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2.
Rev Port Cardiol ; 38(8): 573-580, 2019 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31679647

RESUMO

INTRODUCTION: The early diagnosis of infective endocarditis (IE) is a medical challenge and a multidisciplinary approach is essential to improve its frequently fatal prognosis. Our goal was to evaluate the usefulness of [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET) in the diagnosis of this disease. MATERIALS AND METHODS: We prospectively assessed 43 patients (five female and 38 male) with clinical suspicion of IE between 2014 and 2017. All patients underwent transesophageal echocardiography (TEE) and an 18F-FDG PET scan, and the results were compared. A positive PET finding was defined as increased FDG uptake on cardiac valves or intracardiac devices. RESULTS: Out of 43 patients with suspected IE, the diagnosis was confirmed in 30 cases (79.7%). 18F-FDG PET was positive in 24 patients, with 19 showing FDG uptake on cardiac valves (two native and 17 prosthetic) and five on cardiac devices, being concordant with echocardiographic findings in 11 cases. 18F-FDG PET sensitivity was 80%, specificity 92%, positive predictive value (PPV) 96% and negative predictive value (NPV) 66%. Echocardiography presented sensitivity, specificity, PPV and NPV of 36%, 84%, 84% and 36%, respectively. CONCLUSIONS: 18F-FDG PET proved to be a sensitive technique with a high diagnostic value in patients with prosthetic valves and intracardiac devices and suspected IE. Its utility decreased dramatically in patients with suspected IE on native valves, in which TEE presented higher sensitivity and thus better diagnostic value.


Assuntos
Diagnóstico Precoce , Endocardite/diagnóstico , Fluordesoxiglucose F18/farmacologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes
3.
BMC Infect Dis ; 19(1): 918, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31699053

RESUMO

BACKGROUND: In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. METHODS: We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. RESULTS: We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID. CONCLUSION: PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.


Assuntos
Endocardite/diagnóstico , Abuso de Substâncias por Via Intravenosa/complicações , Procedimentos Cirúrgicos Cardíacos , Endocardite/etiologia , Endocardite/mortalidade , Humanos , Estimativa de Kaplan-Meier , Modelos de Riscos Proporcionais , Infecções Estafilocócicas/diagnóstico , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(45): e17899, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702666

RESUMO

This survey was to investigate the short-term effect of particulate matters (PMs) exposure on clinical and microbiological variables, especially septic emboli, in infective endocarditis (IE). The study analyzed 138 IE patients in Far Eastern Memorial Hospital from 2005 to 2015 and clinical variables were retrospectively requested. The data of air quality were recorded and collected by a network of 26 monitoring stations spreading in Northern part of Taiwan. We found that IE patients with septic emboli were found to be exposed to a significantly higher level of PM2.5 (32.01 ±â€Š15.89 vs. 21.70 ±â€Š13.05 µg/m, P < .001) and PM10 (54.57 ±â€Š24.43 vs 40.98 ±â€Š24.81 µg/m, P = .002) on lag 0 day when compared to those without. Furthermore, multivariate regression analysis revealed that that ambient exposure to PM2.5 (odds ratio: 3.87, 95% confidence interval: 1.31-8.31; P = .001) and PM10 (odds ratio: 4.58, 95% confidence interval: 2.03-10.32; P < .001) significantly increased risk of septic emboli in IE patients. To our knowledge, this is the first study demonstrating that short-term exposure to PMs was associated with septic emboli in IE.


Assuntos
Endocardite/microbiologia , Exposição Ambiental/estatística & dados numéricos , Material Particulado/envenenamento , Adulto , Idoso , Poluição do Ar/efeitos adversos , Estudos de Casos e Controles , Endocardite/diagnóstico , Endocardite/etiologia , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Heart Surg Forum ; 22(5): E317-E318, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31596704

RESUMO

Cardiac myxoma typically is thought to be a slow-growing, benign primary. Atrial myxomas can lead to many complications and can also mimic mitral stenosis, infective endocarditis, and other vascular diseases associated with systemic embolization. A 75-year-old woman with a history of lung cancer (pT1cN1, adenocarcinoma), atrial fibrillation, and a cerebral infarction presented with dysarthria and visual disturbances. In our case, we had to consider some questionable issues with the left atrial mass, and whether the recurrence of cerebral events was due to the thrombotic material in the left atrium or from locally recurrent lung cancer from the stump margin of the previously resected left superior pulmonary vein. We present a case with a rapidly-growing left atrial myxoma with a growth rate of 12.60 mm/month, rather than a thrombus or local recurrence of tumor under a medication of non-VKA oral antagonists.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Mixoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Fibrilação Atrial/etiologia , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Diagnóstico Diferencial , Progressão da Doença , Endocardite/diagnóstico , Feminino , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Estenose da Valva Mitral/diagnóstico , Mixoma/patologia , Mixoma/cirurgia
7.
Medicine (Baltimore) ; 98(38): e17141, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567953

RESUMO

The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients' heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.


Assuntos
Endocardite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Ecocardiografia , Endocardite/diagnóstico , Endocardite/patologia , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Adulto Jovem
8.
Rev Bras Parasitol Vet ; 28(4): 661-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618303

RESUMO

We report the first documented case of endocarditis associated with Bartonella clarridgeiae in a dog in Latin America. Infective vegetative valvular aortic endocarditis was diagnosed in a 10-year-old male mixed breed dog. The dog presented grade V/VI systolic and diastolic murmur, hyperthermia, and progressive weight loss. Cardiomegaly and presence of diffuse alveolar pattern in the lung fields were observed in the thorax radiography evaluation. Irregular and hyperechogenic structures adhered to the aortic leaflets, causing obstruction of the left ventricular outflow tract and severe aortic insufficiency, were observed in the echocardiography evaluation. A vegetative, whitish, hardened structure measuring 1.0 cm in diameter was observed in aortic semilunar valve at necropsy. Based on a combination of pre-enrichment insect-based medium liquid culture, quantitative real-time and conventional PCR assays based on nuoG and gltA genes, respectively, followed by sequencing and phylogenetic inferences, B. clarridgeiae DNA was detected in the patient's aortic valve lesions. Clinical, echocardiographic, anatomopathologic and molecular features supported the diagnosis of severe aortic vegetative endocarditis possibly caused by B. clarridgeiae in a dog in Brazil.


Assuntos
Valva Aórtica/microbiologia , Infecções por Bartonella/veterinária , Bartonella/genética , Doenças do Cão/microbiologia , Endocardite/veterinária , Animais , Bartonella/classificação , Infecções por Bartonella/diagnóstico , Doenças do Cão/diagnóstico , Cães , Endocardite/diagnóstico , Endocardite/microbiologia , Evolução Fatal , Masculino , Índice de Gravidade de Doença
9.
Pan Afr Med J ; 33: 97, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489075

RESUMO

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.


Assuntos
Anticorpos Antinucleares/imunologia , Endocardite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Ecocardiografia Doppler/métodos , Endocardite/etiologia , Endocardite/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Superinfecção/diagnóstico
10.
Cleve Clin J Med ; 86(8): 559-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385793

RESUMO

Infective endocarditis remains a diagnostic challenge. Although echocardiography is still the mainstay imaging test, it misses up to 30% of cases. Newer imaging tests--4-dimensional computed tomography (4D CT), fluorodeoxy-glucose positron emission tomography (FDG-PET), and leukocyte scintigraphy--are increasingly used as alternative or adjunct tests for select patients. They improve the sensitivity of clinical diagnosis of infective endocarditis when appropriately used, especially in the setting of a prosthetic valve.


Assuntos
Endocardite/diagnóstico , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Coração/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Imagem por Ressonância Magnética , Neuroimagem , Tomografia por Emissão de Pósitrons
11.
Epidemiol Mikrobiol Imunol ; 68(2): 104-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398984

RESUMO

The Bartonella genus comprises more than 20 species of Gram-negative rods which are difficult to culture. These are facultative intracellular bacteria. Humans are reservoir hosts for B. quintana and B. bacilliformis or accidental hosts for other species. Bartonella is a cause of zoonosis. Bartonella infection can be completely asymptomatic or can be linked to various conditions. Our experience with Bartonella endocarditis from 2012-2017 is presented. The most effective diagnostic method for Bartonella endocarditis is PCR detection of DNA of the pathogen from excised valve tissue. The European Society of Cardiology (ESC) in the guidelines from 2015 recommends the combination doxycycline gentamycin for the treatment of Bartonella endocarditis.


Assuntos
Infecções por Bartonella , Endocardite , Animais , Bartonella , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Zoonoses/diagnóstico , Zoonoses/tratamento farmacológico
12.
Cardiol Rev ; 27(5): 236-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31393286

RESUMO

With the expansion of the indications of transcatheter aortic valve replacement (TAVR), it is being increasingly performed in older patients with aortic stenosis to improve their quality of life. However, TAVR is not without serious complications. Despite being infrequent, prosthetic valve endocarditis after TAVR is a deadly complication associated with high rates of mortality related to a delayed diagnosis from variable clinical presentations and nonconfirmatory imaging findings. Furthermore, lower intervention rates in these patients, due to their high surgical risk, increases overall mortality. Clinicians should be aware of the differences in presentation and postprocedural anatomical considerations that delay the diagnosis of infectious endocarditis post TAVR. Studies evaluating the role of the procedural setting, implant and access type, and periprocedural antibiotic prophylaxis on the development of prosthetic valve endocarditis, and consensus guidelines that address the appropriate diagnosis and management of prosthetic valve endocarditis after TAVR, are needed.


Assuntos
Endocardite/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Antineoplásicos/uso terapêutico , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/prevenção & controle , Feminino , Humanos , Masculino
13.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444523

RESUMO

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/tratamento farmacológico , Adulto , Comorbidade , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Incidência , Micoses/diagnóstico , Micoses/epidemiologia
14.
Int Heart J ; 60(4): 986-989, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308324

RESUMO

So far, there is still controversy regarding the optimal prosthetic valve for patients with active infective valve endocarditis with annular abscess. Here, we report the case of a 65-year-old woman who was diagnosed with infective endocarditis associated with extensive annular abscess. The patient underwent debridement of the abscess cavity followed by aortic valve replacement using a Solo Smart (SS) stentless bioprosthesis. Postoperative recovery was uneventful, with no signs of recurrent infection. Since the SS valve is designed for supra-annular and subcoronary implantation, it is considered to be an alternative to conventional prosthetic valves in patients with infective endocarditis with aortic annular abscess.


Assuntos
Abscesso/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Infecções Estreptocócicas/cirurgia , Abscesso/diagnóstico , Abscesso/microbiologia , Idoso , Valva Aórtica/microbiologia , Endocardite/diagnóstico , Feminino , Próteses Valvulares Cardíacas , Humanos , Desenho de Prótese , Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação
15.
Int Heart J ; 60(4): 983-985, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257331

RESUMO

Infective endocarditis (IE) is a lethal complication inpatients with congenital heart disease. We report a case of percutaneous implanted pulmonary valve IE in a 49-year-old female. She underwent a previous surgery for tetralogy of Fallot with transannular patching of the right ventricular outflow tractat the age of 18 years. Echocardiography showed chronic moderate to severe pulmonary regurgitation with right heart enlargement. She underwent transcatheter pulmonary valve implantation with a 26 mm Venus-P valve (Venus Medtech, Shanghai, China) in order to release pulmonary insufficiency. Two months after implantation, she presented with recurrent chills and febrile for one week, and percutaneous implanted pulmonary valve IE was diagnosed. According to the antibiotic susceptibility test, she was given penicillin and gentamycin. At 12 months follow-up, TTE showed vegetation completely disappeared and the valve functioned normally. The patient recovered uneventfully without any complications like recurrent IE.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
16.
Med. clín (Ed. impr.) ; 153(2): 63-66, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183365

RESUMO

Introducción: Descripción de las características de las endocarditis infecciosas izquierdas con el cambio del milenio. Método: Estudio multicéntrico prospectivo de endocarditis izquierdas recogidas en la cohorte andaluza para el estudio de las infecciones cardiovasculares entre 1984-2014. Resultados: De 1.604 endocarditis recogidas 382 pertenecen al grupo 1 (período 1983-1999) y 1.222 al grupo 2 (2000-2014). Los pacientes del grupo 2 presentan mayor edad media, comorbilidad y enfermedades concomitantes, más nosocomialidad, endocarditis asociadas a la atención sanitaria y endocarditis complicadas. Se aprecia un aumento de los Staphylococcus aureus meticilín-resistentes, Enterococcus sp., bacilos gramnegativos y Streptococcus bovis. En el tratamiento aumenta el uso de cefalosporinas y desciende el de penicilina; hay más cirugía al ingreso y menos diferida. La mortalidad se sitúa alrededor del 30% en ambos milenios. En el análisis multivariante la mortalidad se asoció con: milenio anterior (grupo 1), edad, índice de Charlson, fracaso renal y shock séptico y, etiológicamente, Staphylococcus aureus. Conclusiones: La mortalidad se mantiene estable, pese a mejoras diagnósticas y terapéuticas, debido a que los pacientes son mayores, con mayor comorbilidad, endocarditis relacionadas con la atención sanitaria/nosocomialidad y gérmenes más agresivos


Introduction: a description of infective left endocarditis at the turn of the millennium. Method: A multicentre prospective study into the left endocarditis using data collected from the Andalusian cohort for the study of cardiovascular infections during 1984-2014. Results: Of the 1,604 endocarditis cases collected, 382 belonged to G1 (group-1, period 1983-1999) and 1,222 to G2 (group-2, 2000-2014). Patients in the new millennium have a significantly higher mean age, have more comorbidity and concomitant diseases, and nosocomial and health-related endocarditis are more frequent, as well as complications. An increase in methicillin-resistant Staphylococcus aureus, Enterococcus sp., Gram-negative bacilli and Streptococcus bovis was noted. Regarding treatment, there is an increase in the use of cephalosporins and a decrease in penicillins; there is more surgery when admitted to hospital and less delay. Mortality stands at around 30% in both millennia. In the multivariate analysis, mortality was associated with: previous millennium (G1), age, Charlson index, renal failure and septic shock, and aetiologically with Staphylococcus aureus. Conclusions: Mortality remains stable, despite diagnostic and therapeutic improvements, because patients are older, have greater comorbidity, a closer relationship with the health care system (nosocomial) and microorganisms are more aggressive


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Endocardite/diagnóstico , Endocardite/terapia , Infecções Estafilocócicas/complicações , Staphylococcus aureus Resistente à Meticilina , Cefalosporinas/uso terapêutico , Estudos Prospectivos , Estudos de Coortes , Infecção Hospitalar/mortalidade , Falência Renal Crônica
18.
BMC Infect Dis ; 19(1): 504, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174479

RESUMO

BACKGROUND: Urinary tract infection (UTI) is frequently diagnosed in the Emergency Department (ED). Staphylococcus aureus (SA) is an uncommon isolate in urine cultures (0.5-6% of positive urine cultures), except in patients with risk factors for urinary tract colonization. In the absence of risk factors, community-acquired SA bacteriuria may be related to deep-seated SA infection including infective endocarditis. We hypothesized that SA bacteriuria could be a warning microbiological marker of unsuspected infective endocarditis in the ED. METHODS: This is a retrospective chart review of consecutive adult patients between December 2005 and February 2018. All patients admitted in the ED with both SA bacteriuria (104 CFU/ml SA isolated from a single urine sample) and SA bacteremia, without risk factors for UT colonization (i.e., < 1 month UT surgery, UT catheterization) were analyzed. Diagnosis of infective endocarditis was based on the Duke criteria. RESULTS: During the study period, 27 patients (18 men; median age: 61 [IQR: 52-73] years) were diagnosed with community-acquired SA bacteriuria and had subsequently documented bacteremia and SA infective endocarditis. Only 5 patients (18%) had symptoms related to UT infection. Median delay between ED admission and SA bacteriuria identification was significantly shorter than that between ED admission and the diagnosis of infective endocarditis (1.4 ± 0.8 vs. 4.3 ± 4.2 days: p = 0.01). Mitral and aortic valves were most frequently involved by infective endocarditis (93%). Mortality on day 60 reached 56%. CONCLUSIONS: This study suggests that community-acquired SA bacteriuria should warn the emergency physician about a potentially associated left-sided infective endocarditis in ED patients without risk factors for UT colonization.


Assuntos
Bacteriúria/diagnóstico , Endocardite/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Bacteriúria/complicações , Bacteriúria/microbiologia , Ecocardiografia , Serviço Hospitalar de Emergência , Endocardite/etiologia , Endocardite/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Estudos Retrospectivos , Fatores de Risco
19.
Nat Rev Cardiol ; 16(10): 623-635, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31175343

RESUMO

The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.


Assuntos
Antibioticoprofilaxia , Endocardite/diagnóstico , Endocardite/terapia , Valvas Cardíacas/cirurgia , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia , Endocardite/complicações , Endocardite/microbiologia , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios , Fatores de Risco
20.
BMC Infect Dis ; 19(1): 511, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182045

RESUMO

BACKGROUND: Infective endocarditis caused by Actinomyces spp. is extremely rare. However, cases by new species of Actinomyces have been increasingly reported due to advances in laboratory techniques, and many of these species do not cause classic presentations of actinomycosis. Actinomyces neuii is reported to have a tendency to cause endovascular infection. The course of infective endocarditis caused by Actinomyces spp. is usually indolent. CASE PRESENTATION: A 61-year-old man with history of infective endocarditis, end stage renal disease, and monoclonal gammopathy was admitted for an abrupt fever, confusion, dysarthria, and facial droop after hemodialysis. Echocardiogram showed vegetations on both the aortic and mitral valves. Two sets of blood culture grew A. neuii. Brain MRI showed multiple bilateral cerebral infarcts consistent with septic emboli. The patient recovered after valvular surgery and prolonged intravenous and oral antibiotic therapy. CONCLUSIONS: This case illustrates an unusually acute presentation of A. neuii infective endocarditis. As with other Gram-positive bacilli, Actinomyces spp. isolates are often regarded as a result of contamination. One should keep it in mind as a cause of infective endocarditis in vulnerable patient populations.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Endocardite/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/microbiologia , Doença Aguda , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade
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