Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOCARDITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources
PubMed1995

Notes on the early history of infective endocarditis and the development of an experimental model.

Experimental models of infective endocarditis antedate Garrison and Freedman's work in 1970. The hypothesis of the role of parasites (microorganisms) microscopically observed in vegetations and cardiac valves of patients with endocarditis was first put forth by Winge in Sweden in 1869. Winge's work led Klebs and Rosenbach in Germany to establish, between 1878 and 1881, an animal model of experimental endocarditis in which the aortic valves of rabbits were perforated with a metallic probe (loaded with septic material) introduced through the carotid artery. Ten years after Winge's work, Pasteur emphasized the importance of bacteriologic "blood cultures." During the period 1881-1886, Netter and Grancher (Pasteur's associates) introduced a method for drawing aseptic blood samples from patients with clinical endocarditis and performing bacteriologic blood cultures. In Vienna in 1885-1886, Orth, Weichselbaum, and Wyssokowitsch further developed Rosenbach's procedure of inducing experimental endocarditis by injecting material from a bacterial culture into a rabbit's ear vein. The development of an experimental model of endocarditis by investigators in the latter part of the nineteenth century provided anatomopathological and bacteriologic data that in turn led to a better understanding of infective endocarditis.

Animals↗
PubMed1984

Neurologic complications in a group of 86 bacterial endocarditis.

Criteria defined by von Reyn were applied to 86 cases of bacterial endocarditis. Neurologic complications (NC) were categorized according to Pruitt definitions. Neurologic accidents were observed in 48 cases. They were the first clinical manifestation in 20 patients. Neurologic events were of poor prognosis in BE, mortality increasing from 26% in patients without NC to 83% in patients with NC (P less than 0.01). Two factors affect the incidence of NC: first, the location of endocarditis with 76% of NC in mitral valve endocarditis compared with 37% in other cases (P less than 0.005); and second the infecting organism: 71% of NC in staphylococcus aureus endocarditis versus 45% in endocarditis with other bacteria (P less than 0.02). Cerebral embolism was the most common NC (25 cases) related to an occlusion of the middle cerebral artery in 21 cases with a fatal outcome in 19 patients. Other NC included 15 intracranial hemorrhages with the evidence of an aneurysm in 4 cases, 6 septic meningitis, 2 macroscopic abscesses, and 2 multiple microscopic abscesses. This study emphasizes the high rate and severity of NC in staphylococcal mitral endocarditis despite antibiotic therapy and supports early surgery in this group of bacterial endocarditis.

Adolescent↗
PubMed1986

Viridans streptococcal endocarditis: clinical, microbiological, and echocardiographic correlations.

Infections caused by species within the viridans streptococci have been associated with different clinical characteristics. We studied 36 patients with viridans streptococcal endocarditis. Complications were seen in 10 (32%) of 31 patients with native valve endocarditis and four (80%) of five with prosthetic valve endocarditis and included death in two, valve replacement in six, persistent infection in three, emboli in two, and congestive heart failure in nine. Two-dimensional echocardiograms demonstrated vegetations in 26 (72%) of 36, flail mitral valves in seven, disruption of aortic valve prosthesis in one, and perivalvular abscesses in three (two Streptococcus sanguis I and one Streptococcus intermedius I). All twelve patients with native valve endocarditis who suffered complications had vegetations detected by two-dimensional echocardiography, whereas seven patients with native valve endocarditis without vegetations, as detected by two-dimensional echocardiography, had no complications (P = .03). We found no significant correlation between streptococcal species and clinical outcome. To confirm our identifications, we sent 16 identical viridans streptococcal endocarditis isolates to five institutions; only three of 16 were identified as the same species by all five institutions. We conclude that viridans streptococcal endocarditis can be associated with a virulent clinical course and that there is marked variability in species designations of individual strains by different laboratories.

Adolescent↗
PubMed2006

Linezolid for the treatment of patients with endocarditis: a systematic review of the published evidence.

BACKGROUND: Linezolid is a bacteriostatic oxazolidinone antibiotic that has been proven to be effective for the treatment of patients with pneumonia, skin and soft tissue infections, and possibly bacteraemia, due to Gram-positive cocci. However, the drug is sometimes used for the treatment of patients with endocarditis due to Gram-positive cocci resistant to other antibiotics. METHODS: We carried out a review of the available literature to evaluate whether linezolid is also effective for the treatment of patients with infective endocarditis. RESULTS: We identified 23 case reports and 3 case series reporting the experience with 56 patients with endocarditis treated with linezolid. Evaluable data for 33 patients who received linezolid and for whom individual patient data were reported were further analysed. Prosthetic valve infective endocarditis accounted for 25% of the reviewed cases. Methicillin-resistant Staphylococcus aureus and vancomycin-intermediate S. aureus were the most commonly isolated cocci (24.2% and 30.3% of cases, respectively). Linezolid alone was administered to 66.7% of patients while the rest received the antibiotic in combination with rifampicin, gentamicin, fusidic acid or amikacin. A total of 63.6% (21/33) of patients with endocarditis were cured after linezolid administration. The overall and endocarditis-related mortality was 33.3% (11/33) and 12.1% (4/33), respectively. Thrombocytopenia developed in 30.8% (8/26) of patients for whom relevant data were available. CONCLUSIONS: The limited available evidence suggests that linezolid may be considered as a therapeutic option for the treatment of patients with endocarditis due to multidrug-resistant Gram-positive cocci. However, further published experience is needed to answer the question of whether a bacteriostatic antibiotic could be proven beneficial for patients with an infection for which bactericidal antibiotics have been traditionally used.

Acetamides↗
PubMed1990

Cerebrovascular accidents in infective endocarditis: role of anticoagulation.

Anticoagulation is still a matter of debate in infective endocarditis, since it can increase the risk of complications, mostly neurological. In our series of 269 patients with native valve endocarditis studied between 1970 and 1982, 35 were anticoagulated. We observed 14 patients with brain infarcts, of whom five died, and 12 patients with cerebromeningeal or brain haemorrhage of whom six died. In a similar series of 63 patients with prosthetic valve endocarditis, all of whom were on anticoagulation and were studied between 1972 and 1987, we observed five patients with brain infarcts, three of whom died, and two patients with brain haemorrhage, one of whom died. The frequency of cerebrovascular accident (CVA) was similar for both groups (11.1% in prosthetic endocarditis vs 11.5% in native valve endocarditis, P = ns), as was mortality rate (57% vs 48.4%, P = ns). CVA are significantly more frequent among anticoagulated patients (19/94 vs 19/238: P less than 0.01), but the mortality rate in CVA is similar for anticoagulated and non-anticoagulated patients (11/19 vs 8/19: P = ns). The indications for anticoagulation in infective endocarditis remain similar to those in valvular heart disease. In patients with infective endocarditis, anticoagulation with heparin should be maintained whenever a brain infarct is present, unless it is large and/or haemorrhagic.

Adolescent↗
PubMed1995

Characteristics of infective endocarditis in France in 1991. A 1-year survey.

OBJECTIVE: To update data on incidence and characteristics of infective endocarditis in France. BACKGROUND: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations. METHODS: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions. RESULTS: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis. The adjusted annual incidence was 24.3 cases per million inhabitants. Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions. Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6%. Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8%. The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23%. Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis. During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died. CONCLUSIONS: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

Adolescent↗
PubMed1985

Duration of symptoms and the effects of a more aggressive surgical policy: two factors affecting prognosis of infective endocarditis.

One hundred and six patients were analysed in order to assess the effect of a more aggressive surgical policy in relation to the delays in diagnosis of infective endocarditis. The average duration of symptoms before diagnosis was 9.7 weeks, even though the patients had sought medical advice at a relatively early stage of their illness (2.2 weeks). Three of the 29 (10.3%) patients who were treated surgically died and all three were operated upon five weeks or later after diagnosis. Seventy-seven patients did not have surgery and 15 died (19.5%). The outcome of surgical treatment for prosthetic valve endocarditis was no worse than for native valve endocarditis. The mortality of prosthetic valve endocarditis including early infections was 32% with medical but only 10% with surgical management compared with 14.5% and 10.5% in native valve endocarditis. Endocarditis cannot always be prevented but earlier diagnosis would reduce mortality and prevent complications. When medical treatment is failing then surgery should be considered early and urgently particularly in staphylococcal infection or when large mobile vegetations are recognized; surgery is mandatory in fungal endocarditis. Earlier diagnosis would greatly reduce the current high incidence of surgery, but that depends on a much heightened index of suspicion amongst both general practitioners and hospital physicians.

Adolescent↗
PubMed2000

The surgical management of bacterial valvular endocarditis.

Bacterial endocarditis is an important cause of cardiac valvular problems. The diagnosis of bacterial endocarditis can be difficult, and, often, an aggressive clinical evaluation including serial blood cultures is necessary. The pathophysiology of endocarditis is changing with the rise of intravenous drug use; staphylococci are an increasingly common cause. Endocarditis often warrants surgical intervention. Operations for bacterial endocarditis range from valve repair to valve replacement to homograft replacement. The operations are technically challenging, but new methods of myocardial protection have markedly improved the surgical outcomes. Valve excision is an option for intravenous drug users with tricuspid valve endocarditis. Surgical management of endocarditis is a technically challenging but rewarding procedure that should be offered to appropriate patients.

Debridement↗
PubMed1978

Neurologic complications of bacterial endocarditis.

(1) Neurologic complications remain a significant problem in bacterial endocarditis. Of 218 patients with endocarditis, 84 (39%) had a neurologic complication and 58% of these 84 patients died. In contrast, the mortality rate was only 20% among those endocarditis patients without neurologic complications. (2) Of the neurologic complications, cerebral embolism is the most frequent and important. An embolic stroke occurred in 37 (17%) of our patients, with 30 of these patients dying. Emboli are important not only in terms of the direct morbidity and mortality they cause via cerebral infarction, but also because of their role in the causation of mycotic aneurysms, brain abscesses, and abnormal CSF formulae. (3) Cerebral emboli are particularly common in patients with mitral valve infection, and in patients with infection due to virulent organisms, particularly S. aureus and enteric gram-negative bacilli. (4) Mycotic aneurysms occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Management of angiographically demonstrated mycotic aneurysms is dependent upon the presence or absence of hemorrhage, the anatomic location of the aneurysm, and the clinical course of the patient. Healing of mycotic aneurysms can occur during the course of effective antimicrobial therapy, thus obviating the need for neurosurgical intervention in all such patients. (5) Macroscopic brain abscess is a rare complication of bacterial endocarditis. Miliary microscopic abscesses are more common than larger abscesses, particularly in patients with acute disease and miliary infection in other organs of the body. (6) Focal seizures occur most commonly in endocarditis patients with acute embolic disease; generalized seizures are of diverse etiologies, with metabolic factors being most important. Penicillin neurotoxicity should be considered in patients with impaired renal function who are receiving high dose penicillin. (7) With the exception of hemorrhagic complications, lumbar puncture results tend to reflect the nature of the infecting organism rather than the nature of the neurologic complication. Endocarditis due to virulent organisms such as S. aureus is usually associated with a purulent CSF formula while nonvirulent organisms, such as viridans streptococci, susually have aseptic or normal CSF formulae.

Adolescent↗
PubMed1986

Infectious endocarditis at three hospitals in the same city: two study periods a decade apart.

We reviewed the records of patients with infectious endocarditis from three hospitals in the same city from 1970 to 1972 and from 1980 to 1982. A total of 43 episodes of infectious endocarditis occurred in 42 patients. The clientele of these hospitals differ in that one is a teaching hospital which treats principally indigent tertiary care patients, one treats principally private patients, and one provides care for military veterans. In our study we noted that changes in the frequency and etiology of endocarditis observed at our teaching hospital were not seen in either of the other hospitals. We also noted that the predilection for men and mitral valve involvement observed in some retrospective reviews of endocarditis from large metropolitan centers could not be extended to our city's hospitals. Although some interhospital variations in epidemiologic and microbiologic parameters in infectious endocarditis may be explained by different patient populations, others, such as local variations in the frequency of valvular involvement, cannot be reliably predicted from published series. We conclude that a larger data base founded on statewide reporting of infectious endocarditis would lead to a better understanding of the microbiology, anatomy, and demography of infectious endocarditis.

Adolescent↗
PubMed2006

Inappropriate use of antibiotic prophylaxis to prevent infective endocarditis in obstetric patients.

OBJECTIVE: To evaluate infective endocarditis prophylaxis practices during the intrapartum period and to assess obstetric providers' adherence to the American Heart Association and American College of Obstetrics and Gynecology guidelines for infective endocarditis prophylaxis. METHODS: We performed a chart review of pharmacy, electronic nursing, and physician records to report this case series of obstetric patients who received infective endocarditis prophylaxis during the intrapartum period at a single tertiary referral care center during a 1-year study period from August 1, 2004, to July 31, 2005. RESULTS: Fifty patients received antibiotics for infective endocarditis prophylaxis. Three of the 50 patients who received infective endocarditis prophylaxis had high-risk cardiac lesions and three other patients had moderate-risk cardiac lesions and evidence for intrapartum infection. Thus, only six patients (12.0%, 95% confidence interval 4.5%-24.3%) met the American Heart Association and American College of Obstetricians and Gynecologists criteria for an appropriate indication for infective endocarditis prophylaxis. Of these six patients who had an appropriate indication for infective endocarditis prophylaxis, only three (50.0%, 95% confidence interval 11.8%-88.2%) received appropriate antibiotic regimens. CONCLUSION: Antibiotics are frequently given to obstetric patients during pregnancy. Although many obstetric patients receive antibiotics for recommended indications, some patients, as our study shows, do not. A concerted effort by all practitioners and institutions to reduce the amount of inappropriate antibiotics given to obstetric patients will have positive public health effects in addition to benefiting individual mothers and neonates.

Anti-Bacterial Agents↗
PubMed2006

New insight into the diagnosis of fastidious bacterial endocarditis.

Sterile blood cultures are noted in one third of patients with infectious endocarditis. Although in half of cases this is due to previous antibiotic therapy, in the other half, the aetiology of culture-negative endocarditis is intracellular bacteria such as Coxiella burnetii or fastidious growing bacteria. Although it was previously considered that the prevalence of such organisms was identical throughout the world, recent investigations on Bartonella endocarditis clearly showed that the aetiology of culture-negative endocarditis is likely to be strongly related to epidemiology of the agent in each country. During the past decade the use of molecular techniques such as PCR with subsequent sequencing to detect or to identify bacteria in valves from patients with infectious endocarditis have considerably improved the aetiological diagnosis. This is especially true in the case of culture-negative endocarditis following earlier antibiotic therapy. However, the fact that DNA remnants of past endocarditis can be detected some time after the acute episode, when the patient has been cured, suggests that the predictive value of these techniques along with the traditional histology and culture need to be evaluated closely.

Anti-Bacterial Agents↗
PubMed2003

Is there a link between tooth brushing and infective endocarditis?

Tooth brushing is known to cause bacteraemias, which could theoretically potentially lead to the development of infective endocarditis. It is therefore paradoxical that tooth brushing is not thought to cause infective endocarditis. The reasons for this lack of association are not clear, but may be related to the fact that most oral procedures do not have a high association with infective endocarditis. There is no definitive data on the relative risks of using manual or electric toothbrushes in patients predisposed to infective endocarditis. It may be prudent to advise patients predisposed to infective endocarditis to use adjunctive chlorhexidine when cleaning their teeth with either a manual or electric toothbrush. The use of adjunctive chlorhexidine reduces the magnitude of any bacteraemia caused by tooth brushing and may interfere with the bacteria that could potentially cause infective endocarditis. Prophylactic antibiotics are not warranted for tooth brushing in patients at risk of infective endocarditis.

Anti-Infective Agents, Local↗
PubMed2000

Coxiella burnetii survives in monocytes from patients with Q fever endocarditis: involvement of tumor necrosis factor.

Endocarditis is the most frequent form of chronic Q fever, an infectious disease caused by Coxiella burnetii. As this obligate intracellular bacterium inhabits monocytes and macrophages, we wondered if pathogenesis of Q fever endocarditis is related to defective intracellular killing of C. burnetii by monocytes. Monocytes from healthy controls eliminated virulent C. burnetii within 3 days. In contrast, monocytes from patients with ongoing Q fever endocarditis were unable to eliminate bacteria even after 6 days. In patients who were cured of endocarditis, the monocyte infection was close to that of control monocytes. This killing deficiency was not the consequence of generalized functional impairment, since patient monocytes eliminated avirulent C. burnetii as did control cells. The addition of supernatants of C. burnetii-stimulated monocytes from patients with ongoing endocarditis to control monocytes enabled them to support C. burnetii survival, suggesting that some soluble factor is responsible for bacterial survival. This factor was related to tumor necrosis factor (TNF): expression of TNF mRNA and TNF release were increased in response to C. burnetii in patients with ongoing endocarditis compared to cured patients and healthy controls. In addition, neutralizing anti-TNF antibodies decreased C. burnetii internalization, an early step of bacterial killing, in monocytes from patients with ongoing endocarditis but did not affect delayed steps of intracellular killing. We suggest that Q fever-associated activation of monocytes allows the survival of C. burnetii by modulating early phases of microbial killing.

Adult↗
PubMed1990

Serological response in Enterococcus faecalis endocarditis determined by enzyme-linked immunosorbent assay.

Enterococcus (Streptococcus) faecalis expresses three species-specific surface protein antigens of molecular weights 73,000, 40,000, and 37,000. On Western blotting (immunoblotting), they were detected strongly by immunoglobulin G (IgG) in sera from patients with E. faecalis endocarditis, but not in sera from patients with other E. faecalis infections or with endocarditis due to other streptococci. We developed an enzyme-linked immunosorbent assay system to measure IgG, IgM, and IgA levels to these antigens and evaluated its potential as a serodiagnostic test for E. faecalis endocarditis. The test correctly diagnosed E. faecalis endocarditis in 15 of 16 cases. Of 10 cases of endocarditis due to other streptococci and 10 E. faecalis infections other than endocarditis, 9 and 8, respectively, gave negative results. The test should prove particularly useful in culture-negative cases, for which choice of appropriate antibiotic therapy for E. faecalis endocarditis is vital.

Antibodies, Bacterial↗
PubMed2004

Repeated echocardiographic examinations of patients with suspected infective endocarditis.

OBJECTIVE: To study the diagnostic contribution of repeated transthoracic (TTE) and transoesophageal echocardiography (TOE) among patients with suspected infective endocarditis. METHODS: 262 patients with 266 episodes of suspected infective endocarditis were referred for TTE and TOE over three years in a 423 bed university cardiology hospital. Patients were a mean (SD) of 47.6 (17.9) years old. 139 (52.3%) episodes occurred in men and 127 (47.7%) in women. The diagnostic information obtained from repeated TTE and TOE examinations was evaluated relative to the diagnosis of endocarditis. RESULTS: TTE examinations were repeated in 192 (72.2%) and TOE examinations were repeated in 49 (18.4%) of 266 episodes. A mean of 2.4 TTE and 1.2 TOE examinations were performed for each episode of suspected endocarditis. The second and third TTEs added diagnostic information in 34 (26.7%) and the second and third TOEs added diagnostic information in 25 (19.7%) of 127 episodes with definite endocarditis. After the third TTE or TOE no additional diagnostic information was obtained. CONCLUSIONS: The diagnostic contribution of repeated TTE or TOE for the diagnosis of endocarditis decreased as the number of repetitions increased. In this setting, the data do not substantiate more than three TTE or TOE examinations as an efficient strategy to increase the diagnostic yield for all but selected patients with suspected endocarditis.

Adult↗
PubMed1987

Infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without.

The diagnostic and prognostic features of 44 episodes of infective endocarditis in 42 children with congenital heart disease were reviewed. Endocarditis occurred in 18 patients who had not had surgical correction or palliation of the defect (non-operated group). There were 26 episodes in 24 patients who had been treated surgically (operated group) (16 open and eight closed cardiac operations). Endocarditis occurred soon after open heart surgery in eight patients and as a late complication in the other 16. It recurred in two patients (operated group). Invasive monitoring and low cardiac output were consistent features in those patients who had endocarditis soon after open heart surgery whereas dental treatment was a common feature in non-operated cases and after closed cardiac operations. Late cases of endocarditis after open heart surgery had various microbiological features that were not typical of infection after dental problems. Gram positive infections occurred in non-operated patients and in those who had had closed cardiac operations. The group that had open heart surgery had infections caused by Gram positive, Gram negative, and anaerobic bacteria and fungi. Fever, anaemia, leucocytosis, and positive blood cultures were the only consistent findings. Vegetations were seen in nine of 12 patients at cross sectional echocardiography. All 12 (four non-operated, one closed, and seven open cases) needed acute surgical treatment. The mortality from infective endocarditis was 17% for non-operated cases, 0% for those who had had closed heart surgery, and 50% for those who had had open heart surgery. Infective endocarditis after open heart surgery differs from that in the other subgroups in terms of microbiology, source of infection, and outcome and its early diagnosis depends on a thorough investigation of minimal symptoms and signs.

Adolescent↗
PubMed1999

Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis.

OBJECTIVE: To assess the long term prognostic significance of aortic valve ring abscess in patients with aortic endocarditis. PATIENTS: A consecutive series of 75 patients who had surgery for aortic infective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group 1) and 40 did not (group 2). Mean age did not differ between the two groups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or beta haemolytic streptococcal endocarditis was more common in patients with native valve endocarditis who had aortic ring abscesses (20% v 5%). DESIGN: Cohort analysis. RESULTS: In-hospital mortality (11.4% v 7.5%) and 10 year survival (56% v 66%) were not significantly different between groups 1 and 2. In patients with native valve endocarditis, 10 year survival was 62% and 66%, respectively for patients with or without ring abscess, and 10 year reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an intercurrent illness, severe congestive heart failure before surgery, and use of valved conduits for surgical treatment were predictors of poorer long term survival. At follow up residual aortic regurgitation was documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01). CONCLUSIONS: Aortic valve ring abscess is not an independent marker of poor long term outcome in patients with infective endocarditis. However, as residual aortic regurgitation appears frequent at follow up, specific surgical techniques should be considered in patients with paravalvar abscesses.

Abscess↗