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2.
BMC Infect Dis ; 20(1): 619, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831055

RESUMO

BACKGROUND: Neisseria macacae was discovered in the oral cavity of monkeys in 1983. In humans, it has been isolated from the upper respiratory tract of neutropenic patients. However, only two cases of N. macacae bacteremia have been reported in a 65-year-old man with infective endocarditis and a 5-month-old child with fever and petechiae. There are no reports of infections in cancer patients. Here, we present two cases of N. macacae bacteremia in cancer patients. CASE PRESENTATION: In the first case, a 42-year-old woman who underwent ovarian cancer surgery presented with duodenal invasion associated with multiple lymph node metastasis. N. macacae was isolated from her blood culture and identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). In the second case, a 69-year-old woman with a long-standing history of esophagogastric junction cancer presented with fever. She had stage IVB cancer with lung, bone, and multiple lymph node metastasis. The last chemotherapy was administered 5 weeks before N. macacae was detected using MALDI-TOF MS and nitrate test negative. In both cases, transthoracic echography showed no vegetation. Antibiotics were administered for 14 and 13 days in the first and second cases, respectively. In both cases, fever alleviated on day 4 of antibiotic administration. Both patients were discharged after their conditions improved. CONCLUSIONS: This, to our knowledge, is the first report of N. macacae bacteremia in cancer patients. Both patients, mucosal damage was observed in the upper gastrointestinal tract. Therefore, exclusion diagnosis suggested that bacteremia invasion was caused by mucosal rupture in both cases. Both cases responded well to treatment with ß-lactam antibiotics and improved after 2 weeks. Modifying the treatment based on the source of the infection may shorten the treatment period. Therefore, further research on N. macacae bacteremia is necessary. Immunocompromised patients such as those with cancer are susceptible to mucosal damage by unusual bacterial species such as N. macacae despite not having contact with monkeys.


Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Neisseria/patogenicidade , Adulto , Idoso , Antibacterianos/uso terapêutico , Hemocultura/métodos , Endocardite Bacteriana/microbiologia , Neoplasias Esofágicas/microbiologia , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Neisseria/genética , Neisseria/isolamento & purificação , Neoplasias Ovarianas/microbiologia , RNA Ribossômico 16S , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos
4.
J Card Surg ; 35(10): 2829-2831, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678968

RESUMO

BACKGROUND: Surgery for failed homograft aortic root replacement with extensive calcification in the setting of endocarditis alone is very challenging. CASE SUMMARY: We report the case of redo aortic valve replacement and mitral valve replacement, in a 39 years old presenting with a rare Streptococcus constellatus endocarditis of a previously implanted homograft root and native mitral valve, where conventional valve replacement proved nonfeasible. S. constellatus had caused severe tissue destruction and the extensive calcification in the homograft prevented conventional valve replacement with sutures. In this case, a sutureless valve provided a useful alternative surgical strategy. DISCUSSION: We consider heavily calcified failed homografts to be a good indication for sutureless (rapid deployment) valves.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Endocardite Bacteriana/complicações , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Desenho de Prótese , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estreptocócicas/cirurgia , Streptococcus constellatus , Procedimentos Cirúrgicos sem Sutura/métodos , Adulto , Aloenxertos , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
5.
J Card Surg ; 35(7): 1717-1720, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32598498

RESUMO

We present a 57-year-old man with recent Streptococcus viridans endocarditis on mitral and aortic valves who had a mycotic aneurysm of the left anterior descending (LAD) coronary artery and associated superior mesenteric and cerebral artery aneurysms. The patient had preoperative renal failure and the infection was controlled with ceftriaxone. Mitral and aortic valve replacement were performed using tissue valves and the LAD aortic aneurysm was ligated and the patient had saphenous venous graft to the LAD. The postoperative course was complicated by pleural effusion and the patient had antibiotic therapy for 6 weeks postoperatively.


Assuntos
Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Veia Safena/transplante , Infecções Estreptocócicas , Resultado do Tratamento , Estreptococos Viridans
6.
BMC Infect Dis ; 20(1): 428, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552765

RESUMO

BACKGROUND: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years. METHODS: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. RESULTS: A total of 407 patients with infective endocarditis were included, the average age was 48 ± 16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common (25.8%), followed by rheumatic heart disease (17.0%) which showed a decreased trend during this period (P < 0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P < 0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length>30 mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. CONCLUSIONS: There were no significant changes in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length>30 mm had an worse in-hospital outcome.


Assuntos
Endocardite Bacteriana/epidemiologia , Centros de Atenção Terciária , Adulto , Idoso , China , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise Renal , Estudos Retrospectivos , Cardiopatia Reumática/complicações , Fatores de Risco , Streptococcus/isolamento & purificação
8.
J Cardiothorac Surg ; 15(1): 135, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522279

RESUMO

BACKGROUND: The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with in-hospital mortality. METHODS: A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included. RESULTS: A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy. CONCLUSIONS: Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.


Assuntos
Endocardite Bacteriana/microbiologia , Mortalidade Hospitalar , Infecções Estreptocócicas/complicações , Estreptococos Viridans , Adulto , Fatores Etários , Idoso , China/epidemiologia , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Centros de Atenção Terciária
10.
Cochrane Database Syst Rev ; 5: CD009880, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32407558

RESUMO

BACKGROUND: Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but due to the differences in presentation, populations affected, and the wide variety of micro-organisms that can be responsible, their use is not standardised. This is an update of a review previously published in 2016. OBJECTIVES: To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference Proceedings Citation Index - Science on 6 January 2020. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) assessing the effects of antibiotic regimens for treating definitive infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates, and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, 'Risk of bias' assessment, and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of the evidence. We described the included studies narratively. MAIN RESULTS: Six small RCTs involving 1143 allocated/632 analysed participants met the inclusion criteria of this first update. The included trials had a high risk of bias. Three trials were sponsored by drug companies. Due to heterogeneity in outcome definitions and different antibiotics used data could not be pooled. The included trials compared miscellaneous antibiotic schedules having uncertain effects for all of the prespecified outcomes in this review. Evidence was either low or very low quality due to high risk of bias and very low number of events and small sample size. The results for all-cause mortality were as follows: one trial compared quinolone (levofloxacin) plus standard treatment (antistaphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin), and rifampicin) versus standard treatment alone and reported 8/31 (26%) with levofloxacin plus standard treatment versus 9/39 (23%) with standard treatment alone; risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49 to 2.56. One trial compared fosfomycin plus imipenem 3/4 (75%) versus vancomycin 0/4 (0%) (RR 7.00, 95% CI 0.47 to 103.27), and one trial compared partial oral treatment 7/201 (3.5%) versus conventional intravenous treatment 13/199 (6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The results for rates of cure with or without surgery were as follows: one trial compared daptomycin versus low-dose gentamicin plus an antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or vancomycin and reported 9/28 (32.1%) with daptomycin versus 9/25 (36%) with low-dose gentamicin plus antistaphylococcal penicillin or vancomycin; RR 0.89, 95% CI 0.42 to 1.89. One trial compared glycopeptide (vancomycin or teicoplanin) plus gentamicin with cloxacillin plus gentamicin (13/23 (56%) versus 11/11 (100%); RR 0.59, 95% CI 0.40 to 0.85). One trial compared ceftriaxone plus gentamicin versus ceftriaxone alone (15/34 (44%) versus 21/33 (64%); RR 0.69, 95% CI 0.44 to 1.10), and one trial compared fosfomycin plus imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR 0.50, 95% CI 0.07 to 3.55). The included trials reported adverse events, the need for cardiac surgical interventions, and rates of uncontrolled infection, congestive heart failure, relapse of endocarditis, and septic emboli, and found no conclusive differences between groups (very low-quality evidence). No trials assessed quality of life. AUTHORS' CONCLUSIONS: This first update confirms the findings of the original version of the review. Limited and low to very low-quality evidence suggests that the comparative effects of different antibiotic regimens in terms of cure rates or other relevant clinical outcomes are uncertain. The conclusions of this updated Cochrane Review were based on few RCTs with a high risk of bias. Accordingly, current evidence does not support or reject any regimen of antibiotic therapy for the treatment of infective endocarditis.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Antibacterianos/efeitos adversos , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Fosfomicina/efeitos adversos , Fosfomicina/uso terapêutico , Humanos , Imipenem/efeitos adversos , Imipenem/uso terapêutico , Levofloxacino/efeitos adversos , Levofloxacino/uso terapêutico , Masculino , Penicilinas/efeitos adversos , Penicilinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Vancomicina/efeitos adversos , Vancomicina/uso terapêutico
11.
Int J Infect Dis ; 97: 160-161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32470600

RESUMO

Endocarditis due to Lactobacillus species is extremely rare. We report an uncommon case of Lactobacillus plantarum bioprosthetic aortic valve endocarditis, presenting with severe aortic steno-regurgitation, which responded to conventional medical and surgical treatment. This case provides a better understanding of the disease process of L. plantarum and highlights the role of transesophageal echocardiography in following the entire course of endocarditis.


Assuntos
Valva Aórtica , Endocardite Bacteriana/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Lactobacillus plantarum , Infecções Relacionadas à Prótese/etiologia , Progressão da Doença , Ecocardiografia Transesofagiana , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Próteses Valvulares Cardíacas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia
12.
Int J Infect Dis ; 95: 224-230, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32289560

RESUMO

AIMS: Non-device related right-sided infective endocarditis (ND-RSIE) is not well characterized. We aimed to characterize patients with infective endocarditis (IE) with emphasis on the epidemiology, clinical characteristics and complications of ND-RSIE. METHODS: In this population-based cohort study, we identified patients with IE using ICD-10 codes from the Danish National Hospital Register in the Region of Southern Denmark between January 2007 and May 2017. Hospital records were reviewed, and characteristics and outcomes recorded. RESULTS: We included 1243 confirmed IE episodes of which 82% were left-sided IE, 11% were cardiac device right sided infective endocarditis (RSIE) and 7% were ND-RSIE. Patients with ND-RSIE were considerably younger, had less comorbidity and had a lower 30-day mortality (6%) compared with patients with device RSIE (24%) and left-sided IE (26%) (p<0.01). ND-RSIE was associated with underlying heart disease, involvement of the tricuspid valve (57%), Staphylococcus species (53%) and complications (61%). Forty percent of ND-RSIE occurred among people who inject drugs (PWID) for whom significant differences were observed compared with non-PWID with regards to tricuspid valve involvement (96% vs. 32%), causative microorganisms (Staphylococcus aureus 79% vs. 27%), complications (86% vs. 45%), recurrence (29% vs. 11%) and 30-day mortality (0% vs. 7%). CONCLUSION: ND-RSIE is relatively rare and differs with regards to epidemiology, clinical characteristics and complications compared with left-sided IE and cardiac device RSIE, but has a favourable prognosis. Forty percent of ND-RSIE occurs among PWID, which is associated with frequent complications but a very low mortality.


Assuntos
Endocardite Bacteriana/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Endocardite/mortalidade , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus
13.
PLoS One ; 15(4): e0231827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32325482

RESUMO

The diagnosis of infective endocarditis (IE) remains a challenge. One of the rare bacterial species recently associated with biofilms and negative cultures in infective endocarditis is Aerococcus urinae. Whether the low number of reported cases might be due to lack of awareness and misidentification, mainly as streptococci, is currently being discussed. To verify the relevance and biofilm potential of Aerococcus in endocarditis, we used fluorescence in situ hybridization to visualize the microorganisms within the heart valve tissue. We designed and optimized a specific FISH probe (AURI) for in situ visualization and identification of A. urinae in sections of heart valves from two IE patients whose 16S rRNA gene sequencing had deteced A. urinae. Both patients had a history of urinary tract infections. FISH visualized impressive in vivo grown biofilms in IE, thus confirming the potential of A. urinae as a biofilm pathogen. In both cases, FISH/PCR was the only method to unequivocally identify A. urinae as the only causative pathogen for IE. The specific FISH assay for A. urinae is now available for further application in research and diagnostics. A. urinae should be considered in endocarditis patients with a history of urinary tract infections. These findings support the biofilm potential of A. urinae as a virulence factor and are meant to raise the awareness of this pathogen.


Assuntos
Aerococcus/isolamento & purificação , Biofilmes , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Valvas Cardíacas/microbiologia , Aerococcus/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hibridização in Situ Fluorescente/métodos , Masculino , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
14.
Medicina (B Aires) ; 80(2): 177-180, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32282327

RESUMO

Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with crossreactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.


Assuntos
Bartonella henselae/isolamento & purificação , Endocardite Bacteriana/microbiologia , Glomerulonefrite/microbiologia , Retinite/microbiologia , Adulto , Endocardite Bacteriana/complicações , Glomerulonefrite/complicações , Humanos , Masculino , Retinite/complicações
15.
JAAPA ; 33(5): 1-4, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32345952

RESUMO

A patient who presented after falling out of bed had signs of right-sided stroke, which, after imaging, was suspicious for embolism with cardiac origin. Further investigation revealed a large aortic valve vegetation with mild aortic insufficiency, and the patient eventually developed heart failure requiring surgical intervention. Infective endocarditis is slowly becoming more prevalent, and clinicians should have a high index of suspicion when patients present with common complications of this disease, such as valvular dysfunction, heart failure, or stroke. Early diagnosis has been shown to reduce time to appropriate antibiotic treatment and definitive care, which can lead to better outcomes.


Assuntos
Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Infecções Estreptocócicas , Streptococcus agalactiae , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Doença das Coronárias/etiologia , Ecocardiografia , Embolia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/terapia , Evolução Fatal , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X
16.
Int J Infect Dis ; 94: 34-40, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32169691

RESUMO

BACKGROUND: The prognostic impact of residual vegetation (RV) after medical treatment for endocarditis remains unknown. METHODS: 134 consecutive patients hospitalized for infective endocarditis, not surgically treated, with the presence of vegetation at diagnosis, were included retrospectively. The follow-up started at the end of antibiotic treatment when healing was complete. The presence or absence of RV was assessed at this time. The primary endpoint was a composite of the occurrence of embolic events, recurrence of endocarditis, or death from any cause. RESULTS: Eighty-five patients were men (63%), mean age was 69 ± 15 years, and median follow-up was 16.3 (IQR: 5-30) months. Sixty-six patients (49%) had RV, 15 (11%) had RV > 10 mm and nine (7%) had RV with an increase in size relative to that of the diagnosis. The primary endpoint occurred in 23 patients (35%) in the group with RV, and in 16 patients (24%) without RV, which was not statistically relevant (HR 1.70; 95% confidence interval (CI) 0.89-3.22; p = 0.10). Based on univariate Cox regression analysis, the occurrence of the primary endpoint was associated with RV that increased (HR 3.90 95% CI 1.61-9.43; p < 0.01), RV size (HR 1.05; 95% CI 1.01-1.09; p < 0.01) or RV > 10 mm (HR 3.35; 95% CI 1.51-7.39; p < 0.01). Only RV > 10 mm remained significant in multivariate Cox regression: HR3.29; 95% CI 1.20-8.96; p = 0.02. CONCLUSIONS: RV is frequent but has no clear prognostic impact in itself; however, its size, particularly in comparison with the start-of-treatment data, merits particular attention as being potentially associated with increased risk.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Embolia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
17.
Georgian Med News ; (298): 75-79, 2020 Jan.
Artigo em Russo | MEDLINE | ID: mdl-32141854

RESUMO

The article presents the results of a multicenter study of the etiology, antibiotic sensitivity and pharmacoepidemiology of infective endocarditis in the Russian Federation. The purpose of this study is to analyze the current practice of management of patients with infective endocarditis in conditions of low frequency of etiologically significant pathogens in the Russian Federation. The study included patients of both sexes of all age groups with definite and probable infective endocarditis. 406 cases of infectious endocarditis (240 in retrospect and 166 in the prospective part) were analyzed. Etiologically significant pathogen was isolated in 144 cases (35.5%). The structure of pathogens was dominated by gram (+) cocci (90.3%), most often - Staphylococcus aureus (46.5% of all isolated pathogens). Aminoglycosides (22.8%), parenteral cephalosporins of the III generation (22.1%) and glycopeptides (14.5%) were most frequently used in the course of starting antimicrobial therapy. When changing the mode of antimicrobial therapy, glycopeptides (18.6%), aminoglycosides (15.3%), fluoroquinolones (11.2%) and parenteral cephalosporins of generation III (9.5%) were most often prescribed.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Cefalosporinas , Resistência a Medicamentos , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Feminino , Cocos Gram-Positivos/patogenicidade , Humanos , Masculino , Testes de Sensibilidade Microbiana , Farmacoepidemiologia , Estudos Prospectivos , Federação Russa/epidemiologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade
18.
J Card Surg ; 35(4): 923-925, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32058604

RESUMO

We report a case of culture-negative aortic valve endocarditis secondary to Tropheryma whipplei infection. Our patient underwent aortic valve replacement after 4 weeks of antibiotic therapy with persistently negative blood culture results. Despite a technically uneventful operation, the patient showed continued sepsis and was unresponsive to a broad-spectrum of antibiotic therapy with subsequent multiorgan failure. He died on the 5th postoperative day, and diagnosis was established at postmortem examination. In this case report, we discuss the diagnosis and treatment of a rare type of endocarditis caused by T. whipplei.


Assuntos
Valva Aórtica/cirurgia , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Tropheryma , Doença de Whipple , Antibacterianos/administração & dosagem , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Evolução Fatal , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Doenças Raras
19.
Int J Cardiovasc Imaging ; 36(5): 939-946, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32060776

RESUMO

The aim of the study was to evaluate the ability to detect extra-cardiac foci by means of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with definite endocarditis (IE) according to the modified Duke criteria and investigate the clinical impact of the findings. From January 2011 to December 2015 we included 178 patients (mean age 66 ± 14 years, 25% female) with IE in this multicentre study. FDG-PET/CT was part of the work-up for extra-cardiac foci in the including hospitals and was performed at a median of 9 days (IQR 10) after IE was diagnosed. In 114 patients FDG-PET/CT identified 166 lesions: 52 (31%) infectious lesions, 21 (13%) cases of cancer, 7 (4%) cases of embolism, 60 (36%) reactive findings, and 26 (16%) other types of lesions. A total of 74 new extra-cardiac findings, not previously discovered by other modalities, were identified in 62 patients and resulted in additional investigations in 29 patients and a change in treatment in 18 patients (10%). The most frequent diagnoses discovered by FDG-PET/CT were colon polyps, cancer, and spondylodiscitis. There was a higher rate of findings leading to a change in treatment in patients above 67 years of age infected with other bacterial aetiologies than streptococci. FDG-PET/CT was useful to detect extra-cardiac foci. FDG-PET/CT findings may lead to unnecessary investigations. One out of 10 the patients with definite endocarditis had underwent a change in treatment regimen based on the FDG-PET/CT findings.


Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Imagem Corporal Total , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/microbiologia , Pólipos do Colo/terapia , Dinamarca , Discite/diagnóstico por imagem , Discite/microbiologia , Discite/terapia , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias/microbiologia , Neoplasias/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco
20.
J Am Coll Cardiol ; 75(5): 482-494, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32029130

RESUMO

BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.


Assuntos
Endocardite Bacteriana/epidemiologia , Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Idoso , Estudos de Coortes , Endocardite Bacteriana/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
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