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 955 records · Page 53Linked to original sources
PubMed1993

[Diagnostic contribution of transesophageal echocardiography in infectious endocarditis. Apropos of 101 cases].

One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with both methods. Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There were 3 false negative results by TEE: small anterior abscesses marked by the prosthesis or aortic calcifications. In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%. These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.

Adolescent↗
PubMed1977

Prosthetic valve endocarditis. The case for prompt valve replacement.

Treatment of patients with prosthetic valve endocarditis with existing guidelines has failed to reduce the over-all mortality rate to below 50 per cent. However, subgroups with high or lower risk of death can be delineated on the basis of risk factors such as early onset following surgery, high-risk causative organisms, cardiodynamic failure, and septic emboli. High-risk patients comprise more than 70 per cent of those with prosthetic valve endocarditis in recent series. Analysis of previously reported series indicates that the mortality rate for high-risk patients with late onset of prosthetic valve endocarditis treated by valve replacement was less than that of patients receiving only medical therapy. We have treated 6 consecutive patients with prosthetic valve endocarditis (3 early onset, 3 late onset) by valve replacement before completion of a course of antibiotics. All patients survived surgery but one patient died after 4 1/2 months of noninfectious causes. Prompt valve replacement is technically feasible and should become the standard therapy for patients with prosthetic valve endocarditis who do not fall into the lower risk group.

Adult↗
PubMed1977

Effect of aspirin on thrombogenesis and on production of experimental aortic valvular Streptococcus viridans endocarditis in rabbits.

Because thrombus formation at the site of endothelial injury has been thought to be a critical step in the pathogenesis of bacterial endocarditis, the effect of aspirin on experimental valvular thrombosis and bacterial endocarditis in rabbits was evaluated. Aortic valvular injury and thrombosis were induced in aspirin-treated and control rabbits with intracardiac catheters. A subsequent inoculation of Streptococcus viridans resulted in the development of infective endocarditis. Rabbits were sacrificed as early as 6 hr, and the effectiveness of aspirin was determined by the weight of the sterile vegetations and the quantitation of bacteria in the thrombotic vegetation. Aspirin, in levels in excess of 50 mg/dl did not attenuate the evolution of infective endocarditis, since the formation of sterile thrombotic vegetation and bacterial endocarditis in aspirin-treated rabbits was similar to those in controls.

Animals↗
PubMed1993

Aminoglycoside resistant enterococcal endocarditis.

There are few well-documented cases of infective endocarditis due to highly aminoglycoside-resistant enterococci reported to date. Nevertheless, strains with high-level resistance to both streptomycin and gentamicin are now sufficiently common that the number of cases of endocarditis due to these organisms will undoubtedly continue to increase. Serious efforts to develop appropriate alternative treatment strategies are now clearly necessary. All high-level gentamicin-resistant bloodstream isolates from patients with suspected or proven endocarditis should be screened for high-level streptomycin resistance. Because these two resistance traits are mediated by distinct genetic elements, a significant minority of highly gentamicin-resistant enterococci will be susceptible to synergistic killing by combinations of cell wall-active antibiotics with streptomycin. For strains highly resistant to both aminoglycosides, there is no evidence of benefit from use of these toxic antimicrobials, and treatment with a cell wall-active agent alone is warranted. Based on older literature and animal models, perhaps as many as 40% to 50% of cases of enterococcal endocarditis might be curable by such regimens. Alternative combinations using a cell wall-active antibiotic together with a fluoroquinolone or rifampin cannot be specifically recommended based on any firm data from the literature, but possible merits of such combinations can be explored in vitro under appropriate circumstances. For ampicillin- and vancomycin-susceptible strains, ampicillin would seem preferable because this drug typically demonstrates greater bactericidal activity in vitro as a single agent. Consideration could be given to administration of ampicillin by continuous intravenous infusion. Several animal studies indicating effectiveness of penicillins for enterococcal endocarditis have used dosing regimens resulting in sustained serum levels. It is unknown whether these observations are relevant to human enterococcal infections. Testing for beta-lactamase production should be undertaken if penicillins are to be used. For strains that are resistant to achievable concentrations of penicillins, or when the patient is intolerant of beta-lactams, vancomycin can be used. In animal models, teicoplanin has appeared to be superior to vancomycin, but high concentrations must be attained. This drug is not yet approved for clinical use, however, and it is unclear if any advantage would exist in treatment of human infections. The recent emergence of enterococci which are resistant to glycopeptides has introduced another potential complicating factor; some of these are also substantially resistant to beta-lactams as well. In some reports, favorable interactions between vancomycin and beta-lactams have been observed against vancomycin-resistant strains.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1993

Prevention of infective endocarditis: an update for clinicians. American Heart Association.

Infective endocarditis is a rare, serious, and sometimes fatal heart disease that can be caused by bacteremia from the mouth, especially by Streptococcus viridans. As a result, dental procedures have often been blamed for cases of infective endocarditis but poor oral health and hygiene may actually cause more cases of infective endocarditis than do dental procedures. The American Heart Association and other groups have published recommendations for the prevention of infective endocarditis in dental patients and advise specific antibiotic regimens for certain dental procedures in cardiac-abnormal patients. The most recent (1990) American Heart Association recommendations are the most conservative yet, reflecting concern about the prevention of not only infective endocarditis, but also problems resulting from the antibiotics themselves. Clinicians should carefully consider not only the patient's medical history, but also the types of dental procedures planned.

Anti-Bacterial Agents↗
PubMed1995

Porcine stentless aortic valve in re-replacements and acute aortic valve endocarditis.

Between June 1990 and June 1993, 135 patients received a porcine stentless aortic valve (PSAV) at our institution. In this group, there were 33 patients in whom the stentless valve was used to replace a previously inserted malfunctioning aortic valve prosthesis (n = 19) or to treat acute aortic valve endocarditis (n = 14, five native, nine prosthetic endocarditis). There was one hospital death caused by multiple organ failure in a patient with endocarditis and preoperative cerebral stroke. Two patients died after hospital discharge; one suffered sudden death following a pacemaker failure four month after surgery and the other died due to Candida albicans sepsis after a prolonged antibiotic treatment. There were two reoperations; one to correct a dehiscence of the proximal suture line and the other to replace a degenerated valve 3.5 years after implantation in a 14 year old boy. All operative survivors were followed clinically with serial color Doppler echocardiography. No recurrence of endocarditis was detected. Aortic root reconstruction was achieved even in the presence of multiple abscesses. All but one patients showed a normally functioning valve with none or minimal aortic insufficiency. In our opinion the PSAV is an excellent aortic valve substitute for patients with damaged aortic annulus, because it promotes aortic root remodeling, decreases the incidence of postoperative paravalvular leaks and helps to prevent endocarditis recurrence.

Acute Disease↗
PubMed1996

Endocarditis in an urban hospital in the 1990s.

OBJECTIVES: To analyze the clinical characteristics and outcome of 159 consecutive patients with endocarditis who presented to an inner-city hospital from 1990 onward and to elucidate the most current problems and advances in the management of endocarditis. METHODS: One hundred eighty-two consecutive cases (in 159 patients) met diagnostic criteria for endocarditis, including histopathologic evidence or multiple positive blood cultures without another primary source, and appropriate signs or symptoms. Transthoracic echocardiography was performed for 171 cases, and 36 patients underwent transesophageal echocardiography. RESULTS: Sixty-seven percent of the patients were known drug users; more than 80% of these were positive for human immunodeficiency virus. Fever, malaise, and fatigue occurred in more than 95%, but other signs were neither sensitive nor specific, and classic microvascular phenomena were uncommon. Blood cultures were positive in 96%, all 7 patients with negative cultures had received prior antibiotic therapy. Staphylococcus aureus was the most common organism, and a significant increase in S aureus infections was noted for tricuspid endocarditis (chi 2 = 71.07, P = .003). The mitral (n = 51) and tricuspid (n = 49) valves were the most common sites of infection. Underlying heart disease was only identified in one fourth of the cases. Transesophageal echocardiography identified vegetation in 34 of 36 studies, 16 of which had negative transthoracic echoes. Five of 6 patients with documented abscesses died within 7 months. A systemic embolism occurred in nearly a third (n = 51) of the cases. Large vegetations (> 20 mm) were significantly correlated with an increased frequency of embolization (chi 2 = 6.77, P = .009), but vegetation mobility was not. Cardiac surgery was performed in 24 patients; there were 2 perioperative deaths. CONCLUSIONS: The changing clinical spectrum of endocarditis exemplified in our series has important implications for diagnosis and management. Close attention to appropriate risk factors can contribute to optimal management of those factors and improve prognosis.

Adult↗
PubMed1996

[Native-valve endocarditis produced by Lactobacillus casei sub. rhamnosus refractory to antimicrobial therapy].

Lactobacillus endocarditis is a rare infection. In fact, only 42 cases have been described in the literature from 1938 up to date. In only 17 previously reported cases have patients been cured with medical therapy alone. Although infections produced by Lactobacillus spp, have been described in our country, none of them included endocarditis. We report herein a case of endocarditis due to a vancomycin-resistant strain of Lactobacillus casei sub. rhamnosus in a 29-year-old man with prolapse of the mitral valve. He required surgical replacement of his valve because of the poor response to antimicrobial therapy with penicillin and gentamicin. The patient displayed a successful clinical outcome, with no evidence of recurrence along the subsequent 2 years. We point out the need to accurately identify Lactobacillus spp. in isolates from blood cultures of patients with endocarditis, since these bacteria may often be mistaken for other species more frequently associated to this infection, which usually respond to conventional antimicrobial therapy. Furthermore, we suggest that early surgical replacement should be considered when lactobacillus endocarditis is diagnosed.

Adult↗
PubMed1996

[Serologic study in patients with streptococcal infective endocarditis].

BACKGROUND: Infective endocarditis is a systemic disease in which there are a continuously antigenic stimulation of immunologic system. Streptococcus is still the most frequent cause of infective endocarditis. PATIENTS AND METHODS: We investigated the presence of antibody (AB), total and IgM by indirect immune fluorescence technique, in four groups of population: streptococcal infective endocarditis (SIE), streptococcal bacteraemia (SB), Staphylococcus aureus endocarditis, and healthy people. Antigens used were: 1) their own strain isolated from the blood of patients with SIE and SB ¿homologous AB¿, and; 2) seven species of Streptococcus: Streptococcus intermedius, Streptococcus salivarius, Streptococcus bovis, Streptococcus sanguis I, Streptococcus sanguis II, nutritional dependent streptococci and Enterococcus faecalis (heterologous AB). RESULTS: Homologous antibodies: titers > or = 1/512 were found in all patients with SIE and only in 2 with SB (sensitivity 100% and specificity 93%). IgM titer (threshold 1/32) was positive only in patients with SIE (sensitivity 75,5% and specificity 100%). The fall of the AB titer was continuous and slow, despite the good clinical evolution of patients. (AB titers were > or = 1/512 and IgM > or = 1/64 in 30% of patients 1 year later). Heterologous AB: in spite of statistically significant difference found in SIE versus the other groups, sensitivity of this test (threshold 1/256) is low, confidence interval include expected random value (50%), specificity is 88%. CONCLUSIONS: The utility of homologous AB for diagnosing infective endocarditis is demonstrated. On the contrary for heterologous AB, antigenic common fractions must be found in the different species.

Adult↗
PubMed1997

[Pneumococcal endocarditis of the tricuspid valve. A case report with review of the literature].

The incidence of invasive infections caused by Streptococcus pneumoniae has increased dramatically in Norway the last 5-10 years. We describe a patient with a pneumococcal endocarditis of the tricuspic valve who illustrates some of the diagnostic and therapeutic problems often connected with right-sided endocarditis. We also review literature on pneumococcal endocarditis. Since the introduction of antibiotics, the incidence of pneumococcal endocarditis has decreased significantly. The most important predisposition still seems to be alcoholism. Cases of pneumococcal endocarditis require prolonged and consistent antibiotic treatment. Rapid destruction of the valves is typical, and often demands surgical intervention at an early stage. So far no multiresistant pneumococci have been observed in Norway. The increased incidence of serious pneumococcal infections has recently made it necessary to recommend that pneumococcal vaccine be given on wider indications.

Endocarditis, Bacterial↗
PubMed1997

[Echocardiographic prediction of risk for embolism in patients with infective endocarditis].

The relationship between two-dimensional echocardiographic findings of vegetation and embolic events was investigated in 26 patients with infective endocarditis (17 males and 9 females, mean [+/-SD] age 51 +/- 17 years). The size and the other morphologic characteristics of vegetation (mobility, extent and consistency) were analyzed retrospectively according to the criteria by Sanfilippo, et al., and parameters were assigned scores from 1 to 4 to provide a total score. Patients with a maximum vegetation diameter > 10 min had a significantly higher incidence of embolic events than those with < or = 10 mm (p < 0.05). Each parameter of vegetation showed no significant difference between patients with and without embolic events; but the total score was significantly higher in patients with embolic events (p < 0.05). Particularly, all patients with a total score > or = 10 had embolic events, whereas those without embolic events had a total score < or = 9. There were no significant differences in the frequency of emergent valve replacement between patients with aortic value and mitral valve endocarditis. However, the incidence of heart failure was higher, but not significantly, in patients with aortic valve (67%) and combined valve endocarditis (67%) than in those with mitral valve endocarditis (36%). The maximum size and total score reflecting mobility, extent and consistency of vegetation using two-dimensional echocardiography provide useful information to predict the occurrence of embolic events in patients with infective endocarditis.

Adult↗
PubMedDate not supplied

Retrospective evaluation of therapies for Staphylococcus aureus endocarditis.

We retrospectively evaluated antiinfective therapy for methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis in 54 patients who had 57 treatment courses for the disease. Three treatments were assessed: 27 nafcillin-treated courses of MSSA endocarditis, 18 vancomycin-treated courses of MSSA endocarditis, and 11 vancomycin-treated courses of MRSA endocarditis. At baseline, patients with MSSA treated with vancomycin had more chronic conditions (p<0.01), a lower frequency of intravenous drug use (p<0.01), a lower hematocrit concentration (p<0.05), and a higher serum creatinine concentration (p<0.05) than the nafcillin group. Vancomycin-treated patients had a higher complication rate during therapy (p<0.05) and a longer duration in an intensive care unit (p<0.01) than the nafcillin group. The trend was for a higher complete response rate in the nafcillin group (74% vs 50%, p=0.12), but no difference in mortality (22% vs 28%, p=0.73). Patients with MRSA infection treated with vancomycin had higher mortality than those with MSSA who received that drug (55% vs 28%, p=0.24). Patients with vancomycin-treated MSSA endocarditis may have a poorer outcome than those who receive nafcillin, but this may be influenced by different or more severe clinical features.

Adult↗
PubMed1997

[Q fever endocarditis and bicuspid aortic valve].

Q fever is caused by the rickettsia Coxiella burnetti, an obligate intracellular bacterium acquired by inhalation of infected dust from subclinically infected animals. Q fever may be acute or chronic; the chronic form mostly presents as endocarditis. Immunocompromised states and underlying heart disease are the most important risk factors. Usually the symptoms of Q fever endocarditis are nonspecific and diagnosis is often established very late. New criteria for diagnosis include a single blood culture positive for Coxiella burnetti, positive Q fever serology and characteristic echocardiographic studies. We describe a 49-year-old man with bicuspid aortic valve admitted with fever, weight loss and a new heart murmur. The diagnosis of Q fever endocarditis was established by positive Q fever serology, and an echocardiogram showing vegetations and valvular dysfunction. This case suggests that Q fever endocarditis should be considered in patients with "sterile" endocarditis.

Aortic Valve↗
PubMed1998

[Surgical treatment of infective endocarditis].

Patients operated on for infective endocarditis (n = 69) at two regional hospitals between 1988 and 1994 are reviewed. 70% had a known valvular heart disease and 16% had prosthetic valve endocarditis. In 28% the offending microorganism was Staphylococcus aureus; in 26% Streptococcus viridans. Therapy was intended to be a six-week antibiotic course before operating, but 55% of the patients had to be operated on earlier. The postoperative course was uncomplicated in 59%, mortality was 16% and one-year survival 81%. Increased risk of death was associated with operating before the six-week course of antibiotics was completed (p = 0.005), with preoperative renal failure (p = 0.006) or lung failure (p = 0.008), with the growth of microorganisms from tissue samples extirpated during the operation (p = 0.01), with additional surgical procedures concomitant to valvular replacement (p = 0.02), S. aureus endocarditis (p = 0.03), and with the presence of paravalvular abscesses or intracardial fistulas (p = 0.03). The study shows that infective endocarditis is a serious disease. Wherever clinically feasible, all patients should be given antibiotics for six weeks before evaluating surgery. However, close surveillance of infection and haemodynamics is necessary to allow for the possibility of acute surgery before the development of organ failure. Special attention must be paid to cases of S. aureus endocarditis.

Adolescent↗
PubMed1998

[Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients].

AIM OF THE STUDY: The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993. PATIENTS AND METHODS: Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence. Methods to confirm the diagnosis include immunohistochemical demonstration of C. burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases). Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever. RESULTS: The average age of the patients was 47 years (15 men and 6 women). 64% of patients had a history of environmental exposure to C. burnetii. The median time of symptomatology before diagnosis was 5 months (1-108). 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis. Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19). All the patients required antibiotic treatment. Cardiac surgery was performed in 15/21 patients. For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40). The fall in anti-phase I titers was significant. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown. CONCLUSIONS: Serology is the key to Q fever diagnosis. The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low.

Adolescent↗
PubMed1998

[Is prophylaxis needed? Is it really effective? Risk of endocarditis after heart surgery].

Infective endocarditis still has an important morbidity and mortality in the acute phase and also in the following years. Because of this, the development and use of preventive strategies have been an important target in developed countries. Until we have some prospective studies their use will be only intuitive and based on the following criteria: endocarditis frequently follows a bacteremia; some diagnostic or therapeutic procedures cause bacteremia; the germs are habitually predictable in each procedure and are sensitive to specific antibiotics; patients with some cardiac or major structural defects have a higher risk of endocarditis. For these reasons, a rational treatment is to give the specific antibiotic against the microorganism prophylactically before it enters the bloodstream during the procedure. Although available data are inconclusive and sometimes even contradictory, most authors recommend the indication of prophylactic measures whose efficacy depends on three basic points: a) identification of patients with a high risk of endocarditis, especially those with a prosthetic cardiac valve; b) knowledge of procedures that need chemoprophylaxis, especially dental and oral procedures, and c) selection of the best prophylactic policy in each specific case. In summary, it is necessary to know to "whom", "when" and "how" to apply prophylactic measures. There are some special situations that must be considered carefully: patients treated with anticoagulant drugs or with a cardiac pacemaker or with an implanted defibrillator, patients with renal insufficiency and an arteriovenous fistulae, and some patients needing open heart surgery, or those who have already had open heart surgery. In conclusion, the prevention of bacterial endocarditis using antibiotics is currently practiced in clinical settings, especially in some specific groups of patients. It is necessary to recommend this treatment in high risk patients (i.e. in those with prosthetic cardiac valves) before a high risk procedure (i.e. dental procedures known to induce gingival or dental bleeding, including professional cleaning) and in medium risk patients, the indication must always be based on an individual analysis according to American Heart Association guidelines.

Adult↗
PubMed1998

[Prosthetic valve endocarditis].

Infective endocarditis occurs in 4% of prosthetic valve carriers. The infection is related to both the injured endocardium and circulating microorganisms. Early prosthetic endocarditis, occurring in the first 12 months after valvular surgery is mainly caused by staphylococci, and late prosthetic endocarditis has a similar etiology as native valve endocarditis. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction. In late cases the clinical picture is similar to native valve disease. Mortality in prosthetic endocarditis remains high, especially in early cases, despite combined medical and surgical treatment.

Echocardiography↗
PubMed1998

Hospital acquired native valve endocarditis: analysis of 22 cases presenting over 11 years.

OBJECTIVE: To analyse hospital acquired infective endocarditis cases with respect to age, sex, clinical, laboratory, and echocardiographic features, predisposition, complications, surgery, mortality, and diagnostic criteria. DESIGN: Prospective cohort study. SETTING: Teaching hospital. PATIENTS: A series of 200 patients with infective endocarditis presenting over 11 years, 168 with native valve infective endocarditis, of whom 22 acquired this infection in hospital. RESULTS: 22 (14%) of the 168 cases of native valve infection were hospital acquired. The most common pathogens were staphylococci (77%). Two thirds of patients had no cardiac predisposition; one third had end stage renal disease. The most common source of infection was vascular access sites (73%). Eleven patients died. In 11 cases, infective endocarditis was proven pathologically (six at necropsy, five during surgery) and analysis of these showed that 45% were classed as probable by the Beth Israel criteria, 73% as definite by the Duke criteria, and 91% as definite by our suggested modifications of the Duke criteria. Figures for the 11 cases not proven pathologically were 27%, 73%, and 91%, respectively. Five of the 22 cases (22%) were rejected by the Beth Israel criteria but none were rejected by the Duke criteria with or without our modifications. CONCLUSIONS: Hospital acquired infective endocarditis is difficult to diagnose. The Duke criteria have improved diagnostic sensitivity and our modifications have improved it further. Mortality is high but has been reduced by surgery. This serious infection could, in many cases, be prevented by improved care of intravascular lines and prompt removal when obviously infected.

Adult↗