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1.
BMC Infect Dis ; 19(1): 987, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752727

RESUMO

BACKGROUND: Infective endocarditis (IE) is a serious mainly bacterial infection associated with high mortality. Epidemiology of fatal IE is however largely unknown. We studied occurrence and trends of fatal IE in a population-based setting. METHODS: All adults (≥18 years of age) who deceased due to IE in Finland during 2004-2016 were studied. Data was collected from the nationwide, obligatory Cause of Death Registry. Background population consisted of 28,657,870 person-years and 651,556 deaths. RESULTS: Infective endocarditis contributed to death in 754 cases and was the underlying cause of death in 352 cases. The standardized incidence rate of deaths associated with IE was 1.42 (95% confidence interval (CI): 1.32-1.52) per 100,000 person-years. Incidence rate increased progressively with aging from 50 years of age. Men had a two-fold risk of acquiring fatal infective endocarditis compared to women (risk ratio (RR) 1.95; 95% CI: 1.71-2.22; P < 0.0001). On average, IE contributed to 1.16 (95% CI: 1.08-1.24) out of 1000 deaths in general adult population. The proportionate amount of deaths with IE was highest in population aged < 40 years followed by gradual decrease with aging. Incidence rate and proportion of deaths caused by IE remained stable during the study period. CONCLUSIONS: Our study describes for the first time the population-based epidemiology of fatal IE in adults. Men had a two-fold risk of acquiring fatal IE compared to women. Although occurrence of fatal IE increased with aging, the proportion of deaths to which IE contributed was highest in young adult population.


Assuntos
Endocardite/epidemiologia , Adolescente , Adulto , Idoso , Endocardite/mortalidade , Endocardite Bacteriana/microbiologia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
2.
BMC Med ; 17(1): 169, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31481119

RESUMO

BACKGROUND: Diagnostic codes from electronic health records are widely used to assess patterns of disease. Infective endocarditis is an uncommon but serious infection, with objective diagnostic criteria. Electronic health records have been used to explore the impact of changing guidance on antibiotic prophylaxis for dental procedures on incidence, but limited data on the accuracy of the diagnostic codes exists. Endocarditis was used as a clinically relevant case study to investigate the relationship between clinical cases and diagnostic codes, to understand discrepancies and to improve design of future studies. METHODS: Electronic health record data from two UK tertiary care centres were linked with data from a prospectively collected clinical endocarditis service database (Leeds Teaching Hospital) or retrospective clinical audit and microbiology laboratory blood culture results (Oxford University Hospitals Trust). The relationship between diagnostic codes for endocarditis and confirmed clinical cases according to the objective Duke criteria was assessed, and impact on estimations of disease incidence and trends. RESULTS: In Leeds 2006-2016, 738/1681(44%) admissions containing any endocarditis code represented a definite/possible case, whilst 263/1001(24%) definite/possible endocarditis cases had no endocarditis code assigned. In Oxford 2010-2016, 307/552(56%) reviewed endocarditis-coded admissions represented a clinical case. Diagnostic codes used by most endocarditis studies had good positive predictive value (PPV) but low sensitivity (e.g. I33-primary 82% and 43% respectively); one (I38-secondary) had PPV under 6%. Estimating endocarditis incidence using raw admission data overestimated incidence trends twofold. Removing records with non-specific codes, very short stays and readmissions improved predictive ability. Estimating incidence of streptococcal endocarditis using secondary codes also overestimated increases in incidence over time. Reasons for discrepancies included changes in coding behaviour over time, and coding guidance allowing assignment of a code mentioning 'endocarditis' where endocarditis was never mentioned in the clinical notes. CONCLUSIONS: Commonly used diagnostic codes in studies of endocarditis had good predictive ability. Other apparently plausible codes were poorly predictive. Use of diagnostic codes without examining sensitivity and predictive ability can give inaccurate estimations of incidence and trends. Similar considerations may apply to other diseases. Health record studies require validation of diagnostic codes and careful data curation to minimise risk of serious errors.


Assuntos
Codificação Clínica/normas , Registros Eletrônicos de Saúde/normas , Endocardite/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Classificação Internacional de Doenças , Estudos Retrospectivos
3.
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
4.
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
6.
Eur J Clin Microbiol Infect Dis ; 38(9): 1753-1763, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187307

RESUMO

Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).


Assuntos
Endocardite/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/microbiologia , Bactérias/isolamento & purificação , Endocardite/microbiologia , Endocardite/mortalidade , Endocardite Bacteriana , Feminino , Mortalidade Hospitalar , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas , Estreptococos Viridans , Adulto Jovem
7.
Lakartidningen ; 1162019 Jun 14.
Artigo em Sueco | MEDLINE | ID: mdl-31211403

RESUMO

International guidelines recommend that the treatment of patients with infective endocarditis (IE) should be directed by a multidisciplinary endocarditis team. The aim of this study was to describe the first-year experience of multidisciplinary rounds by the endocarditis team in Scania, Sweden. This was a retrospective study on all possible and definitive IE episodes that were assessed by the endocarditis team from January 1st to December 31st, 2017. Descriptive statistics were used. A total of 145 multidisciplinary rounds were held and addressed 100 episodes in 97 patients. The median age was 71 years and 66% were males. The most common causative pathogens were alpha-hemolytic streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and enterococci. The endocarditis team recommended surgery in 40 % of episodes. The transfer of patients between different hospitals was facilitated by the team.  The IE team evaluated a large proportion of patients with IE in the region and provided a rapid expert opinion on the optimal management of complicated cases of IE.


Assuntos
Endocardite , Equipe de Assistência ao Paciente , Idoso , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/microbiologia , Endocardite/terapia , Enterococcus faecalis/isolamento & purificação , Feminino , Humanos , Masculino , Estudos Retrospectivos , Staphylococcus/isolamento & purificação , Streptococcus/isolamento & purificação , Suécia/epidemiologia
8.
Presse Med ; 48(5): 513-521, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31056234

RESUMO

The annual incidence of infective endocarditis is estimated around 30 cases per million inhabitants in population-based studies performed in western countries. The incidence of infective endocarditis is markedly increased in patients with prosthetic heart valves and, particularly, in patients with prior infective endocarditis. The epidemiology of infective endocarditis has changed ; it occurs now in older patients and Staphylococcus has become the most frequent responsible microorganism. The pathophysiology of infective endocarditis results of complex interactions between circulating microorganisms, diseased valvular endothelium, and host defences. The main lesions of IE are vegetations which cause emboli and destruction of valvular and/or perivalvular tissues leasing to acute valvular regurgitations.


Assuntos
Endocardite , Endocardite/epidemiologia , Endocardite/patologia , Endocardite/fisiopatologia , Humanos
9.
Kardiol Pol ; 77(5): 561-567, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31066721

RESUMO

BACKGROUND: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland. AIMS: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017. METHODS: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE. RESULTS: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter­defibrillator, in 51 (26%); cardiac resynchronization therapy­defibrillator, in 48 (25%); and cardiac resynchronization therapy­pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients). CONCLUSIONS: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endocardite/etiologia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Serviço Hospitalar de Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite/diagnóstico por imagem , Endocardite/epidemiologia , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/estatística & dados numéricos , Polônia/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia
10.
BMC Infect Dis ; 19(1): 438, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109283

RESUMO

BACKGROUND: Gram-positive organisms are a leading cause of infection in cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive cardiovascular infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. METHODS: ICU patients who received either DAP or VAN, prior to or after cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. RESULTS: Seventy two patients, treated for infective endocarditis, cardiovascular foreign body infection, or surgical site infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39-15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). CONCLUSIONS: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.


Assuntos
Lesão Renal Aguda/etiologia , Daptomicina/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Doenças Cardiovasculares/cirurgia , Estado Terminal , Daptomicina/uso terapêutico , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/etiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Vancomicina/uso terapêutico
11.
EuroIntervention ; 15(6): e500-e507, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31113766

RESUMO

AIMS: The aim of this study was to compare the risk of prosthetic valve endocarditis (PVE) in patients with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). METHODS AND RESULTS: The FinnValve registry included data from 6,463 consecutive patients who underwent TAVR (n=2,130) or SAVR (n=4,333) with a bioprosthesis from 2008 to 2017. PVE was defined according to the modified Duke criteria. In this study, the incidence of PVE was 3.4/1,000 person-years after TAVR, and 2.9/1,000 person-years after SAVR. In competing risk analysis there was no significant difference in the risk of PVE between patients with TAVR and SAVR over an eight-year observational period. Male gender (HR 1.73, 95% CI: 1.04-2.89) and deep sternal wound infection or vascular access-site infection (HR 5.45, 95% CI: 2.24-13.2) were positively associated with PVE, but not type of procedure (HR 1.09, 95% CI: 0.59-2.01) in multivariate analysis. The mortality rate was 37.7% at one month and increased to 52.5% at one year. Surgical treatment was independently associated with decreased in-hospital mortality (HR 0.34, 95% CI: 0.21-0.61). CONCLUSIONS: PVE is rare, and its risk is similar after TAVR and SAVR. ClinicalTrials.gov Identifier: NCT03385915. https://clinicaltrials.gov/ct2/show/NCT03385915.


Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica/cirurgia , Bioprótese , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/fisiopatologia , Endocardite/epidemiologia , Humanos , Masculino , Sistema de Registros , Resultado do Tratamento
12.
Crit Care ; 23(1): 143, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31027489

RESUMO

BACKGROUND: Few studies focus only on severe forms of infective endocarditis, for which organ failure requires admission to an intensive care unit (ICU). This study aimed to describe demographical, comorbidities, organ failure, and pathogen-related characteristics in a population of critically ill patients admitted to ICU for infective endocarditis and to identify risk factors of in-ICU mortality. METHODS: Retrospective observational multicenter (N = 34) study of the CUB-Rea register, based on ICD-10 coding rules, between 1997 and 2014 in France including ICU patients managed for infective endocarditis. In-ICU mortality associated factors were assessed by multivariate logistic regression including an interrupted time analysis of three periods (1997-2003, 2004-2009, and 2010-2014). RESULTS: Four thousand four hundred five patients admitted in ICU for infective endocarditis were included. We observed an increase in endocarditis prevalence, as well as an increase in organ failure severity over the three periods. In addition, valve surgery was more frequently performed (27%, 31%, and 42%, P < 0.0001) while in-ICU mortality significantly decreased (28%, 29%, and 23%, P < 0.001). Since 2010, a significant increase in the trends' slope of incidence for Streptococcus sp. and Staphylococcus sp. was observed with no change concerning intracellular bacteria, Enterococcus sp. or Candida sp. slope trends. In multivariate analysis, age, SAPS2, organ failure, stroke, and Staphylococcus sp. were associated with ICU mortality. Conversely, surgery, intracardiac devices, male gender, and Streptococcus sp.-related infective endocarditis were associated with a better outcome. CONCLUSIONS: Our study reveals a shifting landscape of infective endocarditis epidemiology in French ICUs, characterized by reduced in-ICU mortality despite higher severity, more surgery, and substantial changes in microbial epidemiology.


Assuntos
Endocardite/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
13.
Int J Antimicrob Agents ; 53(6): 850-854, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30851401

RESUMO

BACKGROUND: A variety of microorganisms can cause infective endocarditis (IE), with Staphylococci and Streptococci accounting for the majority of cases. Streptococci are a common cause of community-acquired IE but few studies have focused on this subgroup of endocarditis. METHODS: A retrospective multicentre study was conducted between 2012 and 2017 in 12 hospital centres in France. Data were extracted from the local diagnosis-related group database and matched with microbiological results. After identification, the records were retrospectively analysed. RESULTS: A total of 414 patients with streptococcal endocarditis were included. The patients were predominantly male (72.8%) and the median age was 73.2 years (interquartile range [IQR] 61.3-80.9). The majority of patients (70.6%) had native valve endocarditis. Embolic complications were seen in 38.8% of patients. Viridans group Streptococci (VGS) and bovis-equinus group Streptococci (BGS) accounted for 52.4% and 34.5% of isolated strains, respectively. Minimum inhibitory concentrations (MICs) of amoxicillin were <0.125, 0.125-2 and >2 mg/L for 59.6%, 27% and 1% of isolates, respectively. In-hospital mortality for patients with Streptococci-related IE was 17.8%. In multivariate analysis, the only factor associated with in-hospital mortality was MIC for amoxicillin between 0.25 and 2 mg/L (P = 0.04; OR = 2.23 [95% confidence interval (CI) 1.03-4.88]) whereas performance of cardiac surgery for IE was a protective factor (P = 0.001, OR = 0.23 [95% CI 0.1-0.56]). CONCLUSIONS: IE remains a serious and deadly disease despite recent advances in diagnosis and treatment. Adaptation of antibiotic doses to MICs for amoxicillin and surgery may improve patient outcome.


Assuntos
Amoxicilina/farmacologia , Antibacterianos/farmacologia , Endocardite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Endocardite/epidemiologia , Endocardite/mortalidade , Feminino , França/epidemiologia , Hospitais , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/mortalidade , Streptococcus/classificação , Streptococcus/isolamento & purificação , Análise de Sobrevida , Adulto Jovem
14.
Gen Hosp Psychiatry ; 57: 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908961

RESUMO

BACKGROUND: People who inject drugs (PWID) represent a high-risk subgroup of endocarditis patients. This is highlighted by poorer post-operative outcomes in injection drug use-related infective endocarditis (IDU-IE), which is largely attributable to the increased vulnerability of prosthetic valves to re-infection. Consequently, many centres do not perform valve replacement on these patients. A parallel, but often underrecognized, component of care is the role of multidisciplinary management for individuals with IDU-IE, including perioperative addictions and psychiatric care. Consequently, surgical management options in IDU-IE remain a controversial topic. OBJECTIVES: To determine the characteristics of optimal surgical and psychiatric care for individuals with IDU-IE. METHODS: We conducted a narrative synthesis of the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative text, organizing the findings into several key themes: clinical characteristics and factors associated with mortality in IDU-IE, alternative surgical management options, perioperative risk stratification techniques, principles of psychiatric and addictions management in IDU-IE, ethical considerations and controversies, and future research directions. RESULTS/CONCLUSIONS: Managing IDU-IE involves the treatment of two comorbidities: the intra-cardiac infection and the underlying substance use disorder. Cardiac surgery represents a high-intensity intervention with appreciable risk, and the benefit it is not always clear. As patients often present acutely, it is not feasible to use drug abstinence as a prerequisite to surgery. Involvement of inpatient psychiatry and addictions teams, however, appears to be an evidence-based approach that can bridge IDU-IE patients with opioid agonist therapy in hospital and adequate outpatient treatment options for their underlying addiction upon their discharge from hospital. It is likely that a majority of these patients are not receiving optimal psychiatric management despite increasing recognition of efficacy. Further interdisciplinary studies are needed to elucidate optimal surgical and multidisciplinary protocols. BACKGROUND: Infective endocarditis (IE) is an infection of the innermost lining of the heart often affecting the heart valves. Over the last few decades, the epidemiology of IE has shifted in the developed world and while it continues to be a significant cause of morbidity and mortality, there has been a significant increased incidence among persons who inject drugs (PWID). To date, well-conducted epidemiologic studies of IE among PWID have been sparse, which has limited our ability to fully characterize this disease phenomenon. To address this knowledge deficit, we conducted a narrative synthesis of the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative text, and organized our findings into six key themes: clinical characteristics and factors associated with mortality in IDU-IE, alternative surgical management options, perioperative risk stratification techniques, principles of psychiatric and addictions management in IDU-IE, ethical considerations and controversies, and future research directions.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comorbidade , Endocardite/cirurgia , Serviços de Saúde Mental , Abuso de Substâncias por Via Intravenosa/terapia , Endocardite/epidemiologia , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia
15.
Pediatr Cardiol ; 40(4): 848-856, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30887063

RESUMO

There are limited data regarding the implantation of prosthetic valved conduits for right outflow tract reconstruction in pediatric patients in China. A retrospective review of 128 patients undergoing conduits implantation with a median follow-up of 33.3 months (range, 3.3 months to 10.1 years) was performed between 2009 and 2018. Multivariate Cox regression model was used to analyze the risk factors for mortality, reintervention and endocarditis. Freedom from reintervention and endocarditis were plotted using the Kaplan-Meier curve. Hospital mortality was 7.8%, and the late mortality was 3.1%. Patient survival at 1, 5 and 10 years was 92.2%, 87.1% and 84.3%, respectively. Freedom from reintervention at 1 and 5 years was 94.1% and 60.9%. Small size conduit (p = 0.019) and previous palliation (p < 0.001) were predictive of reintervention. Ten conduits developed endocarditis at a median of 4.8 years after implantation. Freedom from endocarditis at 1, 5 and 10 years was 99.1%, 93.0% and 58.0%, respectively. Diffuse stenosis of the conduit (p = 0.003) was an independent risk factor for late endocarditis. Both bovine jugular venous conduits and bovine pericardial prosthetic conduits are associated with acceptable outcomes. Reintervention remains high in patients who have smaller size conduit and undergo previous palliation. It is plausible that the suboptimal flow may be one of major mechanisms involved in the development of late endocarditis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Animais , Bioprótese/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Bovinos , Criança , Pré-Escolar , China , Endocardite/epidemiologia , Endocardite/etiologia , Seguimentos , Humanos , Lactente , Recém-Nascido , Falha de Prótese/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/mortalidade
16.
Glob Heart ; 14(1): 41-46.e2, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30905692

RESUMO

BACKGROUND: Infective endocarditis (IE) may cause debilitating physical and mental changes that can interfere with activities of daily living. Admission to a nursing home and need for domiciliary care following hospitalization for IE represent such relevant outcomes, yet no such data have been reported. METHODS: Using Danish nationwide registries, we identified all patients discharged alive after a first-time IE hospitalization in the period 1996 to 2014. These were matched by age, sex, calendar year, and relevant comorbidities with the background population in a 1:1 ratio. The 1-year rate of nursing home admission and initiation of domiciliary care, respectively, were assessed by multivariable Cox regression analyses. RESULTS: In total, 4,493 IE patients were matched with 4,493 control subjects from the background population (median age: 66.8 years; interquartile range: 54.1, 76.7; 67.8% men). The 1-year incidence of nursing home admission was significantly higher among IE patients compared with the matched population (3.4% vs. 1.0%; hazard ratio: 7.95; 95% confidence interval: 4.00-15.77). Furthermore, IE patients had an increased use of domiciliary care compared with the matched population (6.6% vs. 2.1%; hazard ratio: 4.39; 95% confidence interval: 2.74-7.05). Factors associated with an increased risk of nursing home admission and domiciliary care among IE patients included older age, living alone, longer length of hospital stay, cardiovascular comorbidities, and stroke during admission. CONCLUSIONS: Patients who survived IE had an 8× higher incidence of nursing home admission and a 4× higher incidence of initiation of domiciliary care than their counterparts from the matched population.


Assuntos
Atividades Cotidianas , Endocardite/terapia , Serviços de Assistência Domiciliar , Casas de Saúde/estatística & dados numéricos , Sistema de Registros , Idoso , Dinamarca/epidemiologia , Endocardite/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Fatores de Risco
17.
Am J Trop Med Hyg ; 100(5): 1125-1129, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30793686

RESUMO

Clinical syndromes associated with Bartonella quintana infection can be insidious and difficult to diagnose for multiple reasons. Clinically, B. quintana can manifest as asymptomatic bacteremia or with subtle subacute constitutional symptoms. Second, it is a fastidious organism that is difficult to identify using traditional culture methods. Last, the body lice vector of B. quintana transmission is likely not uncommon in most patients affected, who are homeless and of low socioeconomic status. Therefore, barriers in seeking medical care and financial constraints for medications are important considerations. The mainstay of literature surrounding B. quintana endocarditis is from Europe and the developing nations. Herein, we describe a case of native valve endocarditis secondary to B. quintana in a homeless male with preexisting valvular disease and undertake a comprehensive literature review of documented B. quintana endocarditis in North America.


Assuntos
Endocardite/microbiologia , Pessoas em Situação de Rua , Pediculus/microbiologia , Febre das Trincheiras/diagnóstico , Alelos , Animais , Anticorpos Antibacterianos/sangue , Bartonella quintana , Endocardite/epidemiologia , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia
18.
Minerva Cardioangiol ; 67(3): 200-206, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30724268

RESUMO

Infective endocarditis (IE) is a potentially life-threatening disease. Regardless the improvements in IE management, it remains associated with high mortality and severe complications. Staphylococci and streptococci account for 80% of all IE cases. Prevention of IE by appropriate administration of antibiotics before procedures with potential bacteremia in selected patients is recommended according to recent and current guidelines. However, recent studies, have questioned the efficacy of antimicrobial prophylaxis in special situations and in some patient-groups. As a consequence, the guideline of the French working group on IE in 2002, the American Heart Association (AHA) guideline in 2007, the National Institute for Health and Clinical Excellence (NICE) guideline for Great Britain in 2008, and the European Society of Cardiology (ESC) guideline in 2009 restricted the recommendation for antibiotic prophylaxis to high-risk patients only, and only for certain invasive procedures. IE incidence increased in the USA, England and Germany in the last two decades. Study results for the USA, England, France, and Germany were not consistent regarding the influence of the revised guidelines for IE prophylaxis on the IE incidence. Although some study results pointed to an increase of the IE cases after the changes in the guideline recommendations, a final appraisal regarding the impact of the revised guideline recommendations on IE incidence could not be drawn at this time point due to the heterogeneous study results.


Assuntos
Antibioticoprofilaxia/normas , Endocardite/epidemiologia , Endocardite/prevenção & controle , Fidelidade a Diretrizes , Europa (Continente)/epidemiologia , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estados Unidos/epidemiologia
19.
Dtsch Med Wochenschr ; 144(2): 114-127, 2019 01.
Artigo em Alemão | MEDLINE | ID: mdl-30674060

RESUMO

Infective endocarditis is a severe, mostly bacterial disease characterized by high mortality and morbidity. Both diagnosis and therapy are difficult, and mortality rates have not improved over decades. We review diagnostic and management problems, the disease's modern face in the era of widespread cardiac implants and valve interventions, and current diagnostic and therapeutic recommendations.


Assuntos
Endocardite , Idoso , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/fisiopatologia , Endocardite/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
CMAJ ; 191(4): E93-E99, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30692105

RESUMO

BACKGROUND: Infective endocarditis is an increasingly common complication among people who inject drugs. We conducted this study to determine whether the removal of traditional controlled-release oxycodone from the Canadian market would be associated with an increase in the use of hydromorphone and an increased risk of infective endocarditis. METHODS: We conducted a retrospective, population-based time series analysis using the linked health administrative databases of Ontario, Canada. We measured the quarterly risk of admissions for infective endocarditis related to injection drug use and changes in opioid prescription rates from 2006 to 2015. We set the intervention point at the fourth quarter of 2011, when traditional controlled-release oxycodone was removed from the Canadian market. RESULTS: We observed an increase in the risk of admissions for infective endocarditis related to injection drug use during the study period. Before the intervention point, we observed a mean of 13.4 admissions per quarter, and after the intervention, we observed a mean of 35.1 admissions per quarter. However, no significant change in this risk occurred at the intervention point. Rather, the risk of infectious endocarditis appeared to have increased earlier and in parallel with the rise in hydromorphone prescriptions. Hydromorphone represented 16% of all opioid prescriptions at the start of the observation period and 53% by the end. INTERPRETATION: The risk of infective endocarditis related to injection drug use is increasing and is temporally associated with increasing prescriptions for hydromorphone. This relation warrants further exploration.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Endocardite/epidemiologia , Hidromorfona/uso terapêutico , Análise de Séries Temporais Interrompida , Oxicodona/uso terapêutico , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Adulto , Endocardite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Vigilância da População , Estudos Retrospectivos , Adulto Jovem
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