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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tricuspid valve excision for tricuspid endocarditis in addicts is recommended to avoid early reinfection, continued sepsis, and late reinfection because of the resumption of intravenous drug abuse. Valvectomy is allegedly well tolerated hemodynamically by some, but it leads to heart failure in at least a third of patients. In our experience in 10 addicts with staphylococcal endocarditis who had failed to respond to antibiotic therapy, tricuspid valve replacement allowed all 10 to leave the hospital free of infection and free of heart failure. Resumption of drug addiction in three led to septic death, but not necessarily to tricuspid reinfection. Two returned to jobs requiring a high level of physical labor and tolerated this without difficulty. We find no need to follow the practice of tricuspid valve excision for tricuspid endocarditis in addicts. Those who refrain from drug abuse are well served by valve replacement. Those who do not are doomed with or without a tricuspid valve.
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PMID:Immediate tricuspid valve replacement for endocarditis. Indications and results. 394 82

A patient with a history of alcoholism and drug abuse who developed Pseudomonas cepacia endocarditis is described. The organism was found to be resistant in vitro to all common antimicrobial agents except chloramphenicol and trimethoprim-sulfamethoxazole. Treatment failed with penicillin and streptomycin and later with chloramphenicol. Orally administered trimethoprim-sulfamethoxazole, however, resulted in sterilization of the patient's blood and aortic valve which was resected 27 days after the start of therapy. A 6-week course of therapy was completed and, to date (6 months after treatment), there has been no recurrence.
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PMID:Successful treatment of Pseudomonas cepacia endocarditis with trimethoprim-sulfamethoxazole. 479 89

The introduction of antibiotic therapy and changing epidemiologic patterns have altered the nature of glomerulonephritis as it occurs during the course of bacterial endocarditis. Observations made predominantly in the pre-antibiotic era suggested that infections with less virulent organisms, by virtue of their indolent subacute course, favored an antibody response predisposing to immune complex glomerulonephritis. Although antibiotic prophylaxis and therapy have reduced the incidence of both Streptococcus viridans bacterial endocarditis and concomitant glomerulonephritis, Staphylococcus aureus has become a major cause of acute bacterial endocarditis with a high incidence of glomerulonephritis. Parenteral drug abuse itself, which has emerged as a major factor predisposing to endocarditis, may also favor the development of glomerulonephritis. The course of glomerulonephritis has been altered in association with these changes in etiology and epidemiology. This review summarizes the clinical and morphologic features of glomerulonephritis as it currently occurs during the course of bacterial endocarditis.
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PMID:Glomerulonephritis in bacterial endocarditis. 638 Feb 88

After an episode of intermittent fever which lasted 45 days, endocarditis of the tricuspid valve was diagnosed using M-mode echocardiography in a 17-year-old female patient who had no history of drug abuse. After unsuccessful therapy with ampicillin, tetracycline and aminoglycosides, clinical improvement was achieved by treatment with temocillin.
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PMID:Haemophilus parainfluenzae endocarditis on tricuspid valve. 647 67

In a retrospective study covering the years 1977 to 1981, the results of antibiotic treatment in 123 patients with staphylococcal septicaemia with or without endocarditis have been analysed. 80 patients (mean age 60 years) were non-drug addicts (Group I) and 43 (mean age 28 years) were drug addicts (Group II). Underlying conditions other than drug abuse were noted in 74 patients in Group I and in only 7 in Group II.S. aureus was isolated from 117 patients and S. epidermidis in 6, all of them in Group I. 91 strains were penicillinase producers, but all susceptible to isoxazolyl-penicillins. In Group I verified or highly suspected endocarditis was registered in 12 patients (15%), always left-sided, as against in 31 (72%) in Group II, of whom 25 had tricuspid valve engagement. In the multivariate pattern of antibiotic treatment 3 groups may be discerned; 1) Cloxacillin, alone (35 patients) or in a combination (57), 2) Penicillin G, alone (6) or in a combination (12), and 3) Lincomycin or clindamycin, a cephalosporin or co-trimoxazole, alone (4) or in combination (9). Additive agents were mostly an aminoglycoside or fusidic acid. Out of the 45 patients in the whole material who received single therapy 9 patients (20%) died, and out of the 78 patients who received combined therapy 13 patients (16.6%) died. In the cloxacillin group 11.8% died, compared to 35% who initially received other antibiotics. In 70 patients the initial therapy had to be changed, in 39 due to adverse drug reactions and in 31 due to therapeutic failures or for unexplained reasons. In these cases linco- or clindamycin, more rarely rifampicin or vancomycin, were used. In Group I, 20 patients (25%) died, 8 of them with endocarditis. Sequels, relapses or reinfections were noted in 21 (25%), and 39 (50%) had an uneventful course. In Group II, 2 patients (5%) died, both with endocarditis. Sequels, relapses or reinfections occurred in 11 (25%), and 30 (70%) had an uneventful course. From this unstructured material no definite conclusions can be drawn. However, the lower mortality rate in the cloxacillin group suggests this regimen to be superior. The addition of other antibiotics did not appear to influence the clinical outcome. There was a more favourable outcome in addicts than in non-addicts, despite the same general principles of antibiotic treatment. Thus, for the outcome the characteristics of the patient group seemed to have more influence than the choice of antibiotic treatment.
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PMID:Antibiotic treatment of staphylococcal septicaemia and endocarditis in a Swedish hospital. 658 54

Due to the lack of specificity of the clinical picture in the right-sided infective endocarditis, the correct diagnosis is rarely made. We reviewed 30 cases with right-sided or right and left infective endocarditis, treated in the INC from 1946 to 1982. The average age was 20 years. Rheumatic fever (53%), congenital heart disease (40%) and cardiac prostheses (7%) were the more common underlying diseases. The diagnosis was made on an average 7.3 months after the first symptom. Heart failure (93%), fever (76%), weight loss (73%), haemoptysis (66%) and general malaise (53%) were the predominant symptoms. There was no diagnostic suspicion in 9 patients (30%) and in 7 from 16 with negative blood culture, the infection was exclusively right-sided. Peripheral and pulmonary embolism was the most frequent complication. (66%) There were 29 deaths (96.6%). In all of them the diagnosis was confirmed in the postmortem examination. Heart failure and septic shock were the main causes of death. Almost all patients were infected with gram-negative germs and staphylococcus Aureus. This diagnosis should be suspected in a patient with known heart disease, who develops unexplained heart failure, moreover if pulmonary emboli are a feature. The diversity of the isolated germs is different from other publication that have shown staphylococcus as the most prevalent microorganism. This difference can be explained by the lack of drug abuse in our cases. The mortality rate is higher than in the left sided endocarditis.
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PMID:[Right infectious endocarditis. Study of 30 cases]. 674 36

Caring for the parenteral drug abuser with infective endocarditis is a challenge. In many ways, the nursing care needed for these patients differs from that needed by other patients with infective endocarditis. This article has identified some of the important considerations: maximizing the effectiveness of the treatment regimen, fostering patient adaptation to hospitalization, and planning for discharge to minimize the risk of recurrence. By understanding the nature of drug abuse and of infective endocarditis, and by understanding how they interact to create a particular set of problems in the parenteral drug abuser with infective endocarditis, the nurse can provide optimal nursing management for these patients.
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PMID:Nursing management of the parenteral drug abuser with infective endocarditis. 690 64

The absence of controlled evidence and the high prevalence of mitral-valve prolapse have created substantial uncertainty about whether this condition is an important risk factor for bacterial endocarditis. We evaluated this risk in a case-control study of hospital inpatients who had undergone echocardiography and who lacked any known cardiovascular risk factors for endocarditis, apart from mitral-valve prolapse and isolated mitral-regurgitant murmurs. Thirteen (25 per cent) of 51 patients with endocarditis had mitral-valve prolapse, as compared with 10 (seven per cent) of the 153 matched controls without endocarditis. For the 51 matched case-control sets, the odds ratio (8.2; 95 per cent confidence interval, 2.4 to 28.4) indicated a substantially higher risk of endocarditis for people with mitral-valve prolapse than for those without it. This association remained statistically significant when parenteral drug abuse and routine antibiotic prophylaxis preceding dental work and other forms of instrumentation were taken into account. Furthermore, the risk may be higher than is indicated by this study, since 46 per cent of the controls underwent echocardiography for clinically suspected mitral-valve prolapse, suggesting an overrepresentation of mitral prolapse in the control group. The results support the contention that mitral-valve prolapse is a significant risk factor for bacterial endocarditis.
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PMID:A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. 711 Feb 42

Ten cases of Pseudomonas maltophilia bacteremia were identified over a five-year period at the University of Pittsburgh Medical Center. Our experience and a review of the literature show that P. maltophilia can cause a wide spectrum of disease. We present cases of pneumonia and infections of the biliary tract and urinary tract in which the organism was isolated simultaneously from blood. P. maltophilia endocarditis occurs in the context of iv drug abuse or as a postoperative complication of prosthetic valve surgery. Pseudobacteremia from contaminated equipment, disinfectants, and vascular catheters is the newest presentation for P. maltophilia infection. Hospitalization and prior antibiotic therapy are risk factors for serious P. maltophilia infection. Mortality due to P. maltophilia infection is low, despite the notable in vitro resistance of the organism to antibiotics. Trimethoprim-sulfamethoxazole, minocycline, doxycycline, and moxalactam are highly active in vitro against P. maltophilia. The triple combination of trimethoprim-sulfamethoxazole plus carbenicillin plus rifampin has been found to be synergistic in vitro and can be considered for serious infections.
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PMID:Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: case reports and a review of the literature. 715 59

We reported a case of tricuspid valve endocarditis in a drug addict. A 25-year-old woman with a history of drug abuse was admitted to our hospital for high fever. Blood cultures revealed staphylococcus aureus, and echocardiography showed vegetation attached to the tricuspid valve and moderate tricuspid regurgitation. Excision of the posterior leaflet including vegetation, and direct suture of the residual posterior leaflet along with annuloplasty was successfully done. Postoperative course was uneventful and endocarditis was eradicated.
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PMID:[A case of tricuspid valve endocarditis in the drug addict]. 761 34


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