RESUMEN
INTRODUCTION: Endocarditis associated with medical care is a rare and serious entity. The risk of occurrence is increased in hemodialysis patients due to the immunosuppression and the multiplicity of vascular accesses of different kinds. The mode of revelation can be variable given the diversity of symptoms it causes. Herein, we describe the case of endocarditis associated with medical care in a patient with renal failure who presents with neurological symptoms. OBSERVATION: A 38-year-old patient with a history of kidney disease in the hemodialysis stage presented to the emergency room with altered neurological status in the context of fever. The patient's condition requires airway control, sedation, and vasopressor medication. Brain imaging revealed Fisher 4 subarachnoid hemorrhage with brain turgor. Transthoracic and transesophageal cardiac ultrasound exploration revealed infective mitro-aortic endocarditis with trigonal abscess fistulized in the left ventricle and destruction of the aortic valve with massive regurgitation. The additional imaging in a second step did not highlight any images of mycotic aneurysm. The indication for early surgery was not approved given the hemodynamic instability and the poor intracerebral hemodynamics demonstrated by transcranial doppler ultrasound. The initial outcome under antibiotic treatment and renal replacement was favorable. But the subsequent course was fatal due to septic shock with multiple organ failure. CONCLUSION: The diagnosis of infective endocarditis should always be considered in hemodialysis patients presenting in a septic state with signs of systemic involvement. It is a source of mortality in these debilitated patients.
Asunto(s)
Endocarditis Bacteriana , Diálisis Renal , Hemorragia Subaracnoidea , Humanos , Diálisis Renal/efectos adversos , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/terapia , Adulto , Masculino , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/microbiología , Resultado Fatal , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/etiologíaRESUMEN
As a consequence of the growing number of implanted transcatheter aortic valve prostheses, the increasing incidence of early and late complications of biological valves requires in several cases surgical explantation of the transcatheter valve and subsequent aortic root or surgical aortic valve replacement. In this video tutorial, we show how to avoid aortic root damage in the surgical explantation of a transcatheter aortic valve bioprosthesis in a patient with a dysfunctional transcatheter aortic valve prosthesis affected by endocarditis 15 months after implantation. The infected prosthesis and all foreign materials, concomitant to the calcified native valve, were excised en bloc in preparation for the extensive debridement of infected tissue in the abscess cavity. The defect on the aortic annulus was reconstructed using a pericardial patch, followed by a surgical valve implant.
Asunto(s)
Válvula Aórtica , Bioprótesis , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Bioprótesis/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/diagnóstico , Endocarditis/cirugía , Endocarditis/etiología , Remoción de Dispositivos/métodos , Masculino , Estenosis de la Válvula Aórtica/cirugía , Reoperación , Anciano de 80 o más Años , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/diagnóstico , AncianoRESUMEN
Infective endocarditis, particularly after implanting valve prostheses, poses significant surgical challenges, often requiring complex interventions. We describe a case of a 37-year-old male with Staphylococcus aureus endocarditis, unsuccessfully treated with mechanical valve prostheses. Continued infection led to the destruction of the intervalvular fibrous body, necessitating a Commando procedure involving radical debridement and replacement of both aortic and mitral valves with complex patch reconstruction. Prosthesis selection remains contentious, considering recurrence risk and long-term prognosis. Our case underscores timely intervention and meticulous technique in managing such complex situations. It highlights successful strategies for treating infective endocarditis with destruction of aortomitral continuity, emphasizing the pivotal role of the Commando procedure.
Asunto(s)
Válvula Aórtica , Endocarditis Bacteriana , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Infecciones Estafilocócicas , Humanos , Masculino , Adulto , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/cirugía , Infecciones Estafilocócicas/etiología , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/etiología , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Válvula Mitral/cirugía , Staphylococcus aureus/aislamiento & purificación , Reoperación , Desbridamiento/métodosRESUMEN
Infective endocarditis is a rare but life-threatening condition, occasionally linked to diverse immunologic manifestations, including mixed cryoglobulinemia. This can lead to cryoglobulinemic vasculitis, which has the potential for widespread organ damage. Although some cases have highlighted the relationship between infective endocarditis and cryoglobulinemic vasculitis, no comprehensive epidemiological evaluation or optimal treatment strategies have been advanced for such a combination. We present a case of methicillin-sensitive Staphylococcus aureus infective endocarditis associated with cryoglobulinemic vasculitis and conduct a literature review to compare management and outcomes in similar cases. Our patient presented with classical Meltzer's triad and mild renal involvement. Cryoimmunofixation confirmed type III cryoglobulinemia, and serum cytokines showed elevated IL-6 levels. The differential diagnosis included infective endocarditis and chronic active hepatitis C virus infection. Rapid symptom resolution after antibiotic treatment identified infective endocarditis as the likely cause of cryoglobulinemic vasculitis. Our case and review of the literature highlight that early identification of the cause of cryoglobulinemic vasculitis is crucial for selecting appropriate treatment and preventing recurrence or morbidity.
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Coinfección , Crioglobulinemia , Endocarditis Bacteriana , Hepatitis C Crónica , Infecciones Estafilocócicas , Staphylococcus aureus , Vasculitis , Humanos , Crioglobulinemia/etiología , Crioglobulinemia/complicaciones , Crioglobulinemia/diagnóstico , Infecciones Estafilocócicas/complicaciones , Hepatitis C Crónica/complicaciones , Vasculitis/etiología , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Masculino , Persona de Mediana Edad , Hepacivirus , Antibacterianos/uso terapéuticoRESUMEN
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
COMPLICATIONS OF INFECTIVE ENDOCARDITIS. The high in-hospital mortality of patients with infective endocarditis (about 20%) is mainly due to its complications. These complications are essentially of cardiac, neurological, and infectious origin. Rapid diagnosis and early antibiotic treatment are of paramount importance and allow drastic reduction of the frequency and severity of such complications. Discussion with all physicians caring for the patients with infective endocarditis in an "endocarditis team" setting is a mandatory step in management optimization and outcome improvement. This "endocarditis team" approach allows faster identification of patients at high risk of acute heart failure and/or cerebral embolism, and selection of those who might benefit from urgent valvular surgery. Factors associated with high embolic risk are the size and mobility of vegetation, mitral valve endocarditis, and infection with Staphylococcus aureus. When neurological complications occur, there is a risk that these may be worsened by the valvular surgery if there is a hemorrhagic component. This risk needs to be careful weighed in a team approach before sending patients to surgery. Persistent sepsis after effective antibiotic treatments prompts to local extension of the disease or to embolic extra cardiac secondary infectious localization.
COMPLICATIONS DE L'ENDOCARDITE INFECTIEUSE. Les complications de l'endocardite infectieuse (EI) sont à l'origine d'une mortalité hospitalière élevée d'environ 20 %. Elles sont essentiellement cardiaques, neurologiques et septiques. Un diagnostic rapide et une antibiothérapie précoce sont essentiels, car ils permettent de réduire la fréquence et la sévérité de ces complications. Une discussion collégiale au sein de l'équipe pluridisciplinaire (endocarditis team) est indispensable pour optimiser la prise en charge et améliorer le pronostic. Elle permet notamment d'identifier rapidement les patients à haut risque d'insuffisance cardiaque aiguë et/ou d'embolie cérébrale et de sélectionner les patients nécessitant une chirurgie valvulaire urgente. Les facteurs prédictifs d'un haut risque embolique sont la taille et la mobilité de la végétation, sa localisation sur la valve mitrale et l'EI à Staphylococcus aureus. La survenue d'une complication neurologique nécessite une évaluation rigoureuse compte tenu des risques d'aggravation de la lésion par la chirurgie valvulaire en présence d'une composante hémorragique. Un sepsis persistant sous traitement antibiotique doit faire rechercher une extension locale de l'endocardite ou des foyers emboliques extracardiaques.
Asunto(s)
Endocarditis , Humanos , Endocarditis/etiología , Endocarditis/diagnóstico , Endocarditis/complicaciones , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/diagnósticoRESUMEN
AIMS: Debulking of infective mass to reduce the burden if infective material is a fundamental principle in the surgical management of infection. The aim of this study was to investigate the validity of this principle in patients undergoing transvenous lead extraction in the context of bloodstream infection (BSI). METHODS AND RESULTS: We performed an observational single-centre study on patients that underwent transvenous lead extraction due to a BSI, with or without lead-associated vegetations, in combination with a percutaneous aspiration system during the study period 2015-22. One hundred thirty-seven patients were included in the final analysis. In patients with an active BSI at the time of intervention, the use of a percutaneous aspiration system had a significant impact on survival (log-rank: P = 0.0082), while for patients with a suppressed BSI at the time of intervention, the use of a percutaneous aspiration system had no significant impact on survival (log-rank: P = 0.25). CONCLUSION: A reduction of the infective burden by percutaneous debulking of lead vegetations might improve survival in patients with an active BSI.
Asunto(s)
Remoción de Dispositivos , Infecciones Relacionadas con Prótesis , Humanos , Femenino , Masculino , Remoción de Dispositivos/métodos , Anciano , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/mortalidad , Persona de Mediana Edad , Resultado del Tratamiento , Desfibriladores Implantables/efectos adversos , Succión , Marcapaso Artificial/efectos adversos , Marcapaso Artificial/microbiología , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/etiología , Estudios Retrospectivos , Factores de Tiempo , Factores de Riesgo , Anciano de 80 o más AñosRESUMEN
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
PURPOSE OF REVIEW: This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology. RECENT FINDINGS: Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
Asunto(s)
Infecciones Relacionadas con Prótesis , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Factores de Riesgo , Infecciones Relacionadas con Prótesis/terapia , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/microbiología , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/terapia , Endocarditis/microbiología , Endocarditis/etiologíaRESUMEN
We present a 70-year-old man with rheumatic mitral valve disease who had undergone 3 previous open-heart surgeries, the last of which was a new mitral valve replacement for a mechanical prosthesis due to early bioprosthetic endocarditis.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral , Humanos , Masculino , Anciano , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/terapia , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/terapia , Bioprótesis/efectos adversos , Cardiopatía Reumática/cirugía , Cardiopatía Reumática/diagnóstico , Resultado del Tratamiento , Endocarditis/diagnóstico , Endocarditis/etiología , Endocarditis/cirugía , Reoperación/métodos , Ecocardiografía Transesofágica/métodos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnósticoRESUMEN
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.
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Profilaxis Antibiótica , Bacteriemia , Procedimientos Quirúrgicos Dermatologicos , Infecciones Relacionadas con Prótesis , Humanos , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/prevención & control , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Incidencia , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Endocarditis/epidemiología , Endocarditis/etiología , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/etiología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
BACKGROUND: Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death. OBJECTIVES: The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors. METHODS: From January 2010 to June 2020, 227 persons who inject drugs, age 36 ± 9.9 years, underwent surgery for infective endocarditis at a quaternary hospital having special interest in developing addiction management programs. Postsurgery loss to follow-up, relapse, and death were assessed as competing risks and risk factors identified parametrically and by machine learning. CIs are 68% (±1 SE). RESULTS: Heroin was the most self-reported drug injected (n = 183 [81%]). Psychosocial issues included homelessness (n = 56 [25%]), justice system involvement (n = 150 [66%]), depression (n = 118 [52%]), anxiety (n = 104 [46%]), and post-traumatic stress disorder (n = 33 [15%]). Four (1.8%) died in-hospital. Medication for opioid use disorder prescribed at discharge increased from 0% in 2010 to 100% in 2020. At 1 and 5 years, conditional probabilities of loss to follow-up were 16% (68% CI: 13%-22%) and 59% (68% CI: 44%-65%), relapse 32% (68% CI: 28%-34%) and 79% (68% CI: 74%-83%), and mortality 21% (68% CI: 18%-23%) and 68% (68% CI: 62%-72%). Younger age, heroin use, and lower education level were predictors of relapse. CONCLUSIONS: Infective endocarditis surgery can be performed with low mortality in persons who inject drugs, but addiction is far more lethal. Risk of loss to follow-up and relapse require more effective addiction strategies without which this major loss to society will continue.
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Consumidores de Drogas , Endocarditis Bacteriana , Endocarditis , Abuso de Sustancias por Vía Intravenosa , Humanos , Adulto , Persona de Mediana Edad , Analgésicos Opioides , Heroína , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Estudios Retrospectivos , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/complicaciones , Endocarditis/epidemiología , Endocarditis/etiología , RecurrenciaAsunto(s)
Válvula Aórtica , Prótesis Valvulares Cardíacas , Humanos , Prótesis Valvulares Cardíacas/efectos adversos , Válvula Aórtica/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/etiología , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/etiología , Procedimientos Quirúrgicos sin Sutura/métodos , Diseño de Prótesis , Endocarditis/cirugía , Endocarditis/etiología , Implantación de Prótesis de Válvulas Cardíacas/métodosRESUMEN
BACKGROUND AND AIMS: Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI). METHODS: All patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE. RESULTS: PVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9% vs. 33.3%; p = 0.005). In SAVR-PVE patients, both therapies were comparable in terms of survival (p = 0.861). However, SAVR-PVE patients who were not operated, despite ESC-guideline recommendation, had significantly poorer one-year survival (p = 0.004). CONCLUSION: TAVI patients did not have a significantly higher risk to develop PVE. Our data suggest that TAVI-PVE patients in contrast to SAVR-PVE patients can more often be treated with antibiotics only, presumably due to the lack of a polymeric suture ring.
Asunto(s)
Estenosis de la Válvula Aórtica , Endocarditis Bacteriana , Endocarditis , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Endocarditis/epidemiología , Factores de Riesgo , Instrumentos Quirúrgicos , Antibacterianos/uso terapéutico , Polímeros , Catéteres/efectos adversos , Resultado del TratamientoAsunto(s)
Candidiasis , Endocarditis Bacteriana , Endocarditis , Prótesis Valvulares Cardíacas , Humanos , Candida , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Endocarditis/diagnóstico por imagen , Endocarditis/etiología , Endocarditis/tratamiento farmacológico , Candidiasis/diagnóstico , Candidiasis/diagnóstico por imagen , Antifúngicos/uso terapéuticoRESUMEN
BACKGROUND: Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. METHODS: Data were collected from the "Infectious Endocarditis after TAVR International" (enrollment from 2005 to 2020) and the "International Collaboration on Endocarditis" (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. RESULTS: A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). CONCLUSIONS: Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up.
Asunto(s)
Estenosis de la Válvula Aórtica , Endocarditis Bacteriana , Endocarditis , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Humanos , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Estenosis de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/cirugía , Resultado del Tratamiento , Prótesis Valvulares Cardíacas/efectos adversos , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Endocarditis/epidemiología , Endocarditis/etiología , Endocarditis/cirugía , Factores de RiesgoRESUMEN
OBJECTIVES: To date, there is a lack of data regarding the acceptance of the guidelines for infective endocarditis (IE) prevention among dentists in Italy, and similarly, there are no data on the understanding and compliance of those among dental hygienists (DH). Thus, we tried to assess the ability of DH to recognize and manage categories of patients at high risk of EI, to identify which dental procedures are at increased risk and to assess the level of knowledge of doses and how antibiotic prophylaxis should be administered in specific cases. METHODS: An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms® link; general personal data and educational background information were collected to obtain a profile of the participants. RESULTS: A total of 362 DH answered to our web-based survey, showing a prevalent female percentage (86.7%) and the most represented age group of 30-39 years old (43.1%). Regarding the gender differences, there were not overall statistically significant differences; similarly, we did not find any differences regarding the overall number of wrong questions if considering the different ages of the participant and the year of graduation. Graduates in Northern Italy have mistaken fewer questions than graduates in other geographical areas. CONCLUSION: To the best of our knowledge, this is the largest survey about the knowledge of IE for DH ever performed. Because the overprescription of antibiotics contributes to the development of drug resistance, antibiotic stewardship should be at the forefront of patient care. Our data reflect the need for placing a greater emphasis on IE prophylaxis education in training and during continuing professional development events for DH.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Humanos , Femenino , Adulto , Higienistas Dentales , Endocarditis/complicaciones , Endocarditis/tratamiento farmacológico , Endocarditis/prevención & control , Endocarditis Bacteriana/prevención & control , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/etiología , Profilaxis Antibiótica/efectos adversos , Antibacterianos/uso terapéuticoRESUMEN
The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation.