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PubMed1998

Infective endocarditis and glycopeptides.

BACKGROUND: Despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years. The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci). OBJECTIVES: To assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria. METHODS: A retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis. RESULTS: Cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this. Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside. By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside. Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates. CONCLUSIONS: Clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials. Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn.

Anti-Bacterial Agents↗
PubMed2000

[Short and long-term prognosis of prosthetic valve endocarditis in non-drug addicts].

INTRODUCTION AND OBJECTIVES: Prosthetic valve infective endocarditis is a complication of valvular replacement surgery with a high morbimortality during the in-hospital phase and an important risk of complications during follow-up. The objective of the present study is to assess the clinical features and the short and long-term prognosis of this disease. PATIENTS AND METHODS: A prospective study of 43 consecutive cases of prosthetic valve endocarditis in non-addict patients from January 1987 to March 1997. RESULTS: The mean age was 51 +/-16 years. Eight patients (19%) had early prosthetic valve endocarditis (two months following heart surgery), fourteen patients (32%) had intermediate (between 2 and 12 months post surgery) and twenty-one (49%) had late prosthetic valve endocarditis (more than one year after heart surgery). Transesophageal echocardiography was performed in 32 patients with a sensibility of 81%. Complications occurred in 86% of patients and 53% of patients underwent surgery during the active phase (25% was emergency surgery). Inpatient mortality was 23% (50% in early prosthetic valve endocarditis). After a mean follow-up of 56 months there were 5 cases of recurrence, four patients required late surgery and 5 patients died. Survival (excluding early mortality) was 82% at 5 years with no significant differences among patients who received only medical treatment and those who underwent surgery in the active phase. CONCLUSIONS: Early mortality of prosthetic valve endocarditis is, according to our experience of 20%. The prognosis of survivors to the active phase is favourable in the majority. Early prosthetic valve endocarditis still causes a high mortality rate despite the use of combined medical surgical treatment in most cases.

Endocarditis↗
PubMed1987

Two-dimensional echocardiographic identification of complicated aortic root endocarditis: implications for surgery.

Two-dimensional echocardiography successfully displayed the location and extent of aortic root complications, annular abscess or mycotic aneurysm in nine patients with aortic valve endocarditis. Five of the nine patients had prosthetic valve endocarditis and four had native valve endocarditis. The infective process extended into the paravalvular structures, including the interventricular septum (seven patients), right ventricular outflow tract (three patients), interatrial septum (one patient) and anterior mitral valve leaflet (four patients). The amount of aorto-left ventricular discontinuity caused by these complications was quantitated in degrees of annular circumference on the parasternal short axis image and in distance on the parasternal long axis image. The echocardiographic findings were confirmed at surgery and were helpful in the preoperative anticipation of the type of surgical procedure required: aortic valve replacement or composite aortic valve and root replacement. Five patients had prosthetic valve endocarditis with calculated aorto-left ventricular discontinuity of 173 +/- 55 degrees on parasternal short axis images and 1.36 +/- 0.72 cm on parasternal long axis images. Initial surgical repair included three composite aortic root-valve prosthesis implants, one reconstructive procedure with valve replacement and one simple aortic valve replacement. During a follow-up period of 18 months (range 1 to 35), a second reparative procedure was required for only one patient to repair an aortic conduit to coronary artery venous bypass graft. Four patients had native valve endocarditis with calculated aorto-left ventricular discontinuity of 100 +/- 17 degrees on parasternal short axis images and 0.88 +/- 63 cm on parasternal long axis images. Initial surgical repair included two reconstructive procedures with valve replacement and two simple aortic valve replacements. During a follow-up period of 30 months (range 16 to 42), three of these four patients required a second reparative procedure: one each for repair of a paraprosthetic leak, a ventricular septal defect and persistent aorto-left ventricular discontinuity. Two-dimensional echocardiography accurately detected aortic annular abscess and mycotic aneurysm complicating aortic valve endocarditis and the resultant degree of aorto-left ventricular discontinuity. Circumferential aorto-left ventricular discontinuity with these complications is greater for prosthetic than native valve endocarditis and predicts a more extensive surgical repair.(ABSTRACT TRUNCATED AT 400 WORDS)

Abscess↗
PubMed1997

Long-term results of surgery for active infective endocarditis.

OBJECTIVE: This paper was undertaken to determine the long-term outcome of active infective endocarditis treated with antibiotic and radical excision of infected tissues by surgery. METHODS: From October 1978 to August 1994, 122 consecutive patients were operated on during the acute phase of infective endocarditis. There were 85 men and 37 women whose mean age was 50 years, ranging from 20 to 79. Surgery was needed because of one or more of the following complications: cardiogenic/septic shock in 19 patients, congestive heart failure in 68, persistent sepsis in 64, peripheral embolization in 20, and cerebral embolization in 10. The offending microorganism was identified in 110 patients, staphylococci were the most common ones. Seventy-six patients had native valve endocarditis and 46 had prosthetic valve endocarditis. Simple valve replacement or repair was performed in 60 patients and radical resection of the valve and surrounding tissues with reconstruction of the heart with either fresh autologous pericardium or glutaraldehyde-fixed bovine pericardium was performed in 62 with paravalvular abscess. Pulmonary autograft and aortic homograft were used in only three patients, the remaining patients had either bioprostheses or mechanical heart valves if valve repair was not feasible. RESULTS: There were nine deaths, for an operative mortality of 7.4%. Logistic regression analysis identified preoperative shock and renal failure as predictors of operative mortality. Operative survivors were followed up from 4 to 173 months, mean of 56.4. The actuarial survival at 10 years was 61 +/- 6%. Logistic regression analysis identified preoperative New York Heart Association functional class IV and perioperative renal failure as predictors of late mortality. Eight patients developed recurrent endocarditis 10-102 months postoperatively. The freedom from recurrent endocarditis at 10 years was 79 +/- 9%. All patients who developed this late complication had paravalvular abscess at the time of original operation. CONCLUSIONS: These data suggest that surgery for active infective endocarditis yield a high probability of eradicating the infection with relatively low operative mortality and good long-term results.

Abscess↗
PubMed1997

Aortic root replacement with human tissue valves in aortic valve endocarditis.

OBJECTIVE: Aortic allograft and pulmonary autograft aortic root replacement in native and prosthetic aortic valve endocarditis are evaluated and risk factors for hospital death are assessed by univariate risk factor analysis. METHODS: From April 1989 to May 1996, 59 patients with aortic valve endocarditis (27 native; 32 prosthetic) underwent aortic root replacement with a human tissue valve. Mean age was 53.4 +/- 12.3 years; 46 patients (78%) were male. The mean preoperative NYHA functional class was 3.4. The predominant infective organisms were streptococci (30%) in the native valve group and staphylococci (30%) in the prosthetic valve group. In native valve endocarditis, valve destruction (32%) was the predominant finding. Abscesses, either annular (29%) or subannular (36%) and valve dehiscence (36%) were the most common findings in patients with prosthetic valve endocarditis. Partial or total ventriculo-aortic discontinuity (20%) and aortico-mitral discontinuity (27%) were other important operative observations. A cryopreserved allograft was used in 53 patients (89.5%), the pulmonary autograft (Ross procedure) in 5 patients (8.5%), and a fresh antibiotic sterilized allograft root in one patient (2%). Mean aortic cross-clamp time was 131 +/- 32 min. In active native and prosthetic valve endocarditis, intravenous antibiotics were continued for at least 6 weeks, monitored by serial CRP measurements. RESULTS: Hospital mortality was 8.5% (n = 5; 70% CL: 4.9-12.1%). Univariate risk factors for hospital mortality were age (P = 0.001), preoperative New York Heart Association functional class (P = 0.001), pre- (P = 0.001) and postoperative (P = 0.001) renal insufficiency. Major complications were allograft failure (n = 1; 2%), technical failure (n = 1; 2%) and false aneurysm formation at the proximal suture line (n = 1; 2%). Follow-up was complete, mean 33.1 +/- 20.1 months. Two late deaths occurred. Actuarial five year survival was 88.8% (70% CL: 80.0-97.5%); actuarial five year freedom from recurrent endocarditis was 98.1% (70% CL: 94.5-100%). CONCLUSION: Allograft aortic root replacement is a valuable technique in the life threatening situations both of native and prosthetic aortic valve endocarditis with involvement of the annular and peri-annular region.

Adult↗
PubMed2005

Results of surgical treatment for infective endocarditis in children.

OBJECTIVE: Infective endocarditis is uncommon condition, with a high degree of morbidity and mortality. It is less common in children, albeit tending to be associated with congenital cardiac malformations. We describe our experience of the need for surgical treatment in children with infective endocarditis. PATIENTS AND METHODS: We analyzed retrospectively the records of 9 children aged below 16 years seen between May 2003 and March 2005 with infective endocarditis, reviewing the demographic details, clinical presentation, microbiological and echocardiographic data, operative findings, and outcome. RESULTS: Apart from pre-existing renal insufficiency in 1 patient, congenital cardiac malformations were the predisposing factors. Blood cultures were positive in 3, but remained negative in the other 6 patients. The indications for surgical treatment included uncontrolled sepsis, congestive heart failure, recurrent endocarditis, patch or graft dehiscence, and pseudoaneursymal formation. Death due to uncontrolled sepsis resulting in multiorgan failure occurred in 1 patient, who had tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. Another patient died late postoperatively due to cardiac failure after relapse of the endocarditis in the setting of negative blood cultures. CONCLUSION: Despite advances in antimicrobial therapy, diagnosis, and measures of treatment for infective endocarditis, complications continue to be responsible for substantial morbidity and mortality. Since blood cultures are frequently negative, clinical and echocardiographic findings should be the major determinants of strategies used for treatment. We believe that our small series of patients seen over the past two years in which surgical treatment was performed will be helpful in guiding the clinical perspectives for children with infective endocarditis.

Adolescent↗
PubMed2000

The 75-kD tumour necrosis factor (TNF) receptor is specifically up-regulated in monocytes during Q fever endocarditis.

Q fever is an infectious disease caused by Coxiella burnetii, an obligate intracellular microorganism that inhabits monocytes/macrophages. The dysregulated production of TNF-alpha in Q fever endocarditis has been associated with defective killing of C. burnetii by patient monocytes. As soluble receptors for TNF-alpha (TNF-R55 and TNF-R75) regulate TNF-alpha activity, we investigated their release by monocytes in Q fever. Spontaneous and C. burnetii-stimulated release of TNF-R75, but not of TNF-R55, was up-regulated in patients with ongoing endocarditis compared with controls. The increase in TNF-R75 release was related to the activity of Q fever endocarditis, since TNF-R75 release was similar in patients with cured endocarditis and controls. While spontaneous release of TNF-R75 by monocytes from patients with ongoing Q fever endocarditis occurred without changes in its membrane expression, C. burnetii increased the surface expression of TNF-R75. In addition, TNF-R75 transcripts were increased in resting and C. burnetii-stimulated monocytes from patients with ongoing endocarditis. On the other hand, TNF-R75 release was not related to TNF-alpha secretion. These results indicate that the modulation of TNF-R75 is a critical feature of the pathophysiology of Q fever endocarditis.

Adult↗
PubMed2002

The importance of secondary mitral valve involvement in primary aortic valve endocarditis; the mitral kissing vegetation.

AIMS: Secondary involvement of the mitral valve is well documented in primary aortic valve endocarditis. A poorly considered, but probably important causative mechanism, involving both left-sided valves, is 'mitral kissing vegetation'. This results from large aortic vegetations prolapsing into the left ventricular outflow tract and making contact with the ventricular aspect of the anterior mitral leaflet thus causing secondary infection. METHODS AND RESULTS: In 192 consecutive patients with aortic valve endocarditis, two to 18 (7.6+/-2.6) serial transoesophageal echocardiographic examinations were analysed per patient to demonstrate the development of mitral kissing vegetation on initially competent, morphologically normal mitral leaflets. In 19 patients (9.9%) with aortic valve endocarditis, mitral kissing vegetation was diagnosed within 11.6+/-9.0 (range 1-31) days following primary transoesophageal echocardiography. In all patients with mitral kissing vegetation, vegetations attached to aortic cusps were >6 mm. On hospital admission, patients with aortic valve endocarditis plus mitral kissing vegetation presented more often with a positive sepsis score, embolic events, renal failure and had larger aortic valve vegetations (9.9+/-3.3 vs 5.7+/-2.3 mm). Prognosis of aortic valve endocarditis plus mitral kissing vegetation was unfavourable (P<0.005) when compared to patients with aortic valve endocarditis alone. CONCLUSION: In aortic valve endocarditis early echocardiographic detection of mitral kissing vegetation and timely surgery may preserve the mitral valve apparatus, and favourably influence the long-term prognosis.

Adolescent↗
PubMed2000

[Severe complications caused by inattention to endocarditis prevention during dental procedures in adults with congenital heart abnormalities].

BACKGROUND AND OBJECTIVE: Despite new guidelines on antibiotic prophylaxis to prevent bacterial endocarditis there is still confusion about the forms of dental procedures requiring antibiotic prophylaxis. Aim of this study was to determine the incidence of bacterial endocarditis following dental procedures in adults with congenital heart disease during a one-year period, and to assess connections with prophylaxis. PATIENTS AND METHODS: The case notes of all adults with congenital heart disease (CHD) treated in hospital during a one year period were analyzed retrospectively to identify cases of endocarditis, and all adults with CHD admitted to hospital for other reasons than endocarditis were interviewed about their knowledge of antibiotic prophylaxis against bacterial endocarditis. RESULTS: Among the 456 adults with CHD 351 (78%) knew about the need for antibiotic prophylaxis against bacterial endocarditis. Three patients developed endocarditis, in each case after a visit to the dentist. The disease started 11-16 days after dental descaling had been performed without antibiotic covering, one patient developing a brain abscess. The patients had to be treated in the hospital for 42-49 days. Despite presentation by the patient of a leaflet with recommendations for prophylaxis, the dentist refused to give antibiotics. CONCLUSIONS: Knowledge of adults with CHD is satisfactory but can still be improved. Even more important is better training of dentists who treat patients with CHD with special emphasis on the specific procedures including dental descaling, which require antibiotic prophylaxis.

Adolescent↗
PubMed1995

[Infectious endocarditis of native and prosthetic valves. A comparative analysis based on 155 cases].

OBJECTIVE: In a retrospective study, we compared the characteristics of native valve and prosthetic valve endocarditis. PATIENTS AND METHODS: All 155 cases of left-sided infective endocarditis in 142 patients admitted at our institution between 1986 and 1992 were analyzed based on their medical records. Native valve endocarditis was found in 119 cases (74 men, 45 women; median age 55, range 29 to 80 years), prosthetic valve endocarditis in 36 cases (11 men, 25 women; median age 63, range 38 to 80 years; 29 cases of late infection). RESULTS: There were more older (P < 0.0005) and more female (P = 0.001) patients with prosthetic valve endocarditis. Most frequently, native aortic valves (53.8%) or mitral prostheses (55.6%) were solely involved. In both groups, Staphylococcus epidermidis was the most frequent isolate followed by Staphylococcus aureus and Enterococci. Symptoms and clinical findings were similar in both groups. In all cases since July 1989, transthoracic echocardiography was suggestive of endocarditis in native valves in 63.9% and in prostheses in 29.2% (P = 0.004), combined with the transesophageal approach in 91.7 and 91.8%, respectively (not significant). Embolism and surgical intervention were about equally frequent in both groups. The in-hospital mortality was 19.3% in native valves and 22.2% in prostheses (not significant). CONCLUSION: Native valve and late prosthetic valve endocarditis are now similar in the spectrum of causative microorganisms, echocardiographic diagnostics, clinical course and prognosis.

Adult↗
PubMed1988

Legionella prosthetic-valve endocarditis.

Since 1982 seven patients at Stanford University Medical Center have been shown to have prosthetic-valve endocarditis caused by Legionella pneumophila or L. dumoffii. We studied the clinical features of legionella endocarditis at the time of diagnosis and performed a case-control study to analyze risk factors for the infection. All patients with endocarditis had a chronic course (3 to 19 months after surgery) of fever, night sweats, weight loss, and anemia, but no embolic events or immune-complex deposition disease. Five patients required surgical replacement of their infected prosthetic valves. The case-control study revealed that during the early postoperative period, patients who later contracted legionella endocarditis were more likely to have had symptoms and signs attributable to postcardiomyotomy syndrome than were patients who did not contract endocarditis (P less than 0.013). Examination of the legionella isolates by means of molecular techniques demonstrated that the Stanford L. pneumophila isolates were genotypically identical to isolates from the hospital drinking water. L. dumoffii isolates from patients with endocarditis were derived from a single strain apparently unique to this medical center. We conclude that legionella infection was nosocomially acquired in the perioperative period. These cases demonstrate an expanding spectrum of illness caused by legionella species and emphasize the need to consider legionella as a cause of "culture-negative" endocarditis.

Endocarditis, Bacterial↗
PubMed1991

Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Abscess↗
PubMed2001

Risks factors and prevention of Q fever endocarditis.

Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985-2000 was conducted. Twelve patients with acute Q fever who developed endocarditis and 102 patients with Q fever endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease (P<10(-7)), especially a prosthetic valve (P=.01), were encountered more often among patients with endocarditis. Among patients with valvular defects, we estimate the risk of developing endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of endocarditis than doxycycline alone (P=.009). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing endocarditis.

Aged↗
PubMed2002

Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962-1998.

We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998. Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%). Surgical valve replacement was performed for 12 patients (40%). Fourteen patients (47%) died. Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively (P=.01). The mortality rate for native valve endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; P<.05). Additionally, 115 cases in the literature from 1962-1998 were reviewed. During 1980-1998, the percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% (P=.05) and the mortality rate decreased from 45% to 34% (P=NS). S. agalactiae is an uncommon cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery.

Adult↗
PubMed2004

Streptococcus bovis endocarditis and its association with chronic liver disease: an underestimated risk factor.

Clinical and epidemiological characteristics of Streptococcus bovis endocarditis were prospectively studied among 199 patients with definite endocarditis. Thirty patients (15.1%) had S. bovis endocarditis. Compared with patients with non-S. bovis endocarditis, these 30 patients were older (mean age, 58.6+/-12.4 years vs. 46.0+/-17.0 years; P<.001) and had higher rates of bivalvular involvement (43.3% vs. 7.7%; P<.001), embolism (73.3% vs. 40.2%; P=.002), and diskitis (23.3% vs. 0.6% P<.001). In patients with S. bovis biotype I (S. bovis I) endocarditis, advanced liver disease was present in 56.7%, compared with 15.3% of patients with non-S. bovis endocarditis (P<.001), and colonic adenoma was present in 46.7%. The in-hospital mortality rate (16.7%) was correlated with delayed diagnosis and advanced liver diseases. In our city, S. bovis I endocarditis is frequently correlated with liver diseases; diskitis may be the first sign of the disease.

Anti-Bacterial Agents↗
PubMed1998

Klebsiella endocarditis: report of two cases and review.

The rarity of endocarditis due to Klebsiella species limits its recognition and awareness of its often malignant course. We describe two recent cases of Klebsiella pneumoniae endocarditis and review the clinical context and outcomes of 48 other cases reported in the literature. At our hospital, endocarditis complicated only one of 86 consecutive episodes of bacteremia due to Klebsiella species. In 22 series of endocarditis that we reviewed, Klebsiella species caused < or =1.2% of cases of native valve endocarditis and up to 4.1% of cases of prosthetic valve endocarditis. Valves were replaced in 44% of these cases, and the mortality rate was 49% in cases for which outcome was specified. Valve replacement may be associated with improved survival. We conclude that Klebsiella species are a rare but ominous cause of complicated bacterial endocarditis that requires careful evaluation during the entire course of therapy.

Aged↗
PubMedDate not supplied

Erysipelothrix rhusiopathiae endocarditis: microbiologic, epidemiologic, and clinical features of an occupational disease.

Ninety percent of the 49 reported cases of serious Erysipelothrix rhusiopathiae infection have been episodes of presumed or proved endocarditis. E. rhusiopathiae endocarditis correlates highly with occupation (farming, animal exposure), affects more males than females, exhibits a peculiar aortic valve tropism, displays a characteristic erysipeloid cutaneous lesion (in 40% of cases), and is associated with significant mortality (overall rate, 38%). Comparison with other unusual gram-positive rods causing endocarditis shows that E. rhusiopathiae resembles Listeria monocytogenes and Lactobacillus species in its propensity to involve structurally damaged but native left-sided valves. Unlike diphtheroid endocarditis, E. rhusiopathiae endocarditis has not involved prosthetic valves and is not associated with intravenous drug abuse, as is Bacillus species endocarditis. E. rhusiopathiae is exquisitely susceptible to penicillin but resistant to vancomycin. Since vancomycin is often employed in empiric therapy for presumed endocarditis, prompt microbiologic differentiation of E. rhusiopathiae from other gram-positive organisms is necessary to avoid delays in the initiation of appropriate antibiotic therapy.

Aged↗
PubMed1994

Native valve endocarditis due to Corynebacterium striatum: case report and review.

We report the first known case of native valve endocarditis due to Corynebacterium striatum and review 51 previously reported cases of native valve endocarditis due to non-diphtheriae corynebacteria. Of the 52 patients with corynebacterial endocarditis, 11 (21%) had no predisposing conditions and 27 (52%) had structural heart disease; endocarditis in the remaining 14 patients (27%) was associated with noncardiac predisposing factors including injection drug use, chronic hemodialysis, vasculitis, alcoholism, liver transplantation and hemodialysis, a peritoneovenous shunt, and prior aspiration of a noninfected bursa. The mortality rate associated with corynebacterial endocarditis was 31%. The majority of corynebacteria in this series were sensitive to penicillin, erythromycin, gentamicin, and vancomycin. Non-diphtheriae corynebacteria are capable of producing acute valvular damage, even in patients without conditions that are predisposing for endocarditis. The occurrence of bacteremia due to non-diphtheriae corynebacteria in the appropriate clinical setting should alert physicians to the possible diagnosis of endocarditis. Empirical antibiotic therapy with vancomycin, with or without an aminoglycoside, should be initiated pending antibiotic susceptibility testing.

Anti-Bacterial Agents↗