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 1,153 records · Page 64Linked to original sources
PubMed1985

Penicillin therapy for treatment of experimental endocarditis caused by viridans streptococci in animals.

We studied the efficacy of penicillin and penicillin combined with streptomycin in the treatment of experimental endocarditis caused by viridans streptococci that are susceptible, tolerant, or relatively resistant to penicillin. Rabbits with experimental endocarditis were treated with procaine penicillin (1.5 X 10(5) U/kg) administered twice daily or with procaine penicillin (1.5 X 10(5) U/kg) plus streptomycin (20 mg/kg) administered twice daily for five days. Compared with control animals, animals treated with penicillin alone experienced a significant reduction (P less than .001) of colony forming units per gram of cardiac valve vegetations when infected with streptococci that are susceptible, tolerant, or resistant to penicillin. This antibiotic alone was less effective against streptococci that were tolerant or resistant to penicillin than against streptococci susceptible to the drug (P less than .01). The combination of penicillin and streptomycin was more effective therapy than was penicillin alone in animals with penicillin-tolerant or penicillin-resistant streptococci causing endocarditis (P less than .01). Penicillin-streptomycin therapy was less active against penicillin-resistant strains than against either penicillin-tolerant (P less than .04) or penicillin-susceptible (P less than .01) strains. The results of our study suggest that tolerance or relative resistance to penicillin in strains of viridans streptococci influences the response to therapy with penicillin alone or penicillin combined with streptomycin in the treatment of experimental endocarditis caused by viridans streptococci.

Animals↗
PubMed1985

Comparison of single doses of amoxicillin or of amoxicillin-gentamicin for the prevention of endocarditis caused by Streptococcus faecalis and by viridans streptococci.

Recent recommendations for the prophylaxis of endocarditis in humans have advocated single doses or short courses of antibiotic combinations (beta-lactam plus aminoglycoside) for susceptible patients in whom enterococcal bacteremia might develop or for patients at especially high risk of developing endocarditis (e.g., patients with prosthetic cardiac valves). We tested the prophylactic efficacy (in rats with catheter-induced aortic vegetations) of single doses of amoxicillin plus gentamicin against challenge with various streptococcal strains (two strains of Streptococcus faecalis, one of Streptococcus bovis, and three of viridans streptococci); we then compared this efficacy with that of single doses of amoxicillin alone. Successful prophylaxis against all six strains was achieved with single doses of both amoxicillin alone and amoxicillin plus gentamicin. This protection, however, was limited, for both regimens, to the lowest bacterial-inoculum size producing endocarditis in 90% of control rats and was not extended to higher inocula by using the combination of antibiotics. We concluded that a single dose of amoxicillin alone was protective against enterococcal and nonenterococcal endocarditis in the rat, but that its efficacy was limited and could not be improved by the simultaneous administration of gentamicin.

Amoxicillin↗
PubMed1985

Yeast adhesion in the pathogenesis of endocarditis due to Candida albicans: studies with adherence-negative mutants.

Two spontaneous cerulenin-resistant mutants of Candida albicans, 4918-2 and 4918-10, were unable to adhere in vitro in fibrin-platelet clots. Because in vitro adherence correlates well with colonization of nonbacterial thrombotic endocarditis on traumatized valvular endocardium, 50% infectious dose studies were performed with a rabbit model of endocarditis. Wild-type C. albicans required 10(3.6) +/- 0.12 cfu in comparison with 10(5.73) +/- 0.31 and 10(7.3) +/- 0.21 cfu for mutants 4918-2 and 4918-10, respectively. The relative avirulence of mutant strains in producing endocarditis was not attributed to accelerated clearance of these strains from the bloodstream. In fact, clearance of wild-type and mutant strains was almost identical. In the same animals renal candidiasis was observed with all strains of C. albicans, although the number of cfu per gram of kidney was higher after infection with wild-type C. albicans. Thus, strains of C. albicans with reduced ability to adhere in vitro to a fibrin-platelet matrix are relatively avirulent in the rabbit endocarditis model.

Adhesiveness↗
PubMed1987

Experimental bacterial endocarditis after dental extractions in rats with periodontitis.

The development of bacterial endocarditis was analyzed after dental extractions in rats with or without periodontal disease. Periodontal disease was produced in rats by tying silk ligatures around the two maxillary first molars and placing the animals on a high sucrose diet for 14 weeks. Sterile aortic valve vegetations were produced by means of a transaortic catheter, and 24 hr later the maxillary first molars were extracted. The animals were killed 72 hr after the extractions. In rats with periodontal disease, extractions resulted in a 48% (14 of 29) incidence of bacterial endocarditis, most cases of which were due to Streptococcus spp. (one was caused by Staphylococcus aureus). In contrast, when the teeth with a healthy periodontium were extracted, only 6% (one of 15) of the rats developed endocarditis. When catheters were placed in animals with periodontal disease but no extractions were performed, no endocarditis occurred.

Animals↗
PubMed1988

Predictors of endocarditis in isolates from cultures of blood following dental extractions in rats with periodontal disease.

Rats with periodontitis and catheter-induced aortic valve vegetations underwent dental extractions. Cultures of blood obtained 1 min later showed polymicrobial bacteremia in 19 of 19 rats, mostly due to viridans streptococci (18 of 19), Morganella (15 of 19), group G streptococci (13 of 19), and Staphylococcus aureus (10 of 19). Viridans streptococci circulated in higher numbers than did group G streptococci and S. aureus (P less than .01). Three days after dental extractions, 18 of 20 rats had endocarditis. Fifteen (83%) of 18 infections were due to group G streptococci, 9 (50%) of 18 were due to S. aureus, and 2 (11%) of 18 were due to viridans streptococci (P less than .05). In vitro, adherence to platelet-fibrin matrices of endocarditis strain 8 of group G streptococcus was two times greater than that of endocarditis strain S. aureus 23 and three to four times greater than that of Streptococcus sanguis 44 and Morganella morganii 93 (P less than 10(-5)). The inoculum size that produced endocarditis in 90% of rats after iv challenge was 10(5) cfu for group G streptococcus strain 8 and 10(7) for S. sanguis 44.

Animals↗
PubMed1990

Culture-negative endocarditis probably due to Chlamydia pneumoniae.

A 59-year-old man had culture-negative endocarditis (clinical evidence compatible with endocarditis and histopathologic evidence of a recent episode of endocarditis) and serology compatible with a recent episode of Chlamydia pneumoniae infection. The conclusion was that this episode of culture-negative endocarditis was probably due to C. pneumoniae.

Antibodies, Bacterial↗
PubMed1995

Incidence of hemolysin, gelatinase, and aggregation substance among enterococci isolated from patients with endocarditis and other infections and from feces of hospitalized and community-based persons.

The presence of hemolysin, gelatinase, and aggregation substance (by use of a probe known to hybridize to most pheromone-responsive plasmids) was determined in 192 isolates of Enterococcus faecalis from patients with endocarditis or other infections and fecal isolates from hospitalized patients or healthy volunteers, and in 86 non-E. faecalis isolates. Hemolysin was more common in nonendocarditis clinical isolates and in hospital fecal isolates (37% and 31%, respectively) than among endocarditis and community fecal isolates (16% and 20%, respectively). Gelatinase and aggregation substance, respectively, were found in 54% and 52% of isolates from endocarditis, in 58% and 72% of isolates from other infections, in 62% and 56% of hospital fecal isolates, and in 27% and 30% of fecal isolates from healthy volunteers. All 86 non-E. faecalis enterococcal isolates were negative for these traits. The absence of hemolysin, gelatinase, or the aggregation substance gene in > 45% of endocarditis E. faecalis isolates suggests that while these traits may play a role in virulence, other properties are also important.

Bacterial Proteins↗
PubMed1983

Significance of penicillin tolerance in vivo: prevention of experimental Streptococcus sanguis endocarditis.

To determine whether in-vitro tolerance to penicillin among viridans streptococci influences the efficacy of penicillin in vivo, we studied four strains of dextran-producing. Streptococcus sanguis serotype II. All four strains were inhibited in vitro by 0.1 mg/l penicillin or less; one was not-tolerant, one intermediate, and two were tolerant to the lethal action of penicillin. The combination of penicillin and streptomycin killed all strains completely within 24 h in vitro. Sera from rabbits injected with penicillin were inhibitory for all strains, but were bactericidal only for the non-tolerant strain. The incidence of endocarditis in untreated rabbits with left heart catheters was 100% after inoculation of each of the four strains. Despite attempted prophylaxis with procaine penicillin G, endocarditis developed in 44 of 70 rabbits (63%) injected with the tolerant strains, contrasting with 2 of 22 (9%) for the non-tolerant strain (P=0.0001). The probability that penicillin would fail to prevent endocarditis was directly related to its minimal bactericidal concentration for each strain (r=0.95). In contrast, the combination of penicillin plus streptomycin always prevented endocarditis. We conclude that penicillin tolerance can be a crucial determinant of the response of viridans streptococci to penicillin in vivo.

Animals↗
PubMed1984

The treatment of endocarditis by vancomycin.

The narrow spectrum of vancomycin includes the common causal bacteria of endocarditis. This agent has been used since the 1960s for therapy and prophylaxis of infections when first-line drugs are inappropriate because of antibiotic resistance or drug allergy. Some personal experiences of vancomycin usage and a literature survey are presented in this paper which is based on the subdivision of endocarditis into medical, surgical (early--less than 60 days after operation--or late), and addict-related. The commonest bacterial causes of medical or late surgical infections are streptococci, and of the early surgical and addict-related infections are staphylococci. Vancomycin is bactericidal for Gram-positive cocci, except enterococci, but for optimal action it is arguable that combinations with gentamicin, fusidic acid, rifampicin or erythromycin should be used for staphylococcal endocarditis. The attainment of bactericidal blood levels may still be accompanied by failure of monotherapy and the need for early surgery is stressed. The prophylaxis of endocarditis is primarily required for tooth extraction and for cardiac surgery. The streptococci and staphylococci involved are normally vancomycin-susceptible, and the rabbit model shows that it is a suitable alternative to a beta-lactam and aminoglycoside combination. The combination is therefore suitable for patients already in hospital, especially those with prosthetic valves or undergoing cardiac surgery.

Adult↗
PubMed1987

One and two doses of cephradine in the prophylaxis of experimental streptococcal endocarditis.

The efficacy of cephradine in the prophylaxis of rabbit Streptococcus sanguis endocarditis was investigated. Three days after cardiac catheterization and prior to challenge with S. sanguis, rabbits received either 1000 mg/kg (ten animals) or 500 mg/kg cephradine intramuscularly. Infective endocarditis was prevented in only 30% of the animals. The addition of a second dose of cephradine (100 mg/kg) 8 h after an initial dose of 400 mg/kg did not prevent streptococcal endocarditis in 80% of animals tested. In one or two dose regimens cephradine was found to be inferior to a single 400 mg/kg prophylactic dose of amoxycillin. Cephradine is not recommended for prophylaxis against streptococcal endocarditis.

Amoxicillin↗
PubMed1987

Aetiology and epidemiology of infective endocarditis in England and Wales.

Comparing data relating to the estimated incidence of infective endocarditis and deaths due to this condition highlights the changing age and sex patterns over the last 50 years. Using these data it is estimated that about 20 cases per million population per year can now be expected many of whom will be aged 65 years or more. About 20% of cases die. Viridans streptococci are responsible for almost half the cases of endocarditis, faecal streptococci for 11%, staphylococci for 20% and Coxiella burnetii for 2-3%. The laboratory data for 1976-85 showed that 86 of 821 (10.5%) patients with Staphylococcus aureus endocarditis had valve prostheses and 55 (6.7%) were iv-drug abusers. Of the patients with endocarditis due to coagulase-negative staphylococci 100 of 361 (27.7%) had prostheses.

Adult↗
PubMed1987

Therapy of streptococcal endocarditis: correlation of animal model and clinical studies.

Streptococci (viridans group, Streptococcus bovis, enterococci still account for the majority of cases of infective endocarditis in the non-addict population. Experimental animal models of endocarditis have been used (primarily in rabbits) to delineate the major therapeutic principles of this disease; viz. bactericidal antimicrobial agents must be given parenterally in high dosages for prolonged period of time. Overall, there is a good correlation between results obtained by: (1) in-vitro susceptibility testing (especially killing kinetics in broth); (2) therapeutic comparisons in experimental animal models and (3) clinical trials of different antimicrobial regimens in humans with streptococcal endocarditis. This review contrasts the published results obtained in vivo with experimental animal models to those obtained with various therapeutic approaches to streptococcal endocarditis in humans. The contribution of animal models to current therapeutic recommendations in man is underscored.

Animals↗
PubMed1992

Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis.

Antibiotics are given before some medical and dental procedures to patients with congenital or acquired heart disease to prevent endocarditis. The majority of practitioners and patients are aware of the need for this prophylaxis, although in practice prophylaxis is administered infrequently. It is not known how often patients at risk for endocarditis undergo procedures which warrant the prophylactic administration of antibiotics, nor how often prophylaxis is actually administered to these patients. Two groups of adult patients and a group of children with a cardiac lesion predisposing to endocarditis were surveyed by either telephone interview or mailed questionnaire about awareness of the need for prophylaxis, procedures undergone within six months of the survey and the actual use of prophylaxis before these procedures. Of 455 patients surveyed, 371 (81.5%) responded, 258 (69.5%) of whom remembered receiving advice on prophylaxis. Recollection of advice ranged from 77% of those younger than sixty years to 48% of those aged sixty or older. The patients underwent 68 procedures for which prophylaxis was definitely indicated and 71 procedures with a possible indication for prophylaxis; 127 (91%) of these procedures were dental. Antibiotics were allegedly administered before the procedure to 31 patients (22%). There is marked discrepancy between recollection of the advice and actual use of prophylaxis. In view of this it is likely that patients often undergo procedures without antibiotic protection; however, only a few of these patients develop endocarditis.

Adolescent↗
PubMed1993

The efficacy of teicoplanin in the treatment of endocarditis caused by gram-positive bacteria.

Twenty-six patients with endocarditis caused by Streptococcus viridans (n = 12), Enterococcus faecalis (n = 5), Streptococcus bovis (n = 2), Staphylococcus aureus (n = 3) and Staphylococcus epidermidis (n = 4) were treated with teicoplanin at a dose of 600 mg/day in patients with normal renal function (creatinine clearance 80-120 mL/min) and at a dose of 400 mg/day in patients with moderately impaired renal function (creatinine clearance < 75 mL/min). In nine patients valve replacements were performed. Twenty-one patients were cured by medical treatment with teicoplanin, five patients had a surgical intervention during treatment which was subsequently stopped. Overall, eighteen patients with native valve endocarditis were cured. Out of eight patients with prosthetic valve endocarditis six patients were cured. In one patient teicoplanin therapy was withdrawn because of clinical failure. One patient had a clinical relapse. All cultures taken from blood, endocardium and excised artificial valves were sterile after a minimum of seven days therapy. Side effects were seen in seven patients and included a moderate increase in liver enzymes and mild leucopenia. No renal toxicity was observed, trough serum levels of teicoplanin were not correlated with renal function, a slight accumulation of teicoplanin on day 28 being seen. Our study confirms that teicoplanin is effective as single agent therapy in the treatment of endocarditis due to Gram-positive bacteria.

Adult↗
PubMed1996

Treatment of endocarditis with teicoplanin: a retrospective analysis of 104 cases.

Infective endocarditis is an uncommon disease but retains a high mortality. Glycopeptides are used for patients with resistant pathogens, those allergic to penicillins or for those outside the hospital. The once daily administration of teicoplanin and its low toxicity suggest that it would be suitable for use in the long courses required for endocarditis. However, the dosage and combinations to be used require further study. A retrospective review has been made of 104 episodes of endocarditis treated with teicoplanin in 101 patients seen over 7 years. Most patients had been referred to major London hospitals following failure of medical treatment. After three loading doses of 400 mg, teicoplanin was given at a dose of 400 mg/day in combination with other antibiotics such as gentamicin. Follow up was for one year. The most common pathogens were Streptococcus sanguis (15 cases), Staphylococcus aureus (13 cases) and Staphylococcus epidermidis (10 cases). Of 80 patients febrile at the start of treatment with teicoplanin, 63 (79%) lost their fever within a median of 2 days (1-35 days). Cure without surgery was effected in 50 (48%) and 75% of patients survived. Other antibiotics, usually gentamicin or rifampicin, were used in 92 (90%) of patients. Two strains of Streptococcus spp. were said to be resistant but there was no relationship between MIC of teicoplanin and outcome. Pathogens with a high MBC tended to be more likely to resist treatment. Adverse effects resulted in the withdrawal of teicoplanin in 20 cases (19%) but most events were mild and renal deterioration occurred in only five patients. Teicoplanin was effective in the treatment of endocarditis and appeared to be safe given the severity of disease in the patients treated.

Adult↗
PubMed2005

Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization.

OBJECTIVES: To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization. PATIENTS AND METHODS: Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to alpha-haemolytic streptococci; 15 due to beta-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery. RESULTS: For alpha-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1-20) and 16 (4-58) days of treatment, respectively, P < 0.001. For beta-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received < or = 4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received < or = 8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received < or = 4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with beta-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative. CONCLUSIONS: Our findings support current treatment guidelines for endocarditis caused by alpha-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.

Adult↗
PubMed2006

Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations.

In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment duration than currently advised by international guidelines. Also, high-dose antibiotics, as recommended today, have a predominantly pharmacokinetic and pharmacodynamic rationale that is based mostly on experimental animal studies. Shortening antimicrobial treatment in select patients with endocarditis would be of great benefit. As yet there are no predictors of cure that can be used to individualize treatment duration in patients with bacterial endocarditis.

Anti-Bacterial Agents↗
PubMed1999

Orthodontics and infective endocarditis.

Infective endocarditis associated with orthodontics is a rare occurrence. Unfortunately, many orthodontic practitioners do not treat patients potentially at risk of developing endocarditis due to the lack of practical guidelines and fear of precipitating the infection. Additionally, many patients that undergo orthodontic treatment are inappropriately prescribed antibiotic cover for procedures that have a minimal bacteraemic risk. In this paper the literature linking orthodontic treatment and infective endocarditis is examined. Recommendations are made for the appropriate management of patients at risk of infective endocarditis for orthodontic procedures. Refereed Paper

Adult↗