Infective endocarditis in childhood: a single-center experience of 18 years

Abstract Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.

Infective Endocarditis in Childhood: a Single-Center Experience of 18 Years.

INTRODUCTION: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. METHOD: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. RESULTS: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. CONCLUSION: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.

Choque séptico con disfunción multiorgánica en paciente con pericarditis supurada y bacteriemia por Staphylococcus aureus meticilino sensible. Reporte de caso / Septic shock with multi-organ dysfunction in a patient with suppurative pericarditis and bacteraemia due to sensitive methicillin staphylococcus. Case report

RESUMEN Choque séptico con disfunción multiorgánica tiene una tasa de mortalidad mayor de 50%. Se presenta el caso de un varón que cursó con choque séptico con disfunción multiorgánica, secundario a bacteriemia por Staphylococcus aureus meticilino sensible, con foco de partida dérmico - partes blandas, quien presentó lesiones alveolo nodulares, pericarditis supurativa, lesiones embolicas a nivel dérmico, ocular y renal; recibió soporte en la unidad de cuidados intensivos, tratamiento antibiótico con oxacilina más vancomicina, pericardiectomia subtotal y drenaje pleural. Salió de alta estable para continuar tratamiento. Presentamos este caso para destacar la gravedad de la bacteriemia por Staphylococcus aureus meticilino sensible, con compromiso multiorgánico y así poder tomar medidas terapéuticas agresivas para disminuir la morbilidad y mortalidad por el mismo.

SUMMARY Septic Septic shock with multi organ dysfunction is associated with a mortality above 50%. We present here the case of a young male patient who presented with septic shock and multi organ dysfunctions secondary to methicillinsusceptible Staphylococcus aureus from a skin and soft tissue infection presenting with alveolar-nodular pulmonary lesions, purulent pericarditis and septic embolic lesions on the skin, eyes and kidneys. The patient was admitted to the ICU receiving antibiotic coverage with oxacillin and vancomycin, subtotal pericardiectomy and pleural drainage, and was discharged clinically stable. We present this case to draw attention to the severity of S. aureus bacteremia to initiate prompt aggressive therapeutic measures to ameliorate associated morbidity and mortality.

Reutilização de perfurocortantes na insulinoterapia e sua associação com infecções estafilocóccicas / Re-use of sharps in insulin therapy and their association with staphylococcus infections / Reutilización de punzocortantes en la insulinoterapia y su asociación con infecciones estafilocócicas

Justificativa e Objetivos: A insulinização de múltiplas doses é um dos tratamentos utilizados para diabetes. O manejo de seringas, agulhas e canetas na insulinoterapia têm sido descrito como um fator de risco ao desenvolvimento de processos infecciosos, causando dano a integridade da pele e lesões tissulares, facilitando a penetração de patógenos oportunistas. Diante disso, o objetivo desta pesquisa foi avaliar a prática de reutilização desses dispositivos na insulinoterapia e sua relação com o surgimento de contaminação por Staphylococcus sp. em agulhas e riscos de infecções. Métodos: Para a coleta de dados foram realizadas entrevistas semi-estruturadas com os participantes da pesquisa acerca dos aspectos da terapia insulínica. A pesquisa entrevistou 15 diabéticos, dos quais 13 (86,7%) do sexo feminino, sendo coletadas 20 agulhas com posterior envio para análise no laboratório de microbiologia da Faculdade Santa Maria. Resultados: Foi constatado que 53,3% dos participantes relataram adotar algum cuidado de hiegiene no local da aplicação, 80% reutilizaram a agulha de um a > 7 dias, variando de dois a > 15 aplicações, e 66,7% sentiram alguma reação no local da aplicação. Um total de nove agulhas reutilizadas mostraram-se contaminadas por Staphylococcus sp. após realização de cultura, coloração de Gram, teste da catalase e coagulase. Conclusão: Diante dos resultados, pode-se constatar que existe um potencial risco de infecção por Staphylococcus sp. associado à insulinoterapia.(AU)

Background and Objectives: Multiple dose insulin is one of the treatments used for diabetes. The management of syringes, needles and pens in insulin therapy has been described as a risk factor for the development of infectious processes, causing damage to skin integrity and tissue injuries, facilitating the penetration of opportunistic pathogens. Therefore, the objective of this research was to evaluate the practice of reuse of these instruments in insulin therapy and their relation with the emergence of Staphylococcus sp. contamination in needles and risks of infections. Methods: Semi-structured interviews were carried out with the participants of the study on the aspects of insulin therapy. The research interviewed 15 diabetic individuals, of which 13 (86.7%) were female, and 20 needles were collected and sent to the microbiology laboratory at Faculdade Santa Maria. Results: 53.3% of the participants reported adopting some hygiene care at the application site, 80% reused the needle from one to > 7 days, ranging from 2 to > 15 applications, and 66.7% felt some reaction at the application site. A total of nine reused needles were contaminated with Staphylococcus sp. after culturing, Gram stain, catalase and coagulase tests. Conclusion: According to the results, it can be verified that there is a potential risk of infection by Staphylococcus sp. associated with insulin therapy.(AU)

Justificación y Objetivos: Se utiliza la insulinización de múltiples dosis como uno de los tratamientos para la diabetes. El manejo de jeringas, agujas y plumas de injección en la insulinoterapia se considera como un factor de riesgo para el desarrollo de procesos infecciosos, siendo la causa de daños a la piel y de lesiones tisulares, lo que facilita la entrada de patógenos oportunistas. Por lo anterior, esta investigación busca evaluar la práctica de reutilización de estos aparatos en la insulinoterapia y su relación con el surgimiento de contaminación por Staphylococcus sp. en agujas y de riesgos de infecciones. Métodos: Para la recopilación de datos, se realizaron entrevistas semiestructuradas con los participantes de la investigación acerca de los aspectos de la terapia con insulina. En el estudio se entrevistó 15 diabéticos, de los cuales 13 (un 86,7%) son del sexo femenino, y se recolectó 20 agujas para enviarlas a análisis en el Laboratorio de Microbiología de la Facultad Santa Maria. Resultados: Se constató que el 53,3% de los participantes relataron adoptar algún cuidado de higiene en el lugar de aplicación; el 80% reutilizó la aguja de 1 a > 7 días, oscilando de 2 a > 15 aplicaciones, y el 66,7% tuvo alguna reacción en el lugar de aplicación. El total de nueve agujas reutilizadas estaban contaminadas con Staphylococcus sp. después de la realización de cultivo, tinción de Gram, prueba de la catalasa y coagulasa. Conclusión: A partir de los resultados, se comprobó que existe un potencial riesgo de infección por Staphylococcus sp. asociado a la terapia con insulina.(AU)

Mycotic aneurysms of the ascending aorta in the absence of endocarditis.

Mycotic aneurysm formation is a rare and potentially fatal sequela of bacteremia. We present the cases of 2 octogenarians who had surgically confirmed mycotic aneurysms that involved the ascending aorta, with contained rupture (pseudoaneurysm). Neither patient had evidence of valvular endocarditis. Patient 1, an 82-year-old man, had streptococcal bacteremia. Imaging confirmed a mycotic aneurysm of the ascending aorta, and resection was successful. Patient 2, an 83-year-old woman, had recurrent staphylococcal bacteremia and progressive widening of the mediastinum, and imaging revealed a mycotic pseudoaneurysm. She underwent surgical repair with use of a bovine pericardial patch, but she died 2 weeks later because of patch dehiscence.We did not initially suspect mycotic aneurysm in either patient. Despite the availability of accurate, noninvasive imaging techniques, strong clinical suspicion is required for the early diagnosis of mycotic aneurysm.

Clinical characters of peritoneal dialysis-related staphylococcus peritonitis / 中华肾脏病杂志

Objective To provide evidence for clinical diagnosis and treatment of staphylococcus peritonitis through retrospective analysis of peritoneal dialysis related clinical characters. Methods Patients who experienced staphylococcus peritonitis were observed as peritonitis group.Patients did not experience peritonitis were observed as one-to-one control group in order to investigate predictors of staphylococcus peritonitis,bacteria spectrum,antimicrobial resistance and clinical outcomes. Results There were 74 patients enrolled in either group.For patients in peritonitis group,Kt/V(1.74±0.03 vs 2.61±0.48,P＜0.01),CrCL[(55.82±2.22) ml/min vs (76.13±17.42) ml/min,P＜0.01],GFR [(1.32±0.55) ml/min vs (3.08±0.75) ml/min,P＜0.01],nutrition index,hemoglobin[(91.70±25.43) g/L vs (111.50±19.59) g/L,P＜0.01],potassium[(3.43±0.70) mmol/L vs (3.78±0.73) mmol/L,P=0.002],sodium [(137.09±5.06) mmol/L vs (140.57±3.55)mmol/L,P＜0.01],chloride [(98.31±6.14) mmol/L vs (101.52±4.58) mmol/L,P=0.001] and calcium [(2.23±0.24) mmol/L vs (2.31±0.22) mmol/L,P=0.04] in serum were significantly lower than those in control group.The morbidity of staphylococcus peritonitis was 0.030 episode per year in recent five yearn.The major strains were Staphylococcus epidermidis,followed by Staphylococcus aureus.Staphylococci were all sensitive to vancomycin,teicoplanin and linezolid.The cure rate was 89.19％,and mortality was 4.05％.Relapse rate of Staphylococcus epidermidis peritonitis was higher (40％) than other strains. Conclusions Poor nutrition,insufficient dialysis,longer followup interval,anemia,electrolytic imbalance are the risk factors of Staphylococcus peritonitis.The morbidity and mortality are lower than before.Staphylococcus epidermidis peritonitis has higher relapse rate and requires more attention to prevention and treatment.