Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.079
Filtrar
2.
Cleve Clin J Med ; 87(4): 191, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32238369
4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(2): 142-147, 2020 Feb 24.
Artigo em Chinês | MEDLINE | ID: mdl-32135615

RESUMO

Objective: To explore the clinical characteristics of patients with Brucella endocarditis. Methods: The clinical data of 9 patients with Brucella endocarditis admitted to Beijing Ditan Hospital from October 2008 to August 2018 were retrospectively analyzed. Through the electronic medical record system of the hospital. Through assessing the electronic medical record system of the hospital, demographic data, main symptoms, vital signs, blood culture, Rose Bengal Plate Agglutination Test, echocardiography, electrocardiogram, chest imaging and other clinical data of included patients were inquired and recorded. Patients were followed up by telephone for medication, operation and outcome. Results: The 9 patients were all Han nationality, aged from 25 to 66 years, 7 out of 9 patients were male, and they came from Hebei, Shandong, Shanxi, Inner Mongolia and Beijing. Of the 9 patients, 5 were farmers, 2 were self-employed, 1 was a technician, and 1 was unemployed. Of the 9 cases, 8 had a history of close contact with cattle and sheep, and 5 had a history of eating beef and mutton. Rose-Bengal Plate Agglutination Test and blood culture were positive in all 9 patients. Aortic valve was involved in 7 out of 9 patients, mitral and tricuspid valve was involved in 1 patient, respectively, and aortic dissection occurred in 1 patient. Condition of 1 patient rapidly deteriorated after admission and finally died during hospitalization despite antibiotic therapy, the remaining patients received long-term antibiotic treatment. A total of 7 patients who underwent valve replacement were followed up. One patient died of cerebral hemorrhage 6 months after operation, and the remaining 6 patients recovered well after valve replacement. Heart failure occurred in all 9 patients, and pericardial effusion occurred in 8 patients. Electrocardiogram showed low voltage of the QRS complex in the limb in 3 cases and poor R-wave progression in V(1)-V(3) lead in 2 cases, and sinus tachycardia in 2 cases. One patient developed non-specific ST-T abnormalities. All patients had fever, 7 patients complained of weakness, and 6 patients complained of palpitations. Among the 9 patients, 7 cases had anemia, 7 patients had pneumonia, 6 had bilateral pleural effusion, 4 had thrombocytopenia. Creatinine was above normal in 4 patients, urine protein was positive in 3 patients, Delta Bilirubin was higher in 3 cases. Conclusions: Patients with Brucella endocarditis often suffer from heart failure and have severe complications. Adequate antibiotic therapy in combination with valve replacement is effective for the treatment of patients with Brucella endocarditis.


Assuntos
Brucella , Brucelose , Endocardite Bacteriana , Próteses Valvulares Cardíacas , Adulto , Idoso , Animais , Bovinos , China , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ovinos , Resultado do Tratamento
5.
Artigo em Russo | MEDLINE | ID: mdl-32119211

RESUMO

The demographic and clinical data of 520 patients with infectious endocarditis treated in 2005-2017 was analyzed with the purpose to assess current trends in epidemiology and approaches to surgical correction of infectious endocarditis. The analysis established increasing of absolute number of patients with infectious endocarditis, their average age and number of female patients. The incidence of early prosthetic endocarditis and its hospital mortality decreased. The study determined increasing of number of emergency interventions, more frequent valve-preserving operations, increasing of number of interventions for perivascular lesions and more frequent application of bioprostheses.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Procedimentos Cirúrgicos Cardíacos/mortalidade , Endocardite/mortalidade , Endocardite Bacteriana/mortalidade , Feminino , Mortalidade Hospitalar , Humanos
7.
S D Med ; 73(2): 68-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32135054

RESUMO

Bartonella species was first reported as a cause of endocarditis in 1993, currently it is thought to account for 3-4 percent of all diagnosed cases. Initial symptoms of Bartonella endocarditis are non-specific like weight loss, fever and fatigue. There are very few reported cases of Bartonella endocarditis causing mycotic aneurysm. We present a case of a 60-year-old male who presented with subarachnoid hemorrhage secondary to mycotic aneurysm. Due to high suspicion of endocarditis leading to mycotic aneurysm he underwent transesophageal echocardiography which showed mitral valve vegetations. His blood cultures were negative, he was eventually diagnosed with Bartonella henselae by elevated IgG titers greater than 1:800. Due to repeated mycotic aneurysms on antibiotics, he underwent surgical mitral valve replacement along with the full course of antibiotics and has been asymptomatic since.


Assuntos
Aneurisma Infectado , Bartonella henselae , Endocardite Bacteriana , Hemorragia Subaracnóidea , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico , Bartonella henselae/isolamento & purificação , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média , Hemorragia Subaracnóidea/etiologia
9.
Rev Med Liege ; 75(2): 94-99, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030933

RESUMO

Infectious endocarditis is a rare pathology whose mortality is high and whose diagnosis is still difficult by the usual clinical, biological and ultrasound tools. We report the case of a patient, drug addict, suffering from an infectious endocarditis of the aortic valve at Streptococcus agalactiae. This germ is rarely at the origin of cardiac infection but it is responsible for quickly destructive lesion by its pathophysiological mechanisms. In this case, the infection unfortunately caused the death of the patient.


Assuntos
Endocardite Bacteriana , Infecções Estreptocócicas , Streptococcus agalactiae , Valva Aórtica , Endocardite Bacteriana/diagnóstico , Humanos , Infecções Estreptocócicas/diagnóstico
10.
BMC Infect Dis ; 20(1): 160, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32085732

RESUMO

BACKGROUND: S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 µg/mL to MRSA. METHODS: Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. RESULTS: We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41-7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14-7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64-9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985-1999) (OR 8.391; 95% CI (2.82-24.9); 2000-2009 (OR 6.4; 95% CI 2.92-14.06); active neoplasm (OR 6.63; 95% CI 1.7-25.5) and sepsis (OR 2.28; 95% CI 1.053-4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). CONCLUSION: MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.


Assuntos
Antibacterianos/farmacologia , Endocardite Bacteriana/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Testes Diagnósticos de Rotina , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação
11.
JAMA ; 323(6): 527-537, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044943

RESUMO

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a ß-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. Objective: To determine whether combining an antistaphylococcal ß-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. Design, Setting, and Participants: Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. Interventions: Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal ß-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the ß-lactam was administered for 7 days. Main Outcomes and Measures: The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. Results: The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). Conclusions and Relevance: Among patients with MRSA bacteremia, addition of an antistaphylococcal ß-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02365493.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Daptomicina/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico , beta-Lactamas/uso terapêutico , Adulto , Idoso , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Cefazolina/uso terapêutico , Cloxacilina/uso terapêutico , Quimioterapia Combinada , Endocardite Bacteriana/tratamento farmacológico , Feminino , Floxacilina/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Falha de Tratamento , beta-Lactamas/efeitos adversos
12.
Int J Cardiol ; 303: 76-77, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31924398
13.
PLoS One ; 15(1): e0225077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951610

RESUMO

BACKGROUND: The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. METHODS: EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. RESULTS: The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. CONCLUSION: The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. STUDY REGISTRATION: PROSPERO registration number CRD42018115943.


Assuntos
Endocardite Bacteriana/microbiologia , Endocardite/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/patologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/patologia , Enterococcus/efeitos dos fármacos , Enterococcus/patogenicidade , Feminino , Próteses Valvulares Cardíacas/microbiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/patologia , Fatores de Risco , Caracteres Sexuais , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/patogenicidade , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
14.
Am J Orthod Dentofacial Orthop ; 157(1): 19-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31901273

RESUMO

INTRODUCTION: Owing to access to high-quality medical care, more medically compromised patients are seeking orthodontic therapy, including those at risk of developing infective endocarditis (IE). The current guidelines for orthodontic therapy and IE are few. The objective of this review is to provide an evidence-based update on the relationship between orthodontic procedures and IE in children. METHODS: A comprehensive review of the English language literature available through PubMed, Ovid Medline, and Google Scholar without any limits of years of publication was conducted to analyze the evidence regarding IE and orthodontics. LITERATURE REVIEW: A necessary prerequisite for IE is bacteremia. Although the only orthodontic procedure included in the current American Heart Association guidelines is the placement of bands, placement of separators has also been found to lead to significant bacteremia. Procedures with possible clinical significance include removal of expanders, placement of separators, and placement of bands. Because of the unavailability of high-quality evidence, elective invasive procedures prone to causing bacteremia should be avoided. CONCLUSIONS: Evidence regarding orthodontic treatment and IE is limited because of ethical considerations of conducting trials in patients who are at risk for IE. Clinical interpretation based on a comprehensive review of the available literature is therefore essential. CLINICAL IMPLICATIONS: Before initiating orthodontic therapy in cardiac patients, the patient's IE risk is best determined by referring to the current American Heart Association guidelines and through consultation with the patient's cardiologist. Procedures that can lead to tissue injury or bacteremia should be avoided. Oral hygiene must be reinforced because inflammation influences bacteremia.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Antibioticoprofilaxia , Criança , Assistência Odontológica , Humanos , Estados Unidos
15.
Kyobu Geka ; 73(1): 4-8, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956243

RESUMO

According to the current guideline, early surgery is recommended in patients with infective endocarditis (IE). On the other hand, mitral valve plasty (MVP) became the preferred surgical option in patients with IE, because of its benefits in the preservation of left ventricular function and prevention of recurrence of infection. Feasibility of MVP is an important issue in surgical strategy, however, it might be associated with the timing of the operation:feasibility of MVP might be higher in healed IE than active IE, although there had been no clear evidence in previous studies. In order to develop scoring system to predict feasibility of MVP in patients with active IE, we have introduced "severity score".Severity score defined as the sum of valvular score which evaluates the extensiveness of the valvular destruction, and technical score which evaluates the complexity and durability of the repair. Probability of feasible MVP was high in severity score≤7 points and low in severity score≥9 points. MVP is basically selected in patients with severity score of 8 points, taking the benefit of patients and risks of longterm durability into consideration. We believe that severity score is valuable and reproducible scoring system in surgical decision making.


Assuntos
Endocardite Bacteriana , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Endocardite Bacteriana/cirurgia , Humanos , Valva Mitral
16.
BMC Infect Dis ; 20(1): 71, 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969117

RESUMO

BACKGROUND: Whipple's disease (WD) is a rare multisystem infectious disorder that is caused by the actinomycete Tropheryma whipplei. It presents with joint pain followed by abdominal pain, diarrhea, malabsorption and finally failure to thrive. Diagnosis requires tissue sampling and histology with periodic acid-Schiff [PAS] staining. Thrombocytopenia associated with endocarditis associated with WD has been reported twice. CASE PRESENTATION: A 56 year old Caucasian male presented with years of steroid treated joint pain and recent onset diarrhea, weight loss and abdominal pain. Ultimately he was found to have a platelet count of 4000 with concomitant endocarditis and embolic stroke. Small bowel biopsy confirmed the diagnosis of WD approximately 1 year after his first visit. His platelets improved with antibiotic treatment but he eventually expired 16 months after his initial consult and 5 months after his definitive diagnosis. CONCLUSION: WD can remain undiagnosed and untreated until late in the course of the illness. A high index of suspicion is recognized as necessary for early diagnosis to begin treatment. Critical thrombocytopenia associated with endocarditis is a rare and potentially poor prognostic sign in late stage Whipple's disease.


Assuntos
Endocardite Bacteriana/etiologia , Trombocitopenia/etiologia , Doença de Whipple/complicações , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Trombocitopenia/tratamento farmacológico , Tropheryma/patogenicidade , Doença de Whipple/diagnóstico
17.
BMC Infect Dis ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914949

RESUMO

BACKGROUND: Despite recent improvement in management, infective endocarditis (IE) continues to be associated with considerable risk of morbidity and mortality. Early identification of predictors of inpatient mortality is key in improving patient outcomes in IE. The aim of our study was to evaluate the role of serum troponin levels measurements as a marker of increased mortality. METHODS: A case-control study included adult patients with IE admitted to a tertiary care hospital in east Tennessee between December 2012 and July 2017. Cases were defined as patients with definitive IE who died in-hospital; controls were patients who did not die in hospital. First patient admission was included only. Data collected included the patients' demographic and baseline clinical information, microbiological data, injection drug use status, elevated serum troponins levels. RESULTS: Two hundred eighty three patients with definitive IE were included; median (IQR) age was 41 (30-57) years, and 153 (54%) patients were men. One-hundred sixty-four (58%) were injection drug users. The most frequent IE type was: 167 (59%) right-sided, 86 (30%) left-sided, 24 (9%) both left and right-sided, and 10 (4%) device related. The most commonly isolated organism was Staphylococcus aureus (n = 141), and 64% were methicillin-resistant. Two-hundred twelve (75%) patients had a troponin level obtained, and 57 (27%) had an elevated troponin value. Thirty-six (13%) patients died in-hospital; in-hospital mortality was associated elevated troponin values (adjusted odds ratio [adjOR], 7.3; 95%CI, 3.3-15.9), and methicillin-resistant S. aureus IE (adjOR 2.6; 95%CI, 1.2-5.8). Forty-four (16%) patients received IE valve surgery, and none of these patients died in the hospital. CONCLUSION: Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels.


Assuntos
Endocardite/diagnóstico , Endocardite/mortalidade , Mortalidade Hospitalar , Troponina/sangue , Adulto , Idoso , Estudos de Casos e Controles , Usuários de Drogas/estatística & dados numéricos , Endocardite/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/microbiologia , Abuso de Substâncias por Via Intravenosa/mortalidade , Tennessee/epidemiologia , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA