion of possible IE cases. RESULTS: Of 845 VGS BSI cases, 349 were analysed and 86 IE cases were identified (24.6%). In the multivariate analysis, heart valve disease [adjusted odds ratio (aOR), 14.14, 95% CI, 6.14-32.58; Pâ<â0.001], persistent bacteraemia (aOR, 5.12, 95% CI, 2.03-12.94; Pâ=â0.001), age (per year, aOR, 0.98; 95% CI, 0.96-1.00; Pâ=â0.015), solid cancer (aOR, 0.26; 95% CI, 0.13-0.53; Pâ<â0.001) and haematologic malignancy (aOR, 0.04; 95% CI, 0.01-0.41; Pâ=â0.006) were independently associated with IE. Sensitivity analyses yielded consistent results; also, infection by a member of the mitis group was independent risk factor for IE (aOR, 6.50; 95% CI, 2.87-14.68; Pâ<â0.001). CONCLUSIONS: Younger age, heart valve disease, persistent bacteraemia, absence of underlying malignancy and BSI by a member of the mitis group were independent risk factors for IE in patients with VGS BSI. Echocardiographic evaluation could be prudently considered based on these clinicomicrobiological risk factors.
Asunto(s)
Bacteriemia , Infecciones Estreptocócicas , Estreptococos Viridans , Humanos , Factores de Riesgo , Masculino , Femenino , Bacteriemia/microbiología , Bacteriemia/epidemiología , Estudios Retrospectivos , Estreptococos Viridans/aislamiento & purificación , Persona de Mediana Edad , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/epidemiología , Anciano , Ecocardiografía , Adulto , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis/microbiología , Endocarditis/epidemiologíaRESUMEN
BACKGROUND: In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. METHODS: Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. RESULTS: The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. CONCLUSIONS: The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.
Asunto(s)
Infecciones Relacionadas con Prótesis , Humanos , Masculino , Noruega/epidemiología , Femenino , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Anciano de 80 o más Años , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Incidencia , Endocarditis/epidemiología , Endocarditis/microbiología , Endocarditis/mortalidad , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Adulto , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Infective endocarditis (IE) remains one of the most serious diseases with a high morbidity and mortality rate. Although the condition is more common in the medical field in a hospital setting, dentists must have a thorough understanding of the overall pathogenesis, epidemiology, risk factors and signs and symptoms that may be present in their patient population. In 2021, the American Heart Association (AHA) updated its guidelines on IE, emphasizing the specific criteria that put a patient at risk of acquiring IE, specific dental procedures that can increase the risk of IE by inducing bacteremia and an antibiotic prophylaxis regimen to act as a preventive measure if needed. This literature review gives the dental practitioner a general overview of the AHA guidelines as well as information on prevention in their at-risk patients and the need to emphasize a well-structured, consistent daily oral hygiene routine.
Asunto(s)
Endocarditis , Guías de Práctica Clínica como Asunto , Humanos , Endocarditis/epidemiología , Endocarditis/prevención & control , Endocarditis/etiología , Factores de Riesgo , Profilaxis Antibiótica , American Heart Association , Estados Unidos/epidemiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/prevención & control , Endocarditis Bacteriana/etiologíaRESUMEN
INTRODUCTION: Infective endocarditis is a rare but potentially severe disease, associated with significant morbidity and mortality. Our study aims to describe the epidemiology and management aspects of endocarditis in northern Morocco and compare it with international management guidelines. MATERIALS AND METHODS: This is a retrospective study involving all patients hospitalized in the cardiology department of the University Hospital of Tangier for infective endocarditis over a period of 4 years and 7 months, from May 2019 to February 2024. RESULTS: Eighty patients were hospitalized for IE during the study period. The average age of the patients was 46 years, with an even sex ratio. IE concerned native valves in 77% of cases, mechanical prostheses in 19% of cases, and on bio prostheses in 4%. The average diagnostic delay was 25 days. Blood cultures were negative in 59% of cases. The predominant infective microorganism was the bacteria Staphylococcus (65.6%). Imaging results showed vegetations in 76.3% of cases, predominantly on the mitral valve (39.3%), followed by the aortic valve (21.3%). The main complications included heart failure (51.2%), peripheral arterial embolisms (22.5%) and splenic infarction (17.5%). Management wise, the most commonly used antibiotic therapy was a combination of ceftriaxone and gentamicin. Clinical and biological improvement was observed in 70% of cases, with a mortality rate of 12.5%. Twelve patients underwent surgery (15%). Urgent surgery was indicated in 66,7% of the operated patients. CONCLUSION: Our study highlights the challenges in managing infective endocarditis in northern Morocco. The prognosis of infective endocarditis can be improved through multidisciplinary management within the implementation of an Endocarditis Team.
Asunto(s)
Antibacterianos , Endocarditis , Humanos , Marruecos/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Pronóstico , Endocarditis/epidemiología , Endocarditis/microbiología , Endocarditis/diagnóstico , Endocarditis/terapia , Endocarditis/mortalidad , Antibacterianos/uso terapéutico , Anciano , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Adulto Joven , AdolescenteRESUMEN
INFECTIOUS ENDOCARDITIS: STRATEGY FOR DIAGNOSIS. The diagnosis of infective endocarditis is often difficult because the clinical presentations are very heterogeneous. Epidemiology has evolved with more acute forms, different microorganisms, and an increase in prevalence in patients with cardiac prosthetic or electronic devices. Diagnosis is based on a clinical suspicion, associated with microbiological data and imaging evidence of lesions of the endocardium. Echocardiography plays a key role, but advanced imaging techniques provide additional information. The 2023 European Society of cardiology (ESC) recommendations like those of 2015 confirmed the essential role of multimodal imaging, integrating lesions highlighted by any imaging technique as major criteria. The diagnostic criteria have thus been modified to consider new epidemiological and imaging data. Different diagnostic strategy algorithms are proposed depending on whether the patient has prosthetic material or not. The endocarditis team is the keystone in this diagnostic approach to improve patient management.
ENDOCARDITES INFECTIEUSES: DÉMARCHE DIAGNOSTIQUE. Le diagnostic d'endocardite infectieuse est souvent difficile, car les présentations cliniques sont hétérogènes. L'épidémiologie a évolué avec des formes plus aiguës, des micro-organismes différents et avec l'augmentation de la prévalence chez les patients porteurs de matériel intracardiaque. Le diagnostic repose sur une suspicion clinique supportée par des données microbiologiques et la mise en évidence de lésions de l'endocarde à l'imagerie. L'échocardiographie joue un rôle clé, mais les techniques avancées d'imagerie permettent d'améliorer les performances diagnostiques. Les recommandations de l'European Society of Cardiology (ESC) 2023, comme celles de 2015, ont confirmé le rôle essentiel de l'imagerie multimodale, intégrant comme critères majeurs les lésions mises en évidence par toute technique d'imagerie. Les critères diagnostiques ont été ainsi modifiés pour prendre en compte les nouvelles données épidémiologiques et d'imagerie. Différents algorithmes de stratégie diagnostique sont proposés selon que le patient est porteur de matériel prothétique ou non. L'équipe multidisciplinaire d'endocardite est la clé de voûte dans cette démarche diagnostique pour améliorer la gestion des patients.
Asunto(s)
Endocarditis , Humanos , Endocarditis/diagnóstico , Endocarditis/terapia , Algoritmos , Ecocardiografía/métodos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/epidemiologíaRESUMEN
EUROPEAN REGISTRY OF INFECTIOUS ENDOCARDITIS. The EURO-ENDO registry was initiated in 2018. Its objectives were to assess the epidemiological, clinical, bacteriological, and prognostic features of infective endocarditis. Initially only European, it rapidly become a world registry including more than 3000 patients worldwide. EURO-ENDO confirms the drastic change in the profile of patients suffering from infective endocarditis, the important improvements in their management, but their persisting high mortality. EURO-ENDO also underlines the value of an early diagnosis of this disease as well as its management in highly specialized centers, with an experienced medical and surgical team.
REGISTRE EUROPÉEN DES ENDOCARDITES INFECTIEUSES. Le registre EURO-ENDO a été créé en 2018 pour préciser les caractéristiques épidémiologiques, cliniques, bactériologiques, diagnostiques et pronostiques de l'endocardite infectieuse. Initialement européen, il est en fait devenu un registre mondial incluant plus de 3 000 patients à travers le monde. Il confirme le changement radical du profil des patients atteints d'endocardite infectieuse, les grands progrès diagnostiques et thérapeutiques mais également la persistance d'une mortalité élevée chez des patients de plus en plus âgés et polypathologiques. Il souligne l'intérêt d'un diagnostic précoce permettant une prise en charge immédiate par une équipe médico-chirurgicale habituée à traiter cette pathologie complexe.
Asunto(s)
Endocarditis , Sistema de Registros , Humanos , Europa (Continente)/epidemiología , Endocarditis/epidemiología , Endocarditis/diagnóstico , Endocarditis/terapia , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapiaRESUMEN
INFECTIOUS ENDOCARDITIS: FROM EPIDEMIOLOGY TO PREVENTION. The incidence of infective endocarditis is estimated between 30 and 80 cases per million inhabitants and per year in the general population in industrialized countries. It is heterogeneous and increases sharply in the presence of certain underlying heart diseases; it exceeds 1% per year in patients with a history of endocarditis. Incidence increases after the age of 60 and Staphylococcus is now the most frequent responsible microorganism. Antibiotic prophylaxis is indicated only in the patients who are at high risk of infective endocarditis and who undergo invasive dental care. The recommendations published in 2023 by the European Society of Cardiology highlig.
ENDOCARDITES INFECTIEUSES: DE L'ÉPIDÉMIOLOGIE À LA PRÉVENTION. L'incidence de l'endocardite infectieuse est estimée entre 30 et 80 cas par million d'habitants et par an en population générale dans les pays industrialisés. Cette incidence est hétérogène et augmente très nettement dans certaines cardiopathies sous-jacentes : elle dépasse 1 % par an chez les patients ayant un antécédent d'endocardite. L'incidence est majorée après 60 ans, et le staphylocoque est désormais la bactérie la plus souvent en cause. L'antibioprophylaxie n'est indiquée que chez les patients ayant un risque élevé d'endocardite infectieuse et soumis à des soins dentaires invasifs. Les recommandations publiées en 2023 par l'European Society of Cardiology soulignent l'importance des mesures non spécifiques d'hygiène bucco-dentaire et cutanée dans la prévention.
Asunto(s)
Endocarditis Bacteriana , Humanos , Endocarditis Bacteriana/prevención & control , Endocarditis Bacteriana/epidemiología , Incidencia , Profilaxis Antibiótica , Endocarditis/prevención & control , Endocarditis/epidemiologíaRESUMEN
Infective endocarditis (IE) is a rare disease in children and is associated with significant morbidity and mortality. In recent years, significant changes have occurred in pediatric care that could have influenced the microbiology and presentation of IE. The aim of this work was to study epidemiological, microbiological, and clinical features of IE treated at a Pediatric Cardiac Surgery Reference Center located in Madrid (Spain) in a 10-years' period. A descriptive observational retrospective study was performed, including pediatric patients < 16 years old with definite or possible IE admitted to a reference center between January 2012 and December 2021. Thirty-two IE episodes were identified. Twenty-eight (87.5%) had congenital heart disease (CHD), 8 (25.0%) were preterm infants, 1 (3.1%) was immunocompromised and 6 (18.8%) had other chronic conditions; in 11 (34.4%) episodes more than one underlying condition was associated. In 20 (62.5%) episodes there was an indwelling central venous catheter (CVC); children with other comorbidities (preterm, immunocompromised, other chronic conditions) were more likely to have a CVC at diagnosis compared with patients with isolated CHD (p < 0.001). Thirty-six microbiological isolates were obtained in the 32 episodes; 4 (12.5%) episodes had 2 isolated microorganisms. Microbiological isolates were 20 (55.6%) Gram-positive bacteria (GPB), 10 (27.8%) non-HACEK Gram-negative bacteria (GNB), 1 (2.8%) HACEK-group bacterium, 4 (11.1%) fungi and 1 (2.8%) Coxiella burnetii. In 10 (31.3%) episodes, patients were colonized by multidrug-resistant bacteria (MDRB) and the etiology of IE in 3 (30.0%) of those episodes was the colonizing MDRB. MDRB colonization was associated with MDRB IE (p = 0.007). The most common complication was septic embolism: 11 (34.4%) episodes (9 pulmonary and 2 cerebral). In-hospital mortality was 6.3% (n = 2), all of them due to underlying conditions and not to IE or its complications. Clinical features and complications of IE episodes caused by non-HACEK GNB and those caused by GPB were compared, finding no statistically significant differences. Conclusion: Risk factors for developing IE, the proportion of embolic complications, and mortality rate were consistent with previously published findings. Proportion of IE cases attributed to non-HACEK GNB was higher than previously reported, suggesting an evolving epidemiology of IE. One-third of children colonized with MDRB subsequently developed IE caused by the same MDRB strains, so empirical coverage of MDRB organisms must be considered when IE is suspected in MDRB colonized patients. No significant differences in clinical features and complications were observed when comparing IE episodes caused by non-HACEK GNB and those caused by GPB, however larger cohort studies are needed. What is Known: ⢠Infective endocarditis (IE) is a rare disease in children, associated with significant morbidity and mortality. ⢠The main risk factor for developing IE in children is an underlying congenital heart disease. What is New: ⢠With current changing epidemiology in pediatric IE, a higher proportion of IE caused by non-HACEK Gram-negative bacteria should be expected. ⢠A significant percentage of children colonized by multidrug-resistant bacteria can develop an IE due to those bacteria.
Asunto(s)
Endocarditis Bacteriana , Humanos , Estudios Retrospectivos , España/epidemiología , Femenino , Masculino , Lactante , Niño , Preescolar , Adolescente , Recién Nacido , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/etiología , Endocarditis/epidemiología , Endocarditis/microbiología , Endocarditis/etiología , Factores de RiesgoRESUMEN
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (LSIE) and exhibits distinct epidemiological, clinical, and microbiological characteristics. Previous studies have focused primarily on RSIE in patients with intravenous drug use. We investigated the characteristics and risk factors for RSIE in an area where intravenous drug use is uncommon. A retrospective cohort study was conducted at a tertiary hospital in South Korea. Patients diagnosed with infective endocarditis between November 2005 and August 2017 were categorized into LSIE and RSIE groups. Of the 406 patients, 365 (89.9%) had LSIE and 41 (10.1%) had RSIE. The mortality rates were 31.7% in the RSIE group and 31.5% in the LSIE group (P = 0.860). Patients with RSIE had a higher prevalence of infection with Staphylococcus aureus (29.3% vs. 13.7%, P = 0.016), coagulase-negative staphylococci (17.1% vs. 6.0%, P = 0.022), and gram-negative bacilli other than HACEK (12.2% vs. 2.2%, P = 0.003). Younger age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.95-0.99, P = 0.006), implanted cardiac devices (aOR 37.75, 95% CI 11.63-141.64, P ≤ 0.001), and central venous catheterization (aOR 4.25, 95% CI 1.14-15.55, P = 0.029) were independent risk factors for RSIE. Treatment strategies that consider the epidemiologic and microbiologic characteristics of RSIE are warranted.
Asunto(s)
Endocarditis , Humanos , Masculino , República de Corea/epidemiología , Femenino , Factores de Riesgo , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Endocarditis/epidemiología , Endocarditis/mortalidad , Endocarditis/microbiología , Adulto , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/patogenicidad , Prevalencia , Centros de Atención TerciariaRESUMEN
PURPOSE: S. aureus bacteremia (SAB) is a common and severe infection with high mortality and morbidity. The clinical relevance of the finding of concurrent S. aureus bacteriuria (SABU) is debated. The goal of this study was to analyze whether a concurrent SABU is associated with complicated SAB, infective endocarditis (IE) and mortality. METHODS: We conducted a retrospective cohort study, reviewing medical charts of all episodes of SAB in patients > 18 years in the region of Skåne, Sweden, between 1st of January and 31st of June 2020. Episodes where a concurrent urine culture was performed were included for analysis. An episode was considered as complicated SAB if there was either attributable mortality, recurrent infection, embolic stroke, or occurrence of a complicated focus of infection. RESULTS: During the study period, there were 279 episodes of SAB. 154 episodes met the eligibility criteria, of whom 37 (24%) had concurrent SABU. In 78 episodes (51%), the patients had a complicated SAB. There was a significantly lower proportion of complicated SAB for episodes with concurrent SABU (32%), compared to episodes without concurrent SABU (56%), p-value 0.014. Moreover, in the cohort there were 11 episodes (7.1%) of IE and a 30 days mortality rate of 16%, with no difference between the groups with or without SABU. CONCLUSIONS: There is an association between concurrent SABU and a decreased risk for complicated SAB among patients with SAB. This study found no significant association between SABU and neither IE nor mortality for patients with SAB.
Asunto(s)
Bacteriemia , Bacteriuria , Infecciones Estafilocócicas , Staphylococcus aureus , Humanos , Estudios Retrospectivos , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/complicaciones , Masculino , Femenino , Bacteriemia/microbiología , Bacteriemia/mortalidad , Bacteriemia/epidemiología , Bacteriemia/complicaciones , Anciano , Persona de Mediana Edad , Bacteriuria/microbiología , Bacteriuria/epidemiología , Bacteriuria/complicaciones , Suecia/epidemiología , Factores de Riesgo , Anciano de 80 o más Años , Endocarditis/microbiología , Endocarditis/mortalidad , Endocarditis/complicaciones , Endocarditis/epidemiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/complicaciones , AdultoRESUMEN
OBJECTIVES: To ascertain whether infective endocarditis (IE) was associated with persistent bacteraemia/candidaemia among patients with suspected IE. METHODS: This study included bacteraemic/candidaemic adult patients with echocardiography and follow-up blood cultures. Persistent bacteraemia/candidaemia was defined as continued positive blood cultures with the same microorganism for 48 h or more after antibiotic treatment initiation. Each case was classified for IE by the Endocarditis Team. RESULTS: Among 1962 episodes of suspected IE, IE (605; 31%) was the most prevalent infection type. Persistent bacteraemia/candidaemia was observed in 426 (22%) episodes. Persistent bacteraemia was more common among episodes with Staphylococcus aureus bacteraemia compared to episodes with positive blood cultures for other pathogens (32%, 298/933 vs 12%, 128/1029; P < 0.001). Multivariable analysis demonstrated that cardiac predisposing factors (aOR 1.84, 95% CI 1.31-2.60), community or non-nosocomial healthcare-associated (2.85, 2.10-3.88), bacteraemia by high-risk bacteria, such as S. aureus, streptococci, enterococci or HACEK (1.84, 1.31-2.60), two or more positive sets of index blood cultures (6.99, 4.60-10.63), persistent bacteraemia/candidaemia for 48 h from antimicrobial treatment initiation (1.43, 1.05-1.93), embolic events within 48h from antimicrobial treatment initiation (12.81, 9.43-17.41), and immunological phenomena (3.87, 1.09-1.78) were associated with infective endocarditis. CONCLUSIONS: IE was associated with persistent bacteraemia/candidaemia, along with other commonly associated factors.
Asunto(s)
Bacteriemia , Cultivo de Sangre , Endocarditis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Bacteriemia/microbiología , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Anciano , Endocarditis/microbiología , Endocarditis/diagnóstico , Endocarditis/tratamiento farmacológico , Candidemia/tratamiento farmacológico , Candidemia/diagnóstico , Candidemia/microbiología , Candidemia/epidemiología , Estudios de Cohortes , Adulto , Factores de Riesgo , Antibacterianos/uso terapéutico , Ecocardiografía , Staphylococcus aureus/aislamiento & purificación , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/epidemiología , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/diagnósticoRESUMEN
Importance: The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007. Objective: To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures. Data Sources: PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023. Study Selection: Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included. Data Extraction and Synthesis: Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis. Main Outcomes and Measures: The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis. Results: Of 11â¯217 records identified, 30 were included (1â¯152â¯345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci-infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis. Conclusions and Relevance: While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.
Asunto(s)
Profilaxis Antibiótica , Endocarditis , Profilaxis Antibiótica/métodos , Humanos , Incidencia , Endocarditis/prevención & control , Endocarditis/epidemiología , Endocarditis Bacteriana/prevención & control , Endocarditis Bacteriana/epidemiología , Atención Odontológica/efectos adversosRESUMEN
OBJECTIVE: The objective of this review was to gain new insight into the rare condition, Austrian syndrome: the triad of endocarditis, meningitis and pneumonia caused by Streptococcus pneumoniae. METHODS: A systematic review of case reports was conducted using the PRISMA guideline. Cases were rigorously screened to meet a set of well-defined inclusion criteria. Relevant data was aggregated and reported using descriptive statistics. RESULTS: Seventy-one cases from 69 case reports were included in the final review. The mean age was 56.5 years with a male-to-female ratio of 2.4:1. Alcoholism was reported in 41% of patients. Altered mental state (69%) and fever (65%) (mean temperature on admission = 38.9°C) were the commonest presenting symptoms. The mean duration of symptoms before presentation to the hospital was 8 days. The aortic valve was most commonly affected (56%). The mean duration of antibiotic therapy was 5.6 weeks. Seventy percent of patients were admitted to the intensive care unit (ICU). Fifty-six percent of patients had valvular surgery. The average length of stay in the hospital was 36.9 days. Mortality was recorded in 28% of patients. CONCLUSION: Austrian syndrome is rare but deadly. The true incidence is unknown but is commoner in middle-aged men and in alcoholics. Affected patients are usually critically unwell, often requiring ICU admission and prolonged hospital stays. Treatment is aggressive including prolonged courses of antibiotics and often, surgery. Despite these, the case fatality rate is high, with death occurring in over a quarter of patients. Surgery appears to be associated with better prognosis.
Asunto(s)
Streptococcus pneumoniae , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/terapia , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/terapia , Neumonía Neumocócica/epidemiología , Neumonía Neumocócica/terapia , SíndromeRESUMEN
BACKGROUND: Few population-based studies have evaluated the epidemiology of infective endocarditis (IE). Changes in population demographics and guidelines on IE may have affected both the incidence and outcomes of IE. Therefore, the aim of our study is to provide contemporary population-based epidemiological data of IE in Spain. METHODS: Retrospective nationwide observational study using data from the Spanish National Health System Discharge Database. We included all patients hospitalized with IE from January 2000 to December 2019. RESULTS: A total of 64,550 IE episodes were included. The incidence of IE rose from 5.25 cases/100,000 person-year in 2000 to 7.21 in 2019, with a 2% annual percentage change (95% CI 1.3-2.6). IE incidence was higher among those aged 85 or older (43.5 cases/100.000 person-years). Trends across the study period varied with sex and age. Patients with IE were progressively older (63.9 years in 2000-2004 to 70.0 in 2015-2019, p < 0.001) and had more frequent comorbidities and predispositions, including, previous valvular prosthesis (12.1% vs 20.9%, p < 0.001). After adjustment, a progressive reduction in mortality was noted including in 2015-2019 compared to 2010-2014 (adjusted odds ratio 0.93, 95% confident interval 0.88-0.99, p = 0.023)., which was associated with more frequent cardiac surgery in recent years (15.1% in 2010-2014 vs 19.9% in 2015-2019). CONCLUSIONS: In Spain, the incidence of IE has increased during the XXI century, with a more pronounced increase in elderly individuals. Adjusted-mortality decreased over the years, which could be related to a higher percentage of surgery. Our results highlight the changing epidemiology of IE.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Anciano , Humanos , España/epidemiología , Estudios Retrospectivos , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/cirugía , Endocarditis/epidemiología , Endocarditis/cirugía , Pronóstico , IncidenciaRESUMEN
BACKGROUND: Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. METHODS: We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. RESULTS: Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae-positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. CONCLUSIONS: Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.
Asunto(s)
Corynebacterium diphtheriae , Difteria , Humanos , Masculino , Adulto , Femenino , Washingtón/epidemiología , Persona de Mediana Edad , Corynebacterium diphtheriae/aislamiento & purificación , Difteria/epidemiología , Difteria/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Adulto Joven , Anciano , Antibacterianos/uso terapéutico , Endocarditis/microbiología , Endocarditis/epidemiologíaRESUMEN
BACKGROUND: Prophylactic antibiotic therapy is widely used in dermatologic surgery to prevent surgical site infections and bacteremia, which can lead to prosthetic joint infections (PJI) and infective endocarditis (IE) in high-risk populations. OBJECTIVE: To evaluate the incidence of bacteremia, PJI, and IE after dermatologic surgery and assess the current evidence for antibiotic prophylaxis. MATERIALS AND METHODS: A search of the computerized bibliographic databases was performed using key terms from the date of inception to March 21, 2021. Data extraction was performed independently by 2 data extractors. RESULTS: The review resulted in 9 publications that met inclusion criteria, including 5 prospective cohort studies and 4 case reports or case series. The prospective studies reported a wide range of bacteremia incidence (0%-7%) after dermatologic surgery. No cases of PJI resulting directly from cutaneous surgery were identified, and only 1 case series reported IE after various skin procedures. CONCLUSION: These findings suggest a low rate of bacteremia and a lack of direct evidence linking dermatologic surgery to PJI or IE. The scarcity of published data on this topic is a limitation, highlighting the need for further research, particularly randomized controlled trials, to guide antibiotic prophylaxis recommendations.