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PubMed2001

Early and late outcomes after reoperation for prosthetic valve endocarditis.

OBJECTIVE: Prosthetic valve endocarditis remains a challenging complication after heart valve replacement. To identify predictive risk factors, we have reviewed 30 patients who underwent surgery for prosthetic valve endocarditis between March 1986 and May 1999. METHODS: There were 15 men and 15 women (mean age 51 years). Prosthetic valve endocarditis was classified as early (< or = 1 year after operation) in 10 cases, and as late in the other 20 cases. The most common indication for surgery was moderate to severe congestive heart failure due to prosthetic valve dysfunction in 21 (70%) patients. The average follow-up period was 6.5 years, with a range of 0.3 to 14.1 years. RESULTS: The most common microorganism was Staphylococcus epidermidis in both patients with early (50%) and late prosthetic valve endocarditis (25%). The in-hospital mortality was 13.3% (4/30). There were six late deaths. The actuarial survival at 5 years was 78% and 66% at 10 years. An early onset of prosthetic valve endocarditis was the only significant determinant of both in-hospital mortality (p = 0.005) and overall mortality (p = 0.021). Emergency surgery had a statistically significant relationship with in-hospital mortality (p = 0.045). No significant influence on mortality after reoperation for prosthetic valve endocarditis was found in age, sex, valve position, antecedent native valve endocarditis, or in the type of pathological findings (ring abscess, valve dehiscence, and vegetation). CONCLUSION: Early onset of prosthetic valve endocarditis and emergency surgery were important risk factors for mortality due to prosthetic valve endocarditis.

Adult↗
PubMed2006

Corynebacterium jeikeium endocarditis: a systematic overview spanning four decades.

Skin flora is an important source of microorganisms that cause infective endocarditis. While staphylococcal and beta-hemolytic streptococcal species are well-recognized components of skin flora that can cause infective endocarditis, other skin flora rarely produce endocardial infection. One species of Corynebacterium has received the most attention, Corynebacterium jeikeium. This bacterium, a gram-positive rod that is a strict aerobe, is known to cause mechanical prosthetic valve infection and vancomycin is generally required for treatment of this multidrug-resistant organism. Following treatment of an unusual case of bioprosthetic valve endocarditis due to C. jeikeium, a Medline search for English-language articles published from January 1966 to October 2004 was performed. Reports of C. jeikeium endocarditis cases with culture of either blood or cardiac surgery tissue samples positive for C. jeikeium and with clinical and echocardiographic findings of infective endocarditis were reviewed. Clinical data and results of diagnostic procedures were examined. All 38 patients with C. jeikeium endocarditis reported in the literature had at least one predisposing condition for the development of infective endocarditis. The majority of patients (74%) had involvement of a prosthetic heart valve. The mortality attributed to C. jeikeium endocarditis was 33% and was similar in patients who did and did not undergo valve replacement. This relatively high mortality rate mandates that clinicians be aware of this rare endocardial infection. C. jeikeium is a rare cause of endocarditis and it more commonly infects prosthetic valves. Careful scrutiny is required when C. jeikeium is isolated from a blood culture, particularly in patients with underlying prosthetic cardiac valves.

Aged, 80 and over↗
PubMed1985

Staphylococcal endocarditis. Laboratory and clinical basis for antibiotic therapy.

Antibiotic therapy for staphylococcal endocarditis is based on in vitro susceptibility, antibiotic efficacy in experimental endocarditis, and clinical experience. Native valve endocarditis due to Staphylococcus aureus in non-addicts is treated with four to six weeks of a penicillinase-resistant penicillin, a cephalosporin, or vancomycin. An aminoglycoside can be added for the initial three to five days, but longer-term multiple-drug therapy (adding an aminoglycoside and rifampin) is reserved for unresponsive infection. Right-sided native valve endocarditis in addicts usually responds to less vigorous therapy than that for native valve endocarditis in non-addicts. Vancomycin is the drug of choice for endocarditis due to methicillin-resistant S. aureus. Intrinsic methicillin-resistance in Staphylococcus epidermidis is often cryptic, requiring special tests for detection. Methicillin-resistant S. epidermidis is the major cause of prosthetic valve endocarditis. Vancomycin, rifampin, and gentamicin therapy for two weeks, followed by vancomycin plus rifampin, is recommended for treating this infection. Despite potent antimicrobial therapy, surgery is important in the therapy of complicated endocarditis, particularly prosthetic valve endocarditis.

Adult↗
PubMed1991

Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis.

To compare the diagnostic value of transesophageal and transthoracic echocardiography in infective endocarditis, paired transesophageal and transthoracic echocardiograms were obtained prospectively for 66 episodes of suspected endocarditis in 62 patients. Echocardiographic results were compared with the presence or absence of endocarditis determined by pathologic or nonechocardiographic data from the subsequent clinical course. All echocardiograms were interpreted by an observer told only that the studies were from patients in whom the diagnosis of endocarditis was suspected. The diagnosis of endocarditis was eventually made in 16 of the 66 episodes of suspected endocarditis (14 by pathologic and 2 by clinical criteria). In 7 of 16 transthoracic and 15 of 16 transesophageal echocardiograms, endocarditis was diagnosed at a probability level of "almost certain," giving a sensitivity of 44% and 94%, respectively (p less than 0.01). For the remaining episodes, 49 of 50 transthoracic and all transesophageal studies yielded normal results, giving a specificity of 98% and 100%, respectively. This study suggests that transesophageal echocardiography is highly sensitive and specific for the diagnosis of infective endocarditis and significantly more sensitive than transthoracic echocardiography. Although echocardiography cannot rule out endocarditis, the high diagnostic sensitivity of transesophageal echocardiography results in a low probability of the disease when the study yields negative results in a patient with an intermediate likelihood of the disease.

Echocardiography, Doppler↗
PubMed1993

Adolescent knowledge of bacterial endocarditis prophylaxis.

OBJECTIVE: To determine if adolescents with congenital heart disease have adequate knowledge of bacterial endocarditis prophylaxis. DESIGN: Forty-eight adolescents attending a congenital heart disease summer camp were asked to complete an eight-question survey to assess their knowledge of heart disease, endocarditis, and endocarditis prophylaxis. RESULTS: Forty-five of 48 (94%) completed the questionnaire. Thirty-one (69%) knew the name of their heart disease. Two correctly defined endocarditis. None knew measures which could prevent endocarditis. Although 36 (80%) knew they needed to take "a medicine" prior to dental procedures, only 18 (40%) knew that an antibiotic was needed. There were significant gender differences for knowledge of antibiotics and for knowledge of current medications. However, patient gender and regular use of cardiac medications did not correlate significantly with knowledge of endocarditis or bacterial endocarditis prophylaxis. CONCLUSION: Whereas most adolescents know the names of their heart lesions and current medications, knowledge of endocarditis and bacterial endocarditis prevention and prophylaxis is inadequate.

Adolescent↗
PubMed2000

Surgery for active culture-positive endocarditis: determinants of early and late outcome.

BACKGROUND: The purpose of this study was to describe a single unit experience in the surgical treatment of active culture-positive endocarditis and identify determinants of early and late outcome. PATIENTS AND METHODS: One hundred eighteen consecutive patients with positive blood culture up to 3 weeks before operation (or positive valve culture) and macroscopic evidence of lesions typical for endocarditis, undergoing operation between January 1973 and December 1996 in Southampton, were evaluated. The aortic valve was infected in 53 (48.9%), the mitral in 46 (39%), both aortic and mitral in 12 (10.1%), the tricuspid in 4 (3.9%), and the pulmonary valve in 3 (2.5%). Native valve endocarditis was present in 83 (70.3%) and prosthetic valve endocarditis in 35 (29.7%). Streptococci and staphylococci were the most common pathogens. Mean follow-up was 5.6 years (range, 0 to 25 years). RESULTS: Operative mortality was 7.6% (9 patients). Endocarditis recurred in 8 (6.7%). A reoperation was required in 12 (10.2%). There was 24 late deaths, 17 of them cardiac. Actuarial freedom from recurrent endocarditis, reoperation, late cardiac death, and long-term survival at 10 years were 85.9%, 87.2%, 85.2%, and 73.1%, respectively. On multiple regression analysis the following were independent adverse predictors: pulmonary edema (p = 0.007) and impaired left ventricular function (p = 0.02) for operative mortality; prosthetic valve endocarditis (p = 0.01) for recurrent infection; myocardial invasion by the infection (p = 0.01) and reoperation (p = 0.04) for late cardiac death; and coagulase-negative staphylococcus (p = 0.02), annular abscess (p = 0.02), and longer intensive care unit stay (p = 0.02) for long-term survival. CONCLUSIONS: Operation for active culture-positive endocarditis carries an acceptable mortality. Freedom from recurrent infection, reoperation, and long-term survival are satisfactory. In our data, patients' hemodynamic status at operation was the major determinant of operative mortality. Prosthetic valve endocarditis, coagulase-negative staphylococcus, and annular or myocardial infectious invasion were the critical adverse determinants of late outcome.

Adolescent↗
PubMed2002

Endocarditis after mitral valve repair.

BACKGROUND: Native valve endocarditis is frequently managed with antibiotics alone, but prosthetic valve endocarditis usually requires an early operation. What is the best treatment of endocarditis after mitral valve repair? METHODS: From 1986 to 2000, 22 patients were treated for endocarditis affecting a previously repaired mitral valve. Causes of mitral valve dysfunction that led to repair were degenerative (11 patients), ischemic (5 patients), endocarditic (3 patients), rheumatic (2 patients), and functional (1 patient). Endocarditis was active in 21 patients and healed in 1. Interval from initial mitral valve repair to onset of endocarditis ranged from 1 week to 10.3 years (median, 6 months). Pathology included leaflet vegetation (15), annuloplasty vegetation (4), leaflet perforation (5), and abscess (3). Mean follow-up was 3.9 +/- 3.3 years. RESULTS: Fifteen patients underwent repeat mitral valve operations with freedom from mitral valve reoperation of 65%, 41%, and 26% at 30 days, 1 year, and 5 years after onset of endocarditis. After a high early hazard, risk of reoperation fell to 10.8% per year. Seven patients, all with a leaflet vegetation, were treated with antibiotics alone. Antibiotics eradicated infection in all; however all had mitral regurgitation 2+ to 4+. Survival was 96%, 74%, and 68% at 30 days, 1 year, and 5 years. Endocarditis recurred in 1 patient (92% free of event). CONCLUSIONS: Most patients that have endocarditis develop after mitral valve repair require reoperation. However if infection is limited to a leaflet, early reoperation may be unnecessary because antibiotics alone can eradicate infection.

Adolescent↗
PubMed1996

Risks for and prevention of infective endocarditis.

It is accepted medical practice to prevent bacterial endocarditis in patients with susceptible congenital or acquired cardiac malformations who are likely to experience predictable procedure-related bacteremia. Patients in general, those with congenital heart disease specifically, are insufficiently aware of the need for such prophylaxis. It is responsibility of the physician to determine which patients are susceptible to endocarditis and the need for endocarditis prophylaxis for each patient for any given instance and to educate the patient as to this need. The American Heart Association provides wallet-sized cards that may be given to each patient. Those patients not previously known to have heart disease are, of course, not eligible for chemoprophylaxis. Because these represent many of the patients with endocarditis each year, it can be argued that only a minority of patients have preventable cases. Regarding the clinical application of anti-infective endocarditis prophylaxis, the American Heart Association gives this perspective: This statement represents recommended guidelines to supplement practitioners in the exercise of their clinical judgement and is not intended as a standard of care for all cases.... Because no adequate, controlled clinical trials of antibiotic regimens for the prevention of bacteria endocarditis in humans have been done, recommendations are based on vitro studies, clinical experience, data from experimental animal models, and assessment of both the bacteria most likely to produce bacteremia from a given site and those most likely to result in endocarditis. Bacterial endocarditis is one of the few infectious disease that almost always result in death unless treated. The dramatic nature of the morbidity and mortality of infective endocarditis in those so afflicted makes the prevention of even a few cases worth the effort.

Animals↗
PubMed2001

Long-term results of multivalve surgery for infective multivalve endocarditis.

OBJECTIVE: The natural history of medically treated multivalvular endocarditis is associated with dismal short and long term survival. However, the impact of surgical intervention on these results is relatively unknown. The objective of this retrospective study was to report our long-term results in patients requiring multivalve surgery for multivalvular endocarditis. METHODS AND RESULTS: Over a 24 year period beginning in 1972, multivalve surgical procedures were performed on 63 patients for infective endocarditis. Prosthetic valve endocarditis was present in 25 (40%), and acute or active endocarditis in 38 (60%). The early mortality was 16%. Out of 53 patients discharged from the hospital 87+/-4% were alive at 5 years and 64+/-9% at 10 years. There was no difference in early or late mortality between patients with prosthetic and native endocarditis (P=0.15 and P=0.77 for early and late mortality, respectively). The presence of active endocarditis did not affect operative outcome or late mortality. Twenty-one patients (88%) were in NYHA FC I, and none were in NYHA FC IV. The only prognostic factor of early and late mortality was the presence of an abscess at the time of the surgery. CONCLUSIONS: These results indicate that multivalve infective endocarditis treated surgically is associated with acceptable early and late mortality and excellent postoperative functional status. The early surgical intervention prior to an abscess formation offers the best chance for survival of patients with multivalve endocarditis.

Adolescent↗
PubMed1998

Treatment of aortic valve endocarditis with the Ross operation.

OBJECTIVE: Standard treatment of patients with infective endocarditis is radical debridement and valve replacement, in cases with advanced pathology the treatment is usually root replacement with either a composite graft or a homograft. Enthusiasm for the use of the Ross operation in non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis has been limited. The objective of this prospective study is to present the technique and results of our experience with aortic valve endocarditis treated with the Ross operation. MATERIALS AND METHODS: Since 1992 we have treated 35 patients (median age 41 years, range 6-71 years) having aortic valve endocarditis with a Ross operation. Twenty-four patients had advanced disease defined as pathology due to endocarditis extending beyond the valve cusps (13 patients) or prosthetic valve endocarditis (11 patients). Twenty-two patients had active disease at the time of surgery, and 12 had undergone one to four previous heart operations. RESULTS: There were two operative deaths (5.8%), both related to severe disease with very advanced pathology and heart failure. Intraoperative echocardiography demonstrated no or trivial autograft insufficiency in all patients. There have been no late deaths. There has been one (probable) recurrent right-sided endocarditis in a drug addict during a follow-up period of 3-56 months. One patient has been reoperated on for homograft stenosis. CONCLUSIONS: We are enthusiastic about the use of the Ross operation in aortic valve endocarditis and in younger patients with advanced pathology, it is our preferred treatment modality. Following removal of the autograft, unparalleled exposure of the left ventricular outflow tract is obtained. Even in patients with very advanced pathology the left ventricular outflow tract is usually intact, allowing autograft implantation in the standard fashion. For selected patients with simple endocarditis, the Ross operation is an attractive option on its usual merits.

Adolescent↗
PubMed2001

Eustachian valve endocarditis: Is it worth searching for?

BACKGROUND: Only a few cases of eustachian valve endocarditis have been reported. Whether the eustachian valve is an uncommon site for a vegetation to be attached or whether the disease is missed because a systematic approach to this valve is not routinely performed in the search for vegetations is not known. METHODS: Every patient suspected of having endocarditis undergoes a specific approach, which includes a systematic study of the eustachian valve. In 10 patients with large valves but without signs and symptoms of endocarditis, we identified 2 specific findings: width <3 mm and a regular oscillating movement. A blinded evaluation in the 10 control subjects and 30 patients with right-sided endocarditis, including the 5 with eustachian valve endocarditis, showed an agreement of 97% (39/40). RESULTS: Five of 152 patients with right-sided endocarditis were found to have eustachian valve vegetations (3.3%). Patients were young (age range 22-34 years) and all had predisposing factors (3 intravenous drug abusers, 2 central venous lines), fever, and septic pulmonary embolism. Staphylococcus aureus was cultured in all cases. Tricuspid involvement was found in 4 patients, and only 1 patient had isolated eustachian valve endocarditis. All patients did well with culture-guided antibiotics. CONCLUSIONS: Our results suggest that eustachian valve endocarditis may be more frequent than is believed. Thus a systematic interrogation of the eustachian valve should be included in the echocardiographic examination of a patient suspected of having endocarditis.

Adult↗
PubMed1997

Prevention of bacterial endocarditis: recommendations by the American Heart Association.

OBJECTIVE: 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. PARTICIPANTS: 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. EVIDENCE: 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 endocarditis, bacteremia, and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. CONSENSUS PROCESS: 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. CONCLUSIONS: 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.

Anti-Bacterial Agents↗
PubMed1995

Procedures associated with infective endocarditis in adults. A case control study.

OBJECT: To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study. BACKGROUND: Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models. METHODS: Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule. RESULTS: Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6; 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7; 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant. CONCLUSIONS: Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis,it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.

Adult↗
PubMed2004

Recent trends in infective endocarditis: influence of case definitions.

PURPOSE OF REVIEW: Infective endocarditis continues to pose major challenges in diagnosis and management despite advances in understanding the epidemiology, microbiology, and pathology of the disease. The purpose of this article is to provide a review of diagnosis, microbiology, and treatment of infective endocarditis, particularly as they are influenced by case definitions. RECENT FINDINGS: Case definitions have a critical effect on the interpretation of trends in infective endocarditis, and recent studies have proposed more specific criteria. Studies have also addressed the appropriate use of echocardiography to assist in the diagnosis and management of infective endocarditis. Staphylococcus aureus has become an increasingly common cause of infective endocarditis, and the microbiology of nosocomial infective endocarditis is changing. Newer techniques are being used to aid in the identification of causal agents in blood culture-negative infective endocarditis. Antimicrobial guidelines for the treatment of infective endocarditis are readily available, including a proposal to avoid premature discharge of patients on outpatient antibiotic therapy. Additional studies have been conducted on combination antibiotic therapy, duration of treatment, dosing of aminoglycosides, alternative agents for gram-positive organisms, aspirin therapy, and surgical interventions. SUMMARY: Recent trends in diagnosis, microbiology, and treatment of infective endocarditis are described, and case definitions play a critical role in their interpretation.

Anti-Bacterial Agents↗
PubMed1996

Human immunodeficiency virus infection and infective endocarditis among injecting drug users.

Human immunodeficiency virus (HIV) infection and infective endocarditis are serious complications of injection drug use. To determine whether HIV infection may increase the risk of endocarditis beyond that associated with drug injection, we performed a nested case-control study among injecting drug users taking part in an ongoing cohort. We identified 26 participants with infective endocarditis between cohort enrollment (in 1988-1989) and June 1992, through reviews of medical records and death certificates. We matched each endocarditis case with up to five controls (N = 120) on enrollment date, race/ethnicity, and follow-up time. Data were taken from baseline and from the one follow-up visit: the last visit before the endocarditis occurred for cases and the closest visit (+/- 3 months) for controls. We used conditional logistic regression to quantify the association between HIV serostatus at follow-up and subsequent endocarditis, after adjusting for a history of endocarditis or sepsis before enrollment, injection duration, current injection frequency, and a recent history of abscess at injection sites. Among current injectors at follow-up, the adjusted odds ratio (OR) of developing endocarditis for HIV-seropositive subjects with > or = 350 CD4 cells per microliter, compared with HIV-seronegative subjects, was 2.31 [95% confidence interval (CI) = 0.61-8.78]; the corresponding OR for HIV-seropositive subjects with < 350 CD4 cells per microliter was 8.31 (95% CI = 1.23-56.37). These data indicate that HIV-related immunodeficiency may independently increase the risk of infective endocarditis among injecting drug users.

Adult↗
PubMed1977

Haemophilus parainfluenzae and influenzae endocarditis: a review of forty cases.

Two cases of bacterial endocarditis caused by Haemophilus parainfluenzae are reported with a review of 33 other cases of H. parainfluenzae endocarditis and 5 cases of H. influenzae endocarditis. Although H. parainfluenzae is usually considered a non-pathogenic microorganism, this review firmly establishes its role as a causative agent in endocarditis. Furthermore, several clinical features were noted which were atypical when compared to findings usually present in patients with bacterial endocarditis. The mean age of the patients was only 27 years. Over 60% of the patients had no identifiable predisposing illness, an unexpected finding in view of the low degree of pathogenicity associated with this microorganism. Polymicrobial bacteremia, usually with viridans streptococci, was found in 11% of patients. Major arterial emboli were documented in 57% of patients, an incidence unchanged from the pre-antibiotic era. Diagnosis of the disease is dependent upon an awareness of the fastidious cultural requirements necessary for isolation of Haemophilus species. Culture media must contain a source of X and V factors. Mortality from H. parainfluenzae endocarditis has been reduced from 100 per cent prior to 1940 to about 12 per cent by use of appropriate antimicrobial agents. Awareness that Haemophilus species can cause bacterial endocarditis is important because the diagnosis is dependent upon utilization of special culture methods and the patient may not respond to some of the empiric regimens used for treating bacterial endocarditis. It should be especially considered as a possible cause of "culture-negative" or "abacteremic" endocarditis.

Adolescent↗
PubMed2002

Value of microimmunofluorescence for diagnosis and follow-up of Bartonella endocarditis.

Bartonella endocarditis is a disease of emerging importance that causes serious complications and high rates of mortality. Due to the fastidious nature of Bartonella species and their high degrees of antibiotic susceptibility, cultures of clinical samples most often remain sterile and valvular biopsy specimens, the best specimens for PCR amplification, are seldom available. Therefore, serology appears to be the easiest diagnostic tool. In order to determine the best cutoff value for serology and its predictive values for the detection of Bartonella endocarditis, we studied 48 patients with culture- and/or PCR-confirmed Bartonella endocarditis. We also applied these serological criteria to 156 patients with blood culture-negative endocarditis. Furthermore, we compared the kinetics of the antibody responses to Bartonella spp. in order to estimate the value of serology for prediction of the occurrence of relapses. A titer of > or = 1:800 for immunoglobulin G antibodies to either Bartonella henselae or B. quintana has a positive predictive value of 0.810 for the detection of chronic Bartonella infections in the general population and a value of 0.955 for the detection of Bartonella infections among patients with endocarditis. When this cutoff was applied to 156 patients with blood culture-negative endocarditis, we were able to diagnose Bartonella infections in an additional 45 patients with definite endocarditis for whom a positive Bartonella serology was the only evidence of infection. On follow-up, the kinetics of the decrease in antibody titers were significantly delayed in two patients with relapses. In conclusion, we recommend the determination of antibodies to both B. quintana and B. henselae and the use of a cutoff value of 1:800 for the diagnosis of Bartonella endocarditis. We propose that this criterion, which may also help with the detection of late relapses, be included as a major criterion in the Duke criteria for the diagnosis of infective endocarditis.

Antibodies, Bacterial↗
PubMed2002

Endocarditis due to anaerobic bacteria.

This review describes the microbiology, diagnosis and management of endocarditis due to anaerobic bacteria. Anaerobic bacteria are an uncommon but important cause of endocarditis. Most cases of anaerobic endocarditis are caused by anaerobic cocci, Propionibacterium acnes and Bacteroides fragilis group. Predisposing factors and signs and symptoms of endocarditis caused by anaerobic bacteria are similar to those seen in endocarditis with facultative anaerobic bacteria with the following exceptions: the gastrointestinal tract was the most common source for B. fragilis group endocarditis, the head and neck were the most common origin for Fusobacterium and Bacteroides spp., and the head and neck and genitourinary tract were the most common source for peptostreptococci. Complications with anaerobic endocarditis include valvular destruction, multiple mycotic aneurysms, aortic-ring abscess, aortitis, cardiogenic shock, dysrhythmias and septic shock. The mortality rate for patients with anaerobes endocarditis is 21-43%. Treatment of endocarditis involving anaerobic bacteria includes the use of antibiotic therapy effective against these organisms.

Bacteria, Anaerobic↗