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1.
Acute Med ; 19(3): 149-153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33020759

RESUMO

Infective endocarditis caused by Proteus mirabilis is strikingly rare. Here, we describe the case of an 86-year old man with five recurrent septic episodes over a period of three months associated with Proteus mirabilis bacteraemia secondary to underlying Proteus endocarditis. The final diagnosis was made based on clinical findings, blood culture results and transoesophageal echocardiogram. The patient was treated medically with 6 weeks of ceftriaxone and long-term oral ciprofloxacin. On completion of intravenous therapy the patient remained well. We performed a literature review and found this to be only the fourth confirmed case of Proteus mirabilis endocarditis successfully treated with antibiotic therapy alone. This case highlights an important but rare cause of endocarditis, reinforcing the need to consider this diagnosis in recurrent Gram-negative bacteraemia even if by an atypical organism.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Endocardite/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Proteus mirabilis
2.
Pediatr Clin North Am ; 67(5): 875-888, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888687

RESUMO

This article presents updates and an overview of pediatric infective endocarditis. It includes a discussion of presentation of illness, diagnosis of this disorder, differential diagnosis, treatment recommendation, and associated morbidity and mortality.


Assuntos
Antibacterianos/uso terapêutico , Gerenciamento Clínico , Ecocardiografia/métodos , Endocardite/diagnóstico , Criança , Endocardite/tratamento farmacológico , Humanos , Prognóstico
3.
PLoS One ; 15(8): e0237011, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745091

RESUMO

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.


Assuntos
Ampicilina/uso terapêutico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Endocardite/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/patogenicidade , Feminino , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
6.
Medicine (Baltimore) ; 99(19): e20120, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384490

RESUMO

INTRODUCTION: Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, AR could increase risk for post-interventional IE. However, no cases have been documented thus far. We firstly described a case of very late-onset IE associated with non-significant AR after transcatheter closure of PmVSD with modified symmetrical double-disk device, underscoring the need for reassessing long-term prognostic implications of non-significant post-procedure AR after PmVSD occlusion and the most appropriate treatment strategy. PATIENT CONCERNS: A 15-year old male received transcatheter closure of a 6.4 mm sized PmVSD with a 9-mm modified symmetric double-disk occluder (SHAMA) 11 years ago in our hospital. A new-onset mild eccentric AR was noted on transthoracic echocardiography (TTE) examination 1-year post procedure, without progression and heart enlargement. At this time, the child was admitted with a complaint of persistent fever for 16 days and nonresponse to 2-weeks course of amoxicillin and cefoxitin. DIAGNOSIS: The diagnosis of post-procedure IE was established since a vegetation (14 × 4 mm) was found to be attached to the tricuspid valve, an anechoic area (8 × 7 mm) on left upper side of ventricular septum and below right aortic sinus, and severe eccentric AR as well as the isolation of Staphylococcus aureus from all three-blood cultures. INTERVENTIONS: Treatment with vancomycin was initially adopted. However, surgical interventions including removal of vegetation, abscess and occluder, closure of VSD with a pericardial patch, tricuspid valvuloplasty, and aortic valvuloplasty were ultimately performed because of recurrent fever and a new-onset complete atrioventricular block 12-days later. The child continued with antibiotic therapy up to six weeks post operation. OUTCOMES: The child's temperature gradually returned to normal with alleviation of AR (mild) and heart block (first degree). The following course was uneventful. CONCLUSION: Late-onset IE could occur following device closure of PmVSD and be associated with post-procedure AR. For non-significant AR after device closure of PmVSD, early surgical intervention could be an alternative for reducing the aggravation of aortic valve damage and the risk of associated IE.


Assuntos
Insuficiência da Valva Aórtica/complicações , Endocardite/complicações , Infecções Estafilocócicas/complicações , Adolescente , Cateterismo Cardíaco/métodos , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Dispositivo para Oclusão Septal , Valva Tricúspide/patologia
8.
Curr Pharm Biotechnol ; 21(12): 1140-1153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324510

RESUMO

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.


Assuntos
Antibacterianos/uso terapêutico , Coagulase/metabolismo , Endocardite/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/patogenicidade , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Próteses Valvulares Cardíacas/microbiologia , Valvas Cardíacas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus/enzimologia
10.
Rev. habanera cienc. méd ; 19(1): 125-142, ene.-feb. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1099151

RESUMO

Introducción: La endocarditis infecciosa es una condición severa que puede presentarse luego de procedimientos odontológicos invasivos, principalmente en pacientes portadores de válvulas cardiacas protésicas y enfermedad cardiaca reumática y congénita. Es importante identificar el nivel de conocimientos de los estudiantes de Odontología para establecer reformas en el plan de estudios de la carrera. Objetivo: Determinar el nivel de conocimiento sobre profilaxis antibiótica de endocarditis infecciosa previa a procedimientos odontológicos en estudiantes de último año de Odontología de Lima. Material y métodos: Estudio analítico y transversal, cuya muestra estuvo constituida por 117 estudiantes del último año de la carrera de Odontología de la Universidad Nacional Mayor de San Marcos (UNMSM), la Universidad Nacional Federico Villareal (UNFV) y la Universidad Peruana Cayetano Heredia (UPCH), de Lima, Perú, durante el año 2014. El instrumento de evaluación fue una encuesta de 20 preguntas cerradas sobre epidemiología y etiopatogenia de endocarditis infecciosa e indicación y farmacología de la profilaxis antibiótica previa a procedimientos odontológicos. Los resultados fueron catalogados en 3 niveles: bajo, regular y alto. Resultados: El 53,84 por ciento de los internos presentó un nivel de conocimiento bajo, mientras el 32,47 por ciento un nivel regular y el 13,69 por ciento un nivel alto. El nivel de respuesta promedio fue 10,1 ± 2,95 [IC95 % (9,57-10,65)]. Por universidad, los internos de la UNMSM tuvieron un nivel de conocimiento promedio de 11 ± 2,60 [IC95 por ciento (9,84-12,15)], los de UNFV tuvieron 8,8 ± 3,36 [IC95 por ciento (7,74 - 9,86)] y los de UPCH tuvieron 10,7 ± 2,41 [IC95 por ciento (10,08-11,39)]; p=0,002. Conclusiones: El nivel de conocimiento sobre profilaxis antibiótica de endocarditis infecciosa en estudiantes de último año de Odontología de Lima es predominantemente bajo(AU)


Introduction: Infective endocarditis is a severe condition that can occur after invasive dental procedures, mainly in patients with prosthetic heart valves and rheumatic and congenital heart disease. It is important to identify the level of knowledge of dental students to establish reforms in the curriculum of the career. Objective: To determine the level of knowledge about antibiotic prophylaxis of infective endocarditis prior to dental procedures in last-year dental students of Lima. Material and methods: Analytical and cross-sectional study whose sample was made up of 117 last-year dental students of the National University of San Marcos (UNMSM), the National University Federico Villareal (UNFV) and the Peruvian University Cayetano Heredia (UPCH) from Lima, Peru, during the year 2014. The evaluation instrument was a survey of 20 closed questions on epidemiology and etiopathogenesis of infective endocarditis and indication and pharmacology of antibiotic prophylaxis prior to dental procedures. The results were cataloged in 3 levels: low, regular and high. Results: The results show that 53,84 percent of the interns presented a low level of knowledge, while 32,47 percent had a regular level and 13,69 percent a high level. The average response level was 10,1 ± 2,95 [95 percent CI (9,57-10,65)]. By university, UNMSM interns had an average level of knowledge of 11 ± 2,60 [95 percent CI (9,84-12,15)], UNFV had 8,8 ± 3,36 [95 percent CI (7,74-9,86)] and those of UPCH had 10,7 ± 2,41 [95 percent CI (10,08-11,39)]; p=0.002. Conclusions: The level of knowledge about antibiotic prophylaxis of infective endocarditis in last- year dental students in Lima is predominantly low(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Estudantes de Odontologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Antibioticoprofilaxia/métodos , Educação em Odontologia/métodos , Endocardite/tratamento farmacológico , Peru/epidemiologia
11.
PLoS One ; 15(1): e0225077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951610

RESUMO

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


Assuntos
Endocardite Bacteriana/microbiologia , Endocardite/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/patologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/patologia , Enterococcus/efeitos dos fármacos , Enterococcus/patogenicidade , Feminino , Próteses Valvulares Cardíacas/microbiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/patologia , Fatores de Risco , Caracteres Sexuais , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/patogenicidade , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
12.
J Microbiol Immunol Infect ; 53(2): 336-343, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30241988

RESUMO

BACKGROUND/PURPOSES: Infective endocarditis (IE) is an important cause of morbidity and mortality in hemodialysis (HD) patients. Data on the differences in the microbiological features as well as clinical characteristics and outcomes of HD and non-HD patients with IE are limited. METHODS: Medical records of patients (aged over 20 years) with IE were retrospectively reviewed from January 2008 to June 2017 in a tertiary care center in Northern Taiwan. Those with definite or possible IE were included in the study. The clinical characteristics, microbiological results, echocardiographic findings and outcomes of patients were analyzed. RESULTS: Of the 183 patients with definite or possible IE, 47 had undergone HD and 136 had not. Advanced age (67.3 vs. 61.5 years, p = 0.027), more female gender (51.1% vs. 33.8%, p = 0.036), comorbidities (a high Charlson comorbidity index, 8.17 vs. 4.21, p < 0.001), diabetes mellitus (68.1% vs. 35.3%, p < 0.001), and hypertension (85.1% vs. 53.7%, p < 0.001) were commonly observed in HD patients than in non-HD patients. The yield rate of the blood cultures was higher in HD group than in non-HD group (89.4% vs. 72.8%, p = 0.02). The proportion of methicillin-resistant Staphylococcus aureus was significantly higher in HD group than in non-HD group (31.9% vs. 5.9%, p < 0.001). HD patients versus non-HD patients had higher cardiac complication rates (38.3% vs. 14%, p < 0.001). CONCLUSION: Advanced age, sex (female), comorbidities, diabetes mellitus, and hypertension were more common in HD patients than in non-HD patients with IE. HD patients had higher proportion of methicillin-resistant S. aureus and cardiac complication rates than non-HD patients with IE. Culture-negative IE was more common in non-HD patients.


Assuntos
Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Endocardite/epidemiologia , Endocardite/microbiologia , Diálise Renal/efeitos adversos , Idoso , Comorbidade , Complicações do Diabetes , Diabetes Mellitus , Endocardite/tratamento farmacológico , Endocardite/fisiopatologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/epidemiologia , Taiwan/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento
15.
J Med Case Rep ; 13(1): 356, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31801609

RESUMO

BACKGROUND: Proteinase 3-antineutrophil cytoplasmic antibody has been reported to be positive in 5-10% of cases of renal injury complicated by infective endocarditis; however, histological findings have rarely been reported for these cases. CASE PRESENTATION: A 71-year-old Japanese man with a history of aortic valve replacement developed rapidly progressive renal dysfunction with gross hematuria and proteinuria. Blood analysis showed a high proteinase 3-antineutrophil cytoplasmic antibody (163 IU/ml) titer. Streptococcus species was detected from two separate blood culture bottles. Transesophageal echocardiography detected mitral valve vegetation. Histological evaluation of renal biopsy specimens showed necrosis and cellular crescents in glomeruli without immune complex deposition. The patient met the modified Duke criteria for definitive infective endocarditis. On the basis of these findings, the patient was diagnosed with proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by Streptococcus infective endocarditis. His renal disease improved, and his proteinase 3-antineutrophil cytoplasmic antibody titer normalized with antibiotic monotherapy. CONCLUSION: Few case reports have described histological findings of proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis. We believe that an accumulation of histological findings and treatments is mandatory for establishment of optimal management for proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Endocardite/complicações , Glomerulonefrite/complicações , Rim/patologia , Mieloblastina/sangue , Infecções Estreptocócicas/complicações , Idoso , Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Glomerulonefrite/tratamento farmacológico , Humanos , Masculino , Infecções Estreptocócicas/tratamento farmacológico
16.
Turk Kardiyol Dern Ars ; 47(8): 687-690, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31802766

RESUMO

Antiphospholipid syndrome (APS) is a clinical disorder that creates an increased risk of arterial or venous thrombotic events or pregnancy-associated complications and includes the presence of autoantibodies against negatively charged phospholipids. This syndrome is often associated with systemic autoimmune diseases, such as systemic lupus erythematosus (SLE). Libman-Sacks endocarditis is a form of non-bacterial thrombotic endocarditis and is infrequently seen in APS. There are few data documenting the echocardiographic response of APS valve disease to medical treatment. This is an unusual case of a young female patient with SLE and APS who had chorea and non-bacterial thrombotic aortic valve endocarditis. Echocardiography revealed that the vegetation had receded after a combination of warfarin and immunosuppressive therapy.


Assuntos
Endocardite/tratamento farmacológico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Varfarina/uso terapêutico , Adulto , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Varfarina/administração & dosagem , Adulto Jovem
17.
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
19.
Cardiol Young ; 29(12): 1526-1529, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31590699

RESUMO

Diagnosing prosthetic valve infective endocarditis in children is challenging. Transthoracic and transesophageal echocardiography can yield false-negative results. Data are lacking in paediatric multimodality imaging in prosthetic valve infective endocarditis. We present two children with repaired CHD where initial echocardiogram was non-diagnostic, while CT angiogram and 18F-fluorodeoxyglucose positron emission tomography in combination with CT angiography, respectively, confirmed the diagnosis of endocarditis affecting clinical management.


Assuntos
Endocardite/diagnóstico por imagem , Endocardite/microbiologia , Gemella/isolamento & purificação , Próteses Valvulares Cardíacas/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Antibacterianos/uso terapêutico , Criança , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Imagem Multimodal , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento
20.
BMC Microbiol ; 19(1): 228, 2019 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638894

RESUMO

BACKGROUND: Infective endocarditis (IE) is associated with high rates of mortality. Prolonged treatments with high-dose intravenous antibiotics often fail to eradicate the infection, frequently leading to high-risk surgical intervention. By providing a mechanism of antibiotic tolerance, which escapes conventional antibiotic susceptibility profiling, microbial biofilm represents a key diagnostic and therapeutic challenge for clinicians. This study aims at assessing a rapid biofilm identification assay and a targeted antimicrobial susceptibility profile of biofilm-growing bacteria in patients with IE, which were unresponsive to antibiotic therapy. RESULTS: Staphylococcus aureus was the most common isolate (50%), followed by Enterococcus faecalis (25%) and Streptococcus gallolyticus (25%). All microbial isolates were found to be capable of producing large, structured biofilms in vitro. As expected, antibiotic treatment either administered on the basis of antibiogram or chosen empirically among those considered first-line antibiotics for IE, including ceftriaxone, daptomycin, tigecycline and vancomycin, was not effective at eradicating biofilm-growing bacteria. Conversely, antimicrobial susceptibility profile of biofilm-growing bacteria indicated that teicoplanin, oxacillin and fusidic acid were most effective against S. aureus biofilm, while ampicillin was the most active against S. gallolyticus and E. faecalis biofilm, respectively. CONCLUSIONS: This study indicates that biofilm-producing bacteria, from surgically treated IE, display a high tolerance to antibiotics, which is undetected by conventional antibiograms. The rapid identification and antimicrobial tolerance profiling of biofilm-growing bacteria in IE can provide key information for both antimicrobial therapy and prevention strategies.


Assuntos
Antibacterianos/farmacologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Endocardite Bacteriana/diagnóstico , Endocardite/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Filogenia , Resultado do Tratamento
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