Medicine › Epidemiology

Infective Endocarditis Diagnosis and Management

Works Count: 52198

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Description

This cluster of papers covers the management, diagnosis, treatment, epidemiology, and prophylaxis of infective endocarditis. It includes discussions on surgical approaches, complications, bacteremia, and guidelines for the diagnosis and antibiotic treatment. The cluster also explores the association between Streptococcus gallolyticus infection and colorectal cancer.

Keywords

Infective Endocarditis; Diagnosis; Treatment; Epidemiology; Prophylaxis; Surgery; Complications; Bacteremia; Endocarditis Guidelines; Streptococcus gallolyticus

Trends in Infective Endocarditis Incidence, Microbiology, and Valve Replacement in the United States From 2000 to 2011

2015-05-01

Sadip Pant , Nileshkumar Patel , Abhishek Deshmukh +5 more

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

2015-10-13

Larry M. Baddour , Walter R. Wilson , Arnold S. Bayer +7 more

Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated … Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations.Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

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2015 ESC Guidelines for the management of infective endocarditis

2015-08-29

Gilbert Habib , Patrizio Lancellotti , Manuel J. Antunes +7 more

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Conjugal Transfer of Plasmid-Borne Multiple Antibiotic Resistance in <i>Streptococcus faecalis</i> var. <i>zymogenes</i>

1974-02-01

A. E. Jacob , Susan J. Hobbs

A strain of Streptococcus faecalis var. zymogenes , designated JH1, had high-level resistance to the antibiotics streptomycin, kanamycin, neomycin, erythromycin, and tetracycline. These resistances were lost en bloc from approximately … A strain of Streptococcus faecalis var. zymogenes , designated JH1, had high-level resistance to the antibiotics streptomycin, kanamycin, neomycin, erythromycin, and tetracycline. These resistances were lost en bloc from approximately 0.1% of cells grown in nutrient broth at 45 C. The frequency of resistance loss was not increased by growth in the presence of the “curing” agents acriflavine or acridine orange, but after prolonged storage in nutrient agar 17% of cells became antibiotic sensitive. Covalently closed circular deoxyribonucleic acid (DNA) molecules were isolated from the parental strain and from antibiotic-sensitive segregants by using cesium chloride-ethidium bromide gradients. DNA molecular species were identified by using neutral sucrose gradients. Strain JH1 contained two covalently closed circular DNA species of molecular weights 50 × 10 6 and 38 × 10 6 . An antibiotic-sensitive segregant, strain JH1-9, had lost the larger molecular species. A second sensitive segregant, strain JH1-5, had also lost the larger molecular species but a new molecular species of approximate molecular weight 6 × 10 6 was present. The antibiotic resistances that were curable from the parental strain were transferred to antibiotic-sensitive strains of S. faecalis and to strain JH1-9, during mixed incubation in nutrient broth at 37 C. Data to be described are interpreted to suggest that the transfer is by a conjugal mechanism. Analysis of the plasmid species in recipient clones showed that all had received the plasmid of molecular weight 50 × 10 6 . Strain JH1-5 was not a good recipient. Analysis of one successful recipient clone of JH1-5 revealed that it had gained the 50 × 10 6 molecular weight plasmid but lost the 6 × 10 6 molecular weight species. These data are interpreted to mean that the multiple antibiotic resistance is borne by a transferable plasmid of 50 × 10 6 molecular weight, and that in clone JH1-5 this plasmid suffered a large deletion leaving only a 6 × 10 6 remnant which was incompatible with the complete replicon.

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Infective Endocarditis in Adults

2001-11-01

Eleftherios Mylonakis , Stephen B. Calderwood

The clinical features of this complex infection have changed in the past several decades. It is now an infection of older people, and mitral-valve prolapse is the most common predisposing … The clinical features of this complex infection have changed in the past several decades. It is now an infection of older people, and mitral-valve prolapse is the most common predisposing cardiovascular problem in developed countries. In contrast, rheumatic heart disease is an important predisposing problem in developing countries. This review article provides a comprehensive assessment of this serious infectious disease, including diagnostic challenges, cardiovascular and neurologic complications, and approaches to therapy.

Slow Response to Vancomycin or Vancomycin plus Rifampin in Methicillin-resistant <i>Staphylococcus aureus</i> Endocarditis

1991-11-01

Donald P. Levine , Barbara S. Fromm , B. Ramesh Reddy

Objective: To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. Design: Cohort analysis of a … Objective: To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. Design: Cohort analysis of a randomized study. Setting: University medical center. Patients: Forty-two consecutive patients with MRSA endocarditis were randomly assigned to receive either vancomycin (group I) or vancomycin plus rifampin (group II) for 28 days. Measurements: Clinical signs and symptoms were recorded, and blood cultures were obtained daily to determine the duration of bacteremia. Main Results: The median duration of bacteremia was 9 days (7 days for group I and 9 days for group II). The median duration of fever for all patients and for each treatment group was 7 days. Six patients failed therapy, including three patients who died 5, 6, and 9 days after therapy was started, respectively. The other three patients who failed therapy required valve surgery on days 2, 22, and 27, respectively. Although patients had sustained bacteremia, no unusual complications were seen in either treatment group, and most patients responded to continued antibiotic therapy. Conclusions: Slow clinical response is common among patients with MRSA endocarditis who are treated with vancomycin or vancomycin plus rifampin. Nevertheless, few complications appear to be related solely to this sustained bacteremia.

Prosthetic valve endocarditis.

1984-02-01

Torbjörn Ivert , William E. Dismukes , C. Glenn Cobbs +3 more

Fifty-three (3.6%; actuarially 4.1% at 48 months) of 1465 consecutive in-hospital survivors of valve replacement from 1975 to July 1979 (aortic, mitral, or aortic and mitral, only one untraced) developed … Fifty-three (3.6%; actuarially 4.1% at 48 months) of 1465 consecutive in-hospital survivors of valve replacement from 1975 to July 1979 (aortic, mitral, or aortic and mitral, only one untraced) developed prosthetic valve endocarditis (PVE). Incremental risk factors for developing PVE were native valve endocarditis (p less than .0001), black race (p = .0001), mechanical prosthesis (vs bioprosthesis) (p = .005), male sex (p = .04), and longer cardiopulmonary bypass time (p = .09). In general, the hazard function for developing PVE was greatest at 3 weeks after valve replacement. Patients with native valve endocarditis had a tendency to develop PVE early after valve replacement, as did patients in whom mechanical prostheses were used. PVE associated with Staphylococcus epidermidis tended to appear within 6 months of valve replacement, whereas streptococcal PVE tended to appear later after valve replacement. PVE took an atypical form in some patients, but patients with possible PVE (n = 6) had the same findings as those with certain PVE (n = 47). In 11 patients bacteriologic confirmation of PVE was not obtained. The typical prosthetic and periprosthetic characteristics of PVE were present in 30 of the 40 cases in which observations were possible. PVE is a serious condition; 34 (64%) of our 53 patients died. Most deaths occurred within 3 months of the first evidence of PVE. Recovery of some patients is possible with appropriate medical and surgical treatment, but more intense preventive measures are indicated.

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Echocardiography in infective endocarditis: Reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach

1989-09-01

Andreas Mügge , Werner G. Daniel , Günter Frank +1 more

The congenitally bicuspid aortic valve

1970-07-01

William C. Roberts

Infective Endocarditis: An Analysis Based on Strict Case Definitions

1981-04-01

C. Fordham von Reyn

Strict case definitions were applied to 123 clinically diagnosed cases of infective endocarditis. Cases were categorized as definite (19), probable (44), or possible (41) endocarditis or were rejected (19). Compared … Strict case definitions were applied to 123 clinically diagnosed cases of infective endocarditis. Cases were categorized as definite (19), probable (44), or possible (41) endocarditis or were rejected (19). Compared to other published studies, our patients had an advanced mean age (57), high incidence of underlying valvular disease (66%), short mean duration of symptoms (27 days), and 15% mortality, the lowest reported for a large series. Most cases were caused by viridans streptococci, Staphylococcus aureus, or enterococci; Enterobacteriacae were absent, and negative cultures infrequent (5%). Subgroups included nosocomial endocarditis (13%), usually with underlying valvular disease and invasive procedures; prosthesis endocarditis (12%); and cases requiring cardiac surgery (18%). Deaths were caused by heart failure, neurologic events, or superinfection. Strict definitions are useful in managing suspect cases, and are essential in comparing clinical studies. Early recognition and treatment should be the focus of efforts to reduce mortality from endocarditis.

Infective Endocarditis in the Antibiotic Era

1966-01-27

Phillip I. Lerner , Louis Weinstein

IMPORTANT contributions to our knowledge and understanding of infective endocarditis were made by a number of students of this disease in the first third of this century. Thayer,1 among others, … IMPORTANT contributions to our knowledge and understanding of infective endocarditis were made by a number of students of this disease in the first third of this century. Thayer,1 among others, preferred the term infective endocarditis for this disorder, giving it equal emphasis with the more common designation bacterial endocarditis. We have chosen to employ Thayer's terminology because a significant aspect of the changing picture of this disease is an increasing involvement of agents such as fungi and even rickettsias; the term bacterial endocarditis, therefore, is not strictly applicable.In 1955 Kerr2 summarized all the significant information concerning subacute bacterial . . .

Systemic Infection Related to Endocarditis on Pacemaker Leads

1997-04-15

Didier Klug , Dominique Lacroix , Christine Savoye +5 more

Background Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To determine in which situations the diagnosis should be evoked and to determine … Background Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To determine in which situations the diagnosis should be evoked and to determine optimal management, we reviewed our experience with endocarditis related to PM-lead infection. Methods and Results Fifty-two patients were admitted for endocarditis related to PM-lead infection. The presentation was acute in 14 patients, with onset of symptoms in the first 6 weeks after the last procedure on the implant site, and chronic in 38 patients. Fever occurred in 86.5%. Clinical and/or radiological evidences of pulmonary involvement were observed in 38.4%. Pulmonary scintigraphy disclosed pulmonary infarcts in 31.2%. Local complications were found in 51.9%. Elevated C-reactive protein was found in 96.2%. A germ was isolated in 88.4% of patients and was a Staphylococcus in 93.5%. Transthoracic echocardiography demonstrated vegetations in only 23% of patients, whereas transesophageal echocardiography disclosed abnormal appearances on the PM lead in 94%. We systematically tried to ablate all the material. Two techniques were used: percutaneous ablation or surgical removal during extracorporeal circulation. All patients were treated with antibiotics after removal of the infected material. Two patients died before lead removal and 2 after surgical removal; the predischarge mortality was 7.6%, and the overall mortality was 26.9% after a follow-up of 20.1±13 months. Conclusions The diagnosis of endocarditis related to PM-lead infection should be suspected in the presence of fever, complications, or pulmonary lesions after PM insertion. Transesophageal echocardiography should be performed to look for vegetations. Staphylococci are involved in the majority of these infections. The endocardial system must be entirely removed and appropriate antibiotic therapy pursued for 6 weeks.

Adherence and Growth of Coagulase-Negative Staphylococci on Surfaces of Intravenous Catheters

1982-10-01

G. Peters , R. Locci , G. Pulverer

Colonization of intravenous catheters by coagulase-negative staphylococci was followed by scanning electron microscopy. Regular sampling of specimens demonstrated adhesion of the staphylococci to the catheter surface followed by cell proliferation, … Colonization of intravenous catheters by coagulase-negative staphylococci was followed by scanning electron microscopy. Regular sampling of specimens demonstrated adhesion of the staphylococci to the catheter surface followed by cell proliferation, possible breakdown of catheter components, and production of a slimy material covering the bacterial colonies. The implications of these findings with reference to nosocomial infections of prosthetic devices are discussed.

New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings

1994-03-01

David T. Durack , Andrea S. Lukes , David K. Bright +1 more

Demonstration of the etiologic role of streptococci in experimental caries in the hamster

1960-07-01

R.J. Fitzgerald , Paul H. Keyes

Diagnosis and Management of Infective Endocarditis and Its Complications

1998-12-22

Arnold S. Bayer , Ann F. Bolger , Kathryn A. Taubert +7 more

HomeCirculationVol. 98, No. 25Diagnosis and Management of Infective Endocarditis and Its Complications HomeCirculationVol. 98, No. 25Diagnosis and Management of Infective Endocarditis and Its Complications

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Extra-Intestinal Manifestations of Salmonella Infections

1987-09-01

Jeffrey I. Cohen , John Bartlett , G. Ralph Corey

COHEN, JEFFREY I. M.D.; BARTLETT, JOHN A. M.D.; COREY, G. RALPH M.D. Author Information COHEN, JEFFREY I. M.D.; BARTLETT, JOHN A. M.D.; COREY, G. RALPH M.D. Author Information

Treatment of Infections Associated with Surgical Implants

2004-03-31

Rabih O. Darouiche

About half of all nosocomial infections are associated with indwelling devices. Infections associated with implanted surgical devices are particularly difficult to deal with because they can require prolonged antibiotic treatment … About half of all nosocomial infections are associated with indwelling devices. Infections associated with implanted surgical devices are particularly difficult to deal with because they can require prolonged antibiotic treatment and repeated surgical procedures. This review summarizes the diagnostic challenges and explains the approaches to managing infections that are associated with various devices, including prosthetic heart valves, vascular grafts, pacemakers and defibrillators, and joint prostheses.

Changing Patient Characteristics and the Effect on Mortality in Endocarditis

2002-01-14

Christopher H. Cabell , James G. Jollis , Gail Peterson +7 more

Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival.Data were collected from all patients with definite or … Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival.Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling.Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P=.04, P=.008, and P<.001, respectively), while rates of infection due to viridans group streptococci decreased (P=.007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P=.04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3).The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.

Association between dental health and acute myocardial infarction.

1989-03-25

Kimmo Mattila , Markku S. Nieminen , Ville Valtonen +7 more

Known risk factors for coronary heart disease do not explain all of the clinical and epidemiological features of the disease. To examine the role of chronic bacterial infections as risk … Known risk factors for coronary heart disease do not explain all of the clinical and epidemiological features of the disease. To examine the role of chronic bacterial infections as risk factors for the disease the association between poor dental health and acute myocardial infarction was investigated in two separate case-control studies of a total of 100 patients with acute myocardial infarction and 102 controls selected from the community at random. Dental health was graded by using two indexes, one of which was assessed blind. Based on these indexes dental health was significantly worse in patients with acute myocardial infarction than in controls. The association remained valid after adjustment for age, social class, smoking, serum lipid concentrations, and the presence of diabetes. Further prospective studies are required in different populations to confirm the association and to elucidate its nature.

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The Gulstonian Lectures, on Malignant Endocarditis

1885-03-07

William Osler

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Prevention of Infective Endocarditis

2007-04-20

Walter R. Wilson , Kathryn A. Taubert , Michael H. Gewitz +7 more

Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. Methods … Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. Methods and Results— A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. Conclusions— The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

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Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)

2009-08-27

G. Habib , Bruno Hoen , P. Tornos +7 more

The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to … The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to take them fully into account when exercising their clinical judgement.The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

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Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy

2011-11-14

F. K. Gould , David W. Denning , Thomas Elliott +6 more

The BSAC guidelines on treatment of infectious endocarditis (IE) were last published in 2004. The guidelines presented here have been updated and extended to reflect developments in diagnostics, new trial … The BSAC guidelines on treatment of infectious endocarditis (IE) were last published in 2004. The guidelines presented here have been updated and extended to reflect developments in diagnostics, new trial data and the availability of new antibiotics. The aim of these guidelines, which cover both native valve and prosthetic valve endocarditis, is to standardize the initial investigation and treatment of IE. An extensive review of the literature using a number of different search criteria has been carried out and cited publications used to support any changes we have made to the existing guidelines. Publications referring to in vitro or animal models have only been cited if appropriate clinical data are not available. Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking and therefore a consensus approach has again been adopted for most recommendations; however, we have attempted to grade the evidence, where possible. The guidelines have also been extended by the inclusion of sections on clinical diagnosis, echocardiography and surgery.

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Recommendations for the practice of echocardiography in infective endocarditis

2010-03-01

Gilbert Habib , Luigi P. Badano , Christophe Tribouilloy +7 more

Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction … Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short- and long-term prognosis, the prediction of embolic events, and the follow-up of patients under specific antibiotic therapy. Echocardiography is also useful for the diagnosis and management of the complications of IE, helping the physician in decision-making, particularly when a surgical therapy is considered. Finally, intraoperative echocardiography must be performed in IE to help the surgeon in the assessment and management of patients with IE during surgery. The current 'recommendations for the practice of echocardiography in infective endocarditis' aims to provide both an updated summary concerning the value and limitations of echocardiography in IE, and clear and simple recommendations for the optimal use of both transthoracic and transoesophageal echocardiography in IE.

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Changing Profile of Infective Endocarditis<SUBTITLE>Results of a 1-Year Survey in France</SUBTITLE>

2002-07-03

Bruno Hoen

ContextSince the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies … ContextSince the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991.ObjectiveTo update information gained from the 1991 study on the epidemiology of IE in France.Design and SettingPopulation-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants).PatientsThree hundred ninety adult inpatients diagnosed with IE according to Duke criteria.Main Outcome MeasuresIncidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes.ResultsThe annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P = .67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P = .97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P = .08).ConclusionAlthough the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.

Infective Endocarditis

2005-06-13

Larry M. Baddour , Walter R. Wilson , Arnold S. Bayer +7 more

Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among … Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results— This work represents the third iteration of an infective endocarditis “treatment” document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions— The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.

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A HITHERTO UNDESCRIBED FORM OF VALVULAR AND MURAL ENDOCARDITIS

1924-06-01

E Libman

In previous communications,<sup>1</sup>cases of endocarditis were classified as rheumatic, syphilitic, bacterial—acute and subacute—and indeterminate. The latter term was introduced to designate certain cases which do not fall into the category … In previous communications,<sup>1</sup>cases of endocarditis were classified as rheumatic, syphilitic, bacterial—acute and subacute—and indeterminate. The latter term was introduced to designate certain cases which do not fall into the category of any of the well-recognized groups of endocarditis, and the etiology of which is not yet established. The term is used to include (a) the cases of so-called "terminal" or "cachectic" endocarditis, occurring at the close of chronic diseases such as carcinoma, tuberculosis, nephritis, and leukemia, and (b) cases of "atypical verrucous endocarditis." The purpose of the present communication is to discuss the cases included in the latter group, which we believe represent a hitherto undescribed form of endocarditis. We are at the present time reporting the study of four cases, clinical observations of which were supplemented by postmortem examinations. In each instance, there were peculiar valvular and mural lesions, which differed in morphology and localization from those generally

Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century

2009-03-09

David Murdoch

<h3>Background</h3> We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. <h3>Methods</h3> Prospective cohort … <h3>Background</h3> We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. <h3>Methods</h3> Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. <h3>Results</h3> The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients.<i>Staphylococcus aureus</i>was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30),<i>S aureus</i>infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. <h3>Conclusions</h3> In the early 21st century, IE is more often an acute disease, characterized by a high rate of<i>S aureus</i>infection. Mortality remains relatively high.

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Prevention of bacterial endocarditis. Recommendations by the American Heart Association

1997-12-01

A S Dajani , Kathryn A. Taubert , Walter R. Wilson +7 more

Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis

2007-03-27

Andrew Wang

HEART VALVE REPLACEMENT surgery is performed in more than 150 000 patients per year in the United States and Europe, 1,2 and the number of prosthetic valve implantations continues to … HEART VALVE REPLACEMENT surgery is performed in more than 150 000 patients per year in the United States and Europe, 1,2 and the number of prosthetic valve implantations continues to increase. 3Infection of a heart valve prosthesis, or prosthetic valve endocarditis (PVE), is an uncommon but potentially lethal complication of heart valve replacement surgery.Despite ad-

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Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Executive Summary The Task Force on Infective Endocarditis of the European Society of Cardiology

2004-01-23

Dieter Horstkotte

Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular … Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by different organizations, the European Society of Cardiology (ESC) and by other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied within the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources. The ESC …

Preeminence of Staphylococcus aureus in Infective Endocarditis: A 1-Year Population-Based Survey

2012-04-09

Christine Selton‐Suty , M. Célard , Vincent Le Moing +7 more

Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for … Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.

Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis

2000-04-01

Jingxiao Li , Daniel J. Sexton , Nathan W. Mick +5 more

Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of … Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984. Databases on echo-cardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema. The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.

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Staphylococcus aureus Endocarditis

2005-06-21

Vance G. Fowler , José M. Miró , Bruno Hoen +7 more

OR DECADES, INFECTIVE ENDOCARditis (IE) caused by Staphylococcus aureus has been viewed primarily as a community-acquired disease, especially associated with injection drug use. [1]][10][11] S aureus IE is relatively infrequent … OR DECADES, INFECTIVE ENDOCARditis (IE) caused by Staphylococcus aureus has been viewed primarily as a community-acquired disease, especially associated with injection drug use. [1]][10][11] S aureus IE is relatively infrequent at any individual institution, and observations of its characteristics were based primarily upon relatively small samples, 1,3,6,9,[12][13][14] single-center experiences, 5,6,8,9,[13][14][15][16] or retrospectively identified patients. 2,7,8,15,16tient characteristics, treatment practices, and outcomes in these single-center studiesoftendifferedconsiderably.Moreover, because no large, prospectively col-

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BSAC standardized disc susceptibility testing method (version 7)

2008-01-31

J. M. Andrews

The changes that have been made to the previous version of the recommendations (version 6) are as follows: medium and incubation condition for testing Acinetobacter spp. (Tables 1 and 6); … The changes that have been made to the previous version of the recommendations (version 6) are as follows: medium and incubation condition for testing Acinetobacter spp. (Tables 1 and 6); use of cefoxitin as an indicator antibiotic for detecting methicillin/oxacillin/cefoxitin resistance in coagulase-negative staphylococci (Tables 1, 6 and 11); MIC breakpoint for co-trimoxazole based on the trimethoprim concentration in a 1:19 combination with sulfamethoxazole (Tables 7, 10, 11, 12, 15, 16 and 19); advice on the use of azithromycin for the treatment of infections with Salmonella typhi (footnote to Table 7); amendment to the recommendation for cefuroxime for the treatment of infections with Proteus mirabilis (footnote Table 7); MIC and zone diameter breakpoints for Stenotrophomonas maltophilia only (Table 10); MIC breakpoints for daptomycin (Tables 11 and 15); clarification for staphylococci that the neomycin zone diameter breakpoints are for topical use only and differentiate the isolates outside the 'wild-type' population in Table 11; clarification for β-haemolytic streptococci that the linezolid zone diameter breakpoints relate to an MIC breakpoint of 2 mg/L as no data for the intermediate category are currently available (Table 15); clarification that strains with reduced susceptibility to fluoroquinolones give no zone of inhibition with a 30 µg nalidixic acid disc (Tables 16 and 21); erythromycin is no longer used for therapy of Neisseria gonorrhoeae, but may be tested for epidemiological purposes (Table 17); clarification that the ciprofloxacin zone diameter breakpoint for Neisseria meningitidis relates to the MIC breakpoint of 0.03 mg/L as no data for the intermediate category are currently available; clarification that the ciprofloxacin zone diameter breakpoints for Campylobacter spp. relate to an MIC breakpoint of 0.5 mg/L as no data for the intermediate category are currently available; clarification that for ciprofloxacin and vancomycin zone diameter breakpoints for coryneform organisms relate to an MIC breakpoint of 0.5 and 4 mg/L, respectively, as no data for the intermediate category are currently available; MIC and zone diameter breakpoints for Gram-negative rods isolated from urinary tract infections have been expanded to include Klebsiella spp.; and a definition of coliforms is also included (Table 26).

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Involvement of Panton-Valentine Leukocidin--Producing Staphylococcus aureus in Primary Skin Infections and Pneumonia

1999-11-01

Gérard Lina , Y. Piémont , F. Godail-Gamot +5 more

Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and tissue necrosis. It is produced by fewer than 5% of Staphylococcus aureus strains. A collection of 172 S. aureus … Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and tissue necrosis. It is produced by fewer than 5% of Staphylococcus aureus strains. A collection of 172 S. aureus strains were screened for PVL genes by polymerase chain reaction amplification. PVL genes were detected in 93% of strains associated with furunculosis and in 85% of those associated with severe necrotic hemorrhagic pneumonia (all community-acquired). They were detected in 55% of cellulitis strains, 50% of cutaneous abscess strains, 23% of osteomyelitis strains, and 13% of finger-pulp-infection strains. PVL genes were not detected in strains responsible for other infections, such as infective endocarditis, mediastinitis, hospital-acquired pneumonia, urinary tract infection, and enterocolitis, or in those associated with toxic-shock syndrome. It thus appears that PVL is mainly associated with necrotic lesions involving the skin or mucosa.

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Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography

2005-06-28

Franck Thuny , Giovanni DiSalvo , Olivier Belliard +7 more

The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the … The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined. In a multicenter prospective European study, including 384 consecutive patients (aged 57+/-17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02). In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.

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Early Surgery versus Conventional Treatment for Infective Endocarditis

2012-06-27

Duk‐Hyun Kang , Yong Jin Kim , Sung‐Han Kim +7 more

The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis remain controversial. We conducted a trial to compare clinical outcomes of early surgery and conventional treatment … The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis remain controversial. We conducted a trial to compare clinical outcomes of early surgery and conventional treatment in patients with infective endocarditis.

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Prevention of Bacterial Endocarditis

1998-04-01

Adnan S. Dajani , Kathryn A. Taubert , Walter R. Wilson +7 more

DAJANI, ADNAN S.; TAUBERT, KATHRYN A.; WILSON, WALTER; BOLGER, ANN F.; BAYER, ARNOLD; FERRIERI, PATRICIA; GEWITZ, MICHAEL H.; SHULMAN, STANFORD T.; NOURI, SORAYA; NEWBUGER, JANE W.; HUTTO, CECILIA; PALIASCH, THOMASJ; … DAJANI, ADNAN S.; TAUBERT, KATHRYN A.; WILSON, WALTER; BOLGER, ANN F.; BAYER, ARNOLD; FERRIERI, PATRICIA; GEWITZ, MICHAEL H.; SHULMAN, STANFORD T.; NOURI, SORAYA; NEWBUGER, JANE W.; HUTTO, CECILIA; PALIASCH, THOMASJ; GAGE, TOMMY W.; LEVISON, MATTHEW E.; PETER, GEORGES; ZUCCARO, GREGORY JR.; Wiklund, Richard A. M.D. Author Information

Improvement in the Diagnosis of Abscesses Associated with Endocarditis by Transesophageal Echocardiography

1991-03-21

Werner G. Daniel , Andreas Mügge , Randolph P. Martin +5 more

Echocardiography is recognized as the method of choice for the noninvasive detection of valvular vegetations in patients with infective endocarditis, with transesophageal echocardiography being more accurate than transthoracic echocardiography. The … Echocardiography is recognized as the method of choice for the noninvasive detection of valvular vegetations in patients with infective endocarditis, with transesophageal echocardiography being more accurate than transthoracic echocardiography. The diagnosis of associated abscesses by transthoracic echocardiography is difficult or even impossible in many cases, however, and it is not known whether transesophageal echocardiography is any better.To determine the value of transesophageal echocardiography in the detection of abscesses associated with endocarditis, we studied prospectively by two-dimensional transthoracic and transesophageal echocardiography 118 consecutive patients with infective endocarditis of 137 native or prosthetic valves that was documented during surgery or at autopsy.During surgery or at autopsy, 44 patients (37.3 percent) had a total of 46 definite regions of abscess. Abscesses were more frequent in aortic-valve endocarditis than in infections of other valves, and the infecting organism was more often staphylococcus (52.3 percent of cases) in patients with abscesses than in those without abscesses (16.2 percent). The hospital mortality rate was 22.7 percent in patients with abscesses, as compared with 13.5 percent in patients without abscesses. Whereas transthoracic echocardiography identified only 13 of the 46 areas of abscess, the transesophageal approach allowed the detection of 40 regions (P less than 0.001). Sensitivity and specificity for the detection of abscesses associated with endocarditis were 28.3 and 98.6 percent, respectively, for transthoracic echocardiography and 87.0 and 94.6 percent for transesophageal echocardiography; positive and negative predictive values were 92.9 and 68.9 percent, respectively, for the transthoracic approach and 90.9 and 92.1 percent for the transesophageal approach. Variation between observers was 3.4 percent for transthoracic and 4.2 percent for transesophageal echocardiography.The data indicate that transesophageal echocardiography leads to a significant improvement in the diagnosis of abscesses associated with endocarditis. The technique facilitates the identification of patients with endocarditis who have an increased risk of death and permits earlier treatment.

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Intra-Arterial Mechanical Thrombectomy: An Effective Treatment for Ischemic Stroke Caused by Endocarditis

2016-10-31

Ólafur Sveinsson , Lars Herrman , Staffan Holmin

Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic … Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis. Mechanical thrombectomy is most likely a more effective and safer treatment than intravenous thrombolysis in this patient group.

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Challenges in Infective Endocarditis

2017-01-01

Thomas J. Cahill , Larry M. Baddour , Gilbert Habib +5 more

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2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2017-03-15

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

Prevention of Bacterial Endocarditis

1997-06-11

Adnan S. Dajani

<h3>Objective.</h3> —To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. <h3>Particpants.</h3> —An ad … <h3>Objective.</h3> —To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. <h3>Particpants.</h3> —An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. <h3>Evidence.</h3> —The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words<i>endocarditis, bacteremia</i>, and<i>antibiotic prophylaxis</i>. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. <h3>Consensus Process.</h3> —The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. <h3>Conclusions.</h3> —Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.

Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis

2018-08-28

Kasper Iversen , Nikolaj Ihlemann , Sabine Gill +7 more

Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral … Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.

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Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

2019-08-12

Gilbert Habib , Paola Anna Erba , Bernard Iung +7 more

The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to … The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated.Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

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Infective endocarditis

2007-02-01

Mark Connaughton , Rivett John G , 李玲 +1 more

A selective medium for Streptococcus mutans

1973-11-01

Olga Gold , H.V. Jordan , J. van Houte

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2023 ESC Guidelines for the management of endocarditis

2023-08-25

Victoria Delgado , Nina Ajmone Marsan , Suzanne de Waha +7 more

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A Rare Case of Odontogenic Life-Threatening Candidal Sepsis; Lessons to Learn

2025-06-24

S. Shivji , E. Mackinnon , Alan Parbhoo | International Journal of Oral and Maxillofacial Surgery

Pulmonary valve endocarditis in the setting of a patent ductus arteriosus: A rare clinical case

2025-06-24

Lamassab Nour El Houda , Noha El Ouafi , Nabila Ismaili | Radiology Case Reports

Navigating Complexity: Precision Assessment Paves the Way for Minimal Intervention in Ludwig’s Angina

2025-06-24

Sahaja Acharya | International Journal of Oral and Maxillofacial Surgery

Serratia marcescens as an Uncommon Cause of Infection Following Craniectomy: A Case Report and Literature Review

2025-06-24

Shreya Veggalam , Venkataramana Kandi | Cureus

Infective Endocarditis in an Intravenous Drug User: Clinical Challenges, Ethical Dilemmas, and Multidisciplinary Management

2025-06-24

Munna Hazime , Shailes Paudel , Alexander A Restum +1 more | Cureus

A Rare Case of Salmonella Myopericarditis in an Athlete: Diagnosis by Stool Polymerase Chain Reaction (PCR)

2025-06-24

David S. McKinsey | Private Practice Infectious Disease

Myocarditis, a potentially life-threatening disease characterized by inflammatory infiltration of the myocardium and/or degeneration of myocardial tissue, has many potential infectious and noninfectious etiologies [1]. The causative organism is often … Myocarditis, a potentially life-threatening disease characterized by inflammatory infiltration of the myocardium and/or degeneration of myocardial tissue, has many potential infectious and noninfectious etiologies [1]. The causative organism is often not elucidated. Myocarditis most commonly affects individuals between the ages of 30 and 45 years, with 60% to 90% of cases occurring in males [1]. Prior to 2020, the incidence of myocarditis ranged from 4 to 14 per 100,000 people annually [1]. COVID-19 infection has been associated with an incidence of 59 to 64 per 100,000 per year. mRNA COVID-19 vaccines also have been linked to myocarditis (2.1 cases per 100,000 vaccine recipients per year), though much less frequently than infection. [1] The true incidence of myocarditis is likely higher, as many cases go unrecognized. The broad range of etiologies of myocarditis includes infections, immune-mediated causes, and exposure to myocardial toxins. Viral infections are most frequently implicated, but various bacteria, fungi, and parasites also cause myocarditis [2]. The most common clinical manifestations are chest pain, which occurs in 82% to 95% of cases, followed by dyspnea (19% to 49%), syncope (5% to 7%), and palpitations [1].

Group B Streptococcus Bacteremia Leading to Aortitis from a Prevertebral Abscess in a 50-Year-Old Male

2025-06-24

Alice Han | Private Practice Infectious Disease

This case report describes a 50-year-old man with a history of hypertension, hyperlipidemia, and poorly controlled diabetes who presented with symptoms of nausea, vomiting, abdominal pain, fevers, and chills. He … This case report describes a 50-year-old man with a history of hypertension, hyperlipidemia, and poorly controlled diabetes who presented with symptoms of nausea, vomiting, abdominal pain, fevers, and chills. He was found to have group B streptococcal bacteremia, leading to a series of complications, including aortitis secondary to a prevertebral abscess. Despite challenges in management, the patient responded well to antibiotics and anticoagulation therapy, resulting in complete resolution of the prevertebral abscess and aortitis. This case highlights the importance of early recognition and multidisciplinary management in cases of severe group B streptococcal infections.

Acute Infective Endocarditis Due to Streptococcus gordonii in a Young Patient with a Bicuspid Aortic Valve

2025-06-24

Harpreet Dosanjh , Mackenzie Geisman , Zeidan Hammad +1 more | Private Practice Infectious Disease

: Infective endocarditis (IE) is a life-threatening infection of the endocardial surface, often affecting individuals with predisposing cardiac abnormalities or recent invasive procedures. This report describes a rare case of … : Infective endocarditis (IE) is a life-threatening infection of the endocardial surface, often affecting individuals with predisposing cardiac abnormalities or recent invasive procedures. This report describes a rare case of acute IE in a previously healthy 22-year-old male with a bicuspid aortic valve and recent dental work, who presented with prolonged fever, myalgias, and peripheral embolic signs. Blood cultures confirmed Streptococcus gordonii as the causative pathogen, a virdans group streptococcus commonly associated with dental flora. Transthoracic and esophageal echocardiography revealed a bicuspid aortic valve with severe aortic insufficiency and a 1cm vegetation with suspected valve perforation. The patient was treated with a four-week course of intravenous ceftriaxone and referred for surgical management. Given the extent of valvular damage and the patients age, a Ross procedure was elected for the most appropriate surgical intervention. This case highlights the need for high clinical suspicion for IE in patients with recent dental procedure, even in the absence of typical risk factors, and emphasizes the importance of early diagnostic imaging and multidisciplinary management.

Next-Generation Sequencing Techniques to Diagnose Culture-Negative Subacute Native Aortic Endocarditis

2025-06-24

D. Vetterli , Maria‐Christina Zennaro , Virginie Tacchini +4 more | Emerging infectious diseases

Next-generation sequencing might improve diagnosis of infective endocarditis. A case in Switzerland was initially attributed to Solobacterium moorei bacteria. Metagenomic analysis of the affected heart valve detected Streptococcus gordonii, but … Next-generation sequencing might improve diagnosis of infective endocarditis. A case in Switzerland was initially attributed to Solobacterium moorei bacteria. Metagenomic analysis of the affected heart valve detected Streptococcus gordonii, but not S. moorei, illustrating that the results of molecular detection can vary depending on sampling time and anatomic site.

Aortic Valve Infective Endocarditis with Root Abscess: Root Repair Versus Root Replacement

2025-06-23

Zaki Haidari , Stephan Knipp , Iskandar Turaev +1 more | Pathogens

Background: Aortic valve infective endocarditis (IE) complicated by an aortic root abscess is a challenging problem that leads to increased morbidity and mortality. Aortic root repair or replacement are two … Background: Aortic valve infective endocarditis (IE) complicated by an aortic root abscess is a challenging problem that leads to increased morbidity and mortality. Aortic root repair or replacement are two potential treatment options. We aimed to compare patients undergoing aortic root repair or replacement with short- and mid-term outcomes. Methods: Consecutive patients with active aortic valve IE complicated by aortic root abscess undergoing cardiac surgery from January 2012 to January 2022 were included. Patients receiving aortic root repair were compared to patients undergoing aortic root replacement. Endpoints included overall mortality, incidence of recurrent IE and re-intervention during a two-year follow-up period. Inverse propensity weighting was employed to adjust for confounders. Results: Seventy-three patients with aortic valve IE with root abscess underwent surgical therapy. Fifty-six patients received aortic root repair and seventeen patients underwent aortic root replacement. Patients undergoing root replacement had significantly higher surgical risk (EuroSCORE II: 9 versus 19, p = 0.02) and extended disease (circumferential annular abscess: 9% versus 41%, p < 0.01). Inverse propensity weighted analysis revealed no relationship between surgical strategy and outcome. Weighted regression analysis revealed EuroSCORE II and disease extension as significant predictors of 30-day and 2-year mortality. Conclusions: In patients with aortic valve IE with root abscess, root repair is mostly performed in lower-risk patients with limited disease extension. Short- and mid-term mortality, recurrent endocarditis and reintervention were comparable between surgical strategies during follow-up. Surgical risk and disease extension, rather than surgical strategy, seem to be significant predictors of short- and mid-term mortality.

Case Report: Infective endocarditis following arteriovenous graft in a peritoneal dialysis patient

2025-06-23

Fangzhong Huang , Xiaoyong Zhang , Xuchun Xu +4 more | Frontiers in Cardiovascular Medicine

Infective endocarditis (IE) is a severe and frequently fatal complication in dialysis patients, particularly those with vascular access devices such as arteriovenous grafts (AVGs) or fistulas. We describe the case … Infective endocarditis (IE) is a severe and frequently fatal complication in dialysis patients, particularly those with vascular access devices such as arteriovenous grafts (AVGs) or fistulas. We describe the case of a 55-year-old male with end-stage renal disease (ESRD) on peritoneal dialysis (PD), who developed advanced IE following repeated punctures of an AVG. The patient initially presented with fever, erythema, and swelling at the graft site, which progressed to bacteremia due to Staphylococcus aureus . Despite completing a full course of antibiotics and undergoing both mitral and aortic valve replacement, the patient suffered recurrent episodes of acute heart failure requiring repeated hospital admissions. This rare case highlights the substantial risk of IE in dialysis patients with vascular access devices and the importance of early detection and timely intervention. The clinical difficulties and economic strain associated with IE management in this population point to the need for close surveillance, rapid diagnosis, and individualized treatment plans to improve outcomes and control healthcare expenditures.

Infective Endocarditis After Aortic Valve Replacement: A Systematic Review and Meta-Analysis of Risks and Realities in Transcatheter Versus Surgical Repair

2025-06-23

Moiuz Chaudhri , Ahmed D Al Mahrizi , Muhammad Hammad Ali +7 more | Cureus

New semiquantitative parameters in digital [18F]FDG PET/CT improve diagnostic accuracy in suspected infective endocarditis

2025-06-22

Carola Bregenzer , Luisa Knappe , Alexander Weissensee +6 more | Deleted Journal

Abstract Background The purpose of this study was to identify semiquantitative parameters of [ 18 F]FDG PET/CT using a digital PET scanner, which may increase diagnostic accuracy and readers’ confidence … Abstract Background The purpose of this study was to identify semiquantitative parameters of [ 18 F]FDG PET/CT using a digital PET scanner, which may increase diagnostic accuracy and readers’ confidence in the diagnosis of infective endocarditis (IE). Results Images of 82 patients undergoing [ 18 F]FDG PET/CT for suspected IE were visually and semiquantitatively analyzed. Standardized uptake values (SUV) of suspected foci, also normalized to liver, mediastinum and surrounding activity were calculated. For each, best thresholds were identified to diagnose endocarditis. Final diagnosis was reached by consensus in a multidisciplinary board. Semiquantitative analysis (SUV max /SUV max mediastinum, SUV max /SUV max liver, SUV peak /SUV peak mediastinum, SUV peak /SUV peak liver, SUV max /SUV mean liver, SUV max /SUV mean mediastinum, SUV max focus/SUV mean focus, SUV peak /SUV peak surrounding) added to visual interpretation increased sensitivity (57–86%), specificity (83–93%), PPV (64–86%), NPV (79–93%) and diagnostic accuracy (74–90%) when using best SUVs thresholds (all p < 0.05). Conclusions Combining visual and semiquantitative analysis allows for a more accurate diagnosis of IE, and might be implemented into clinical routine.

Adenosine/amiodarone

2025-06-21

| Reactions Weekly

Cefepime/vancomycin

2025-06-21

| Reactions Weekly

Lactobacillus rhamnosus, a bacterium commonly found in the gut and used in probiotic supplements, as a cause of endocarditis in a patient with a surgical aortic valve replacement and recent dental cleaning

2025-06-19

Kade Wagers , Raumin Neuville , Casey Strobelt +1 more | European Journal of Case Reports in Internal Medicine

Lactobacillus rhamnosus endocarditis is a rare but significant complication in patients with mechanical heart valves. We present a case of a 73-year-old male with a mechanical aortic valve who developed … Lactobacillus rhamnosus endocarditis is a rare but significant complication in patients with mechanical heart valves. We present a case of a 73-year-old male with a mechanical aortic valve who developed endocarditis following a routine dental cleaning, despite receiving standard of care prophylactic antibiotics. Blood cultures confirmed L. rhamnosus, and imaging highlighted persistent inflammation around the mechanical valve. Management focused on evolving antibiotic therapy with close routine monitoring. This case underscores the diagnostic challenges and therapeutic complexities of Lactobacillus-related endocarditis and highlights the need for heightened vigilance in at-risk populations following invasive procedures. Further research is warranted to optimize management strategies for this uncommon pathogen.

Non-bacterial Thrombotic Endocarditis in a Patient With Anorexia Nervosa: A Case Report

2025-06-19

Tariq Iqbal , Muhammad Asif , Farzeen Saghir +2 more | Cureus

Pancytopenia Unraveled: Tracing Rare Cardiobacterium hominis Bacteremia Back to the Gut

2025-06-19

Annie Kleynerman , Robert C. Day , Iiro Honkanen | Cureus

Major considerations and outcomes of the periodontal diseases and infective endocarditis: a concise systematic review

2025-06-18

Lívia Bosquilia Caselli , Raiene Larissa Maim , Luana Mello Chinarelo +1 more | MedNEXT Journal of Medical and Health Sciences

Introduction: Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. Substantial evidence supports a link between oral health and IE, with the oral microbiome impacting multiple aspects … Introduction: Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. Substantial evidence supports a link between oral health and IE, with the oral microbiome impacting multiple aspects of IE, including pathogenesis, diagnosis, treatment, and mortality rates. Objective: It was to conduct a concise systematic review of the major guidelines by the American Heart Association and work related to bacterial resistance in periodontal diseases and infective endocarditis. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to March 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 105 articles were found, and 27 articles were evaluated in full and 14 were included and developed in the present concise systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=74.7%>50%. It was concluded that there is a significant association between periodontitis and increased cardiovascular risk, promoting integrated health approaches. Infective endocarditis, although relatively uncommon, is a disease that causes substantial morbidity and mortality. Although advances in diagnosis and treatment have improved antimicrobials, prevention is still an important factor. Protocols for the use of prophylactic antibiotics have been used in medical and dental procedures likely to generate the development of the disease in high-risk patients. Thus, the use of antibiotic prophylaxis is associated with a reduced risk of infective endocarditis after invasive dental procedures.

Isolated pulmonary valve endocarditis in a 7-year-old Nigerian girl: a case report

2025-06-18

Ayobami Oyetunji Alabi , Bukola Adetutu Sayomi , Olanike Taye Oladibu +3 more | Journal of Medical Case Reports

Right-sided infective endocarditis is a rare clinical entity, with isolated pulmonary valve infective endocarditis being extremely uncommon. Infective endocarditis carries a high mortality rate and significant complications, making early identification … Right-sided infective endocarditis is a rare clinical entity, with isolated pulmonary valve infective endocarditis being extremely uncommon. Infective endocarditis carries a high mortality rate and significant complications, making early identification and prompt management crucial in improving outcomes. This case highlights an unusual presentation of right-sided infective endocarditis isolated to the pulmonic valve in a pediatric patient with no apparent preexisting heart disease. A 7-year-old girl of Yoruba ethnicity presented with septicemic illness, congestive heart failure, and no evidence of congenital cardiac lesion, underlying valvular disease, or identifiable predisposing factors. She had underweight malnutrition, cachexia, and severe respiratory distress. Echocardiography, which was delayed due to resource limitations, ultimately revealed isolated myxomatous vegetation on the pulmonary valve, dilated right cardiac chambers, and pulmonary hypertension. Blood cultures grew Pseudomonas aeruginosa. The patient was managed with antimicrobial agents, an anticardiac failure regimen, antiplatelets, and supportive therapy. Management was complicated by financial constraints, which delayed optimal intervention. Although isolated pulmonary valve infective endocarditis is rare in the pediatric population, particularly in the absence of identifiable heart disease, a high index of suspicion is essential. Early diagnosis via echocardiography and prompt, adequate treatment are crucial for favorable outcomes. Awareness of potential diagnostic delays and financial barriers can aid in optimizing timely intervention and improving prognosis.

Factores asociados a la endocarditis infecciosa: estudio de casos y controles

2025-06-18

Ledmar Jovanny Vargas Rodríguez , Elkin D. Bedoya-Pérez , Edwar Jassir Rozo-Ortiz +1 more | Revista Colombiana de Cardiología

Eustachian Valve Endocarditis Secondary to Candida glabrata Complicated by Frailty and Acute COVID-19 Infection

2025-06-17

Brittany L Davis , R Garry | Cureus

“Letter to the editor: Risk and predictors of first-time infective endocarditis in adult patients with congenital heart disease: A nationwide, register-based study”

2025-06-17

Noor Ul Huda , N.El Ansari , R. Ansari | International Journal of Cardiology

Epidemiological analysis of infective endocarditis: a decade perspective in a private hospital setting

2025-06-17

Thais Barros Corrêa Ibañez , Nathália Zini , Sérgio Ibañez Nunes +1 more | DELOS Desarrollo Local Sostenible

Background: Infective endocarditis is a pathology with an insidious onset, difficult diagnosis, and high morbidity and mortality rate that requires prolonged treatment with parenteral antibiotic therapy and sometimes surgery. Objective: … Background: Infective endocarditis is a pathology with an insidious onset, difficult diagnosis, and high morbidity and mortality rate that requires prolonged treatment with parenteral antibiotic therapy and sometimes surgery. Objective: To evaluate the ten-year epidemiological profile of infective endocarditis in a private hospital in Volta Redonda, as well as the treatment used in each case and the outcomes. Method: A retrospective study was conducted with a quantitative and qualitative approach and an exploratory objective that sought to evaluate all medical records of patients admitted between 2011 and 2021 at Hospital Unimed Volta Redonda. A descriptive and correlation analysis of the data was performed between the type of treatment, microorganisms, and outcomes. Results: This study analyzed the medical records of 24 patients, 16 (66.6%) male and 8 (33.3%) female. The most frequently affected age group was 50 to 69 years, with a mean of 59 years and a standard deviation of 2.6. The survey revealed a total of 7 (29.16%) deaths and 9 (37.5%) patients presenting complications, such as stroke, embolization, and heart failure. In this study, 11 (45.83%) patients were identified as requiring surgical intervention for valve replacement. Conclusion: In this study, IE presented an epidemiological profile with high mortality and an outcome with a high incidence of surgeries. The mitral and aortic valves were the most affected and the most prevalent bacteria were those of the staphylococcus group, thus showing that IE is still a disease with high morbidity and mortality.

Infective Endocarditis During Pregnancy: Challenges and Future Directions

2025-06-16

Eleni Polyzou , Evangelia Ntalaki , Dimitrios Efthymiou +7 more | Journal of Clinical Medicine

Infective endocarditis (IE) during pregnancy, while uncommon, is associated with substantial maternal and fetal morbidity and mortality due to the complex physiological adaptations of pregnancy. Hemodynamic alterations, including increased cardiac … Infective endocarditis (IE) during pregnancy, while uncommon, is associated with substantial maternal and fetal morbidity and mortality due to the complex physiological adaptations of pregnancy. Hemodynamic alterations, including increased cardiac output and changes in vascular resistance, combined with immunological modulation, predispose pregnant individuals to increased risk of infection and associated complications. Predominant pathogens implicated in pregnancy-associated IE are Staphylococcus aureus, Streptococcus viridans, and Enterococcus faecalis, with S. aureus infections frequently leading to poorer clinical outcomes. Diagnosis remains challenging due to commonly atypical presentation and relies on microbiological identification via blood cultures in conjunction with imaging modalities such as transthoracic echocardiography. IE in pregnancy is associated with increased maternal mortality rates (5-17%) and adverse fetal outcomes, including preterm birth, intrauterine growth restriction (IUGR), and fetal loss. Management necessitates careful selection of antimicrobial therapy to ensure efficacy while minimizing fetal toxicity, especially in settings of increased antimicrobial resistance. Anticoagulation and surgical interventions must be judiciously considered, with surgical timing individualized based on the severity of heart failure and coordinated multidisciplinary care. In conclusion, IE during pregnancy constitutes a significant clinical challenge, underscoring the need for enhanced diagnostic strategies, optimized therapeutic protocols, and the development of pregnancy-specific management guidelines to improve maternal and fetal outcomes.

Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review

2025-06-16

Lixin Lou , Fangqi Li , Bo Qian +1 more | Research Square (Research Square)

<title>Abstract</title> A 62-year-old Asian woman with multiple organ involvement due to Salmonella infection (including heart valves, bone marrow, and central nervous system) was reported. She initially presented with fever and … <title>Abstract</title> A 62-year-old Asian woman with multiple organ involvement due to Salmonella infection (including heart valves, bone marrow, and central nervous system) was reported. She initially presented with fever and hip pain, and blood cultures showed Salmonella infection. Her condition progressed to sepsis, septic shock, nephritis, osteomyelitis, and cerebral infarction. After admission, antibiotics were upgraded, but she later developed infective endocarditis, requiring long-term intravenous antibiotics and eventually oral Faropenem therapy. Timely blood cultures, lesion assessment, and antibiotic adjustments are crucial for managing Salmonella infections and improving outcomes. This case uniquely presents a 62-year-old Asian woman with rapid progression of Salmonella infection to multi-organ involvement including sepsis and cerebral infarction, rarely seen in adults.

Profilaxis antibiótica en odontología: ¿Cuándo está realmente indicada para prevenir endocarditis infecciosa?

2025-06-16

Emilio Felipe Huaier Arriazu | Evidencia actualizacion en la práctica ambulatoria

Enterococcus Durans Endocarditis with Prosthetic Valve and Implantable Electronic Device and Literature Review

2025-06-14

O Aldemir , Murtaza Öz | Diagnostic Microbiology and Infectious Disease

Clinical features and outcomes of infective endocarditis in persons experiencing homelessness

2025-06-13

Torrance Teng , Kyle Crooker , Tess Hickey +7 more | Infectious Diseases of Poverty

Reply to: “Coagulase-negative Staphylococcus bacteremia in ECMO: Examining key influencing factors”

2025-06-13

Christian Wells , Joseph E Marcus | American Journal of Infection Control

Radiomics and machine learning for predicting valve vegetation in infective endocarditis: a comparative analysis of mitral and aortic valves using TEE imaging

2025-06-12

Farid Esmaely , Pardis Moradnejad , Shabnam Boudagh +1 more | Acta Cardiologica

Detecting valve vegetation in infective endocarditis (IE) poses challenges, particularly with mechanical valves, because acoustic shadowing artefacts often obscure critical diagnostic details. This study aimed to classify native and prosthetic … Detecting valve vegetation in infective endocarditis (IE) poses challenges, particularly with mechanical valves, because acoustic shadowing artefacts often obscure critical diagnostic details. This study aimed to classify native and prosthetic mitral and aortic valves with and without vegetation using radiomics and machine learning. 286 TEE scans from suspected IE cases (August 2023-November 2024) were analysed alongside 113 rejected IE as control cases. Frames were preprocessed using the Extreme Total Variation Bilateral (ETVB) filter, and radiomics features were extracted for classification using machine learning models, including Random Forest, Decision Tree, SVM, k-NN, and XGBoost. in order to evaluate the models, AUC, ROC curves, and Decision Curve Analysis (DCA) were used. For native mitral valves, SVM achieved the highest performance with an AUC of 0.88, a sensitivity of 0.91, and a specificity of 0.87. Mechanical mitral valves also showed optimal results with SVM (AUC: 0.85, sensitivity: 0.73, specificity: 0.92). Native aortic valves were best classified using SVM (AUC: 0.86, sensitivity: 0.87, specificity: 0.86), while Random Forest excelled for mechanical aortic valves (AUC: 0.81, sensitivity: 0.89, specificity: 0.78). These findings suggest that combining the models with the clinician's report may enhance the diagnostic accuracy of TEE, particularly in the absence of advanced imaging methods like PET/CT.

Right-Sided Infectious Endocarditis in the Patient With Williams Syndrome: Importance of Recognizing Disease-Specific Pathophysiology in Adults

2025-06-12

Satoshi Nakano , Hirofumi Saiki , Kanchi Saito +4 more | Cureus

Infectious endocarditis (IE) in patients with Williams syndrome is usually associated with left-sided heart lesions, whereas right-sided endocarditis is rarely observed. This can be explained by the natural course of … Infectious endocarditis (IE) in patients with Williams syndrome is usually associated with left-sided heart lesions, whereas right-sided endocarditis is rarely observed. This can be explained by the natural course of congenital heart lesions in Williams syndrome, in which right-sided heart lesions are likely to spontaneously regress with patient growth. We encountered a 29-year-old patient diagnosed with right-sided infective endocarditis. His diagnosis was supported by the modified Duke criteria, one major criterion of positive blood culture twice with Streptococcus oralis, a type of gram-positive viridance Streptococcus, and three minor criteria of the presence of congenital heart disease, persistent fever higher than 38.0℃, and spatial and temporal dissemination of septic pulmonary emboli. Although his supravalvular aortic stenosis remained mild, peripheral pulmonary stenosis was progressive even after adulthood, which might have been attributed to the development of right-sided infectious endocarditis, based on the biased distribution of septic emboli. Severely advanced caries with extensive tooth decay were not diagnosed until the development of IE because of intellectual disability and inability to report subjective symptoms. The subsequent development of diverticulitis after the treatment of infectious endocarditis was difficult to diagnose, and the management of this patient became more complicated. As the disease-specific pathophysiology progresses with age and adult Williams syndrome patients are less likely to express subjective symptoms, a multidisciplinary approach by the medical team comprised of cardiologists, nephrologists, gastroenterologists, dentists, and psychologists is needed in the management of Williams syndrome, particularly in adults in the process of becoming independent.

Major considerations and outcomes of the periodontal diseases and infective endocarditis: a concise systematic review

2025-06-06

Lívia Bosquilia Caselli , Raiene Larissa Maim , Luana Mello Chinarelo +1 more | MedNEXT Journal of Medical and Health Sciences

Endocarditis infecciosa: Cambios epidemiológicos y nuevos retos. A propósito del estudio EIRA 3

2018-01-02

Pilar Tornos