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

Catheter-related infections (CRI) are frequent and manifest in a wide range of clinical situations. A rational approach is necessary for the adequate management of these infections. Whenever a CRI is suspected, two main questions have to be addressed: whether to remove the catheter and whether to initiate empiric antimicrobial treatment. As the clinical diagnosis of CRI has a low specificity, the catheter should be removed only in circumstances such as severe or ongoing sepsis, persistent bacteremia, pulmonary or peripheral embolization, endocarditis, signs of tunnel infection, when the catheters or when the CRI is caused by fungi, Staphylococcus aureus or Pseudomonas aeruginosa are easy to replace among others. Exchanging the catheter through a guidewire is a frequent practice but is not recommended by some authors. Empiric antimicrobial treatment should be administered in any of the following situations: when the catheter is not removed, in the case of central venous or surgically implanted catheters and prosthetic implants, in the presence of severe sepsis, neutropenia or other immunodepressed status, suppurative phlebitis, embolization and acute endocarditis. Empriic antimicrobial treatment should include a glycopeptide (vancomycin or teicoplanin) as staphylococci are the most frequent cause of CRI. Adding an antipseudomonal agent, such as amikacin, aztreonam, ceftazidime, cefepime, piperacillin/tazobactam, or a carbapenem (depending on the local antimicrobial susceptibility data or antibiotic policy) is necessary in cases of neutropenia, burn patients, severe sepsis, or suspicion of contaminated infusate. Empiric treatment against Candida is not initially necessary in most cases. Empiric treatment should be replaced by specific therapy whenever possible.
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PMID:Selection of empiric therapy in patients with catheter-related infections. 1204 4

The literature investigating the association between vascular disorders and malignant neoplasms does not comprehensively review the full spectrum of vascular disorders associated with cancer, or provide proof that cancer is an etiologic factor in the development of these disorders. This paper investigates the causal role of cancer in the pathogenesis of vascular disorders, based on the Bradford-Hill criteria of causation. The Medline database was searched for articles on vascular disorders preceding the diagnosis of cancer (VDPCD). Included in the analysis were vascular disorders caused either by direct tumoral involvement of vessels or by paraneoplastic mechanisms. Vascular disorders caused by adverse reactions to anticancer therapy were excluded from analysis. Seven categories of VDPCDs were recognized: venous thromboembolism, arterial thrombosis and embolism, nonbacterial thrombotic endocarditis, migratory superficial thrombophlebitis, vasculitis, thrombotic microangiopathy, and leukothrombosis. To establish causality of the association between VDPCDs and malignancy, the degree of fulfillment of the Bradford-Hill criteria was assessed. A strong association was found in the literature between venous thromboembolism and cancer (OR 2.3-14.9 and SIR 1.3-4.4). Consistency and temporality of the association were confirmed in all VDPCD variants. Seven Bradford-Hill criteria were fulfilled for cancer associated with venous thromboembolism, six criteria for superficial phlebitis and cancer, and five criteria for each of the other VDPCDs. In conclusion, these data support the causal role of cancer in the pathogenesis of all seven categories of VDPCDs. Recognition of such a causal link between cancer and various vascular disorders may promote an earlier cancer diagnosis.
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PMID:Vascular disorders preceding diagnosis of cancer: distinguishing the causal relationship based on Bradford-Hill guidelines. 1259 91

We report a case of endocarditis due to Arthrobacter woluwensis and review the published reports of Arthrobacter species isolated from human clinical samples. A 39-year-old injection drug user presented with fever and a new heart murmur. A. woluwensis was isolated from blood cultures, and a diagnosis of subacute infective endocarditis of the native mitral valve was made. The patient was successfully treated with a 6-week course of intravenous teicoplanin. From our review of the literature, we were able to retrieve data on 41 cases of Arthrobacter species isolated from human clinical samples. However, Arthrobacter species was documented as a cause of human disease on only 5 other occasions (2 cases of bacteremia, 1 case of postoperative endophthalmitis, 1 case of a Whipple disease-like syndrome, and 1 case of phlebitis). Because of the difficulty of identifying Arthrobacter strains by conventional biochemical assays, it is likely that infections with these coryneform bacteria are underreported.
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PMID:Arthrobacter woluwensis subacute infective endocarditis: case report and review of the literature. 2644 73

Patients with infective endocarditis (IE) were studied to assess incidence, clinical features and mortality in a population with either persistent (PF) or recurrent fever (RF) during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8%) had fever during treatment: 35 had PF and 16 had RF (Group 1). This group was compared with 35 patients with IE without fever (Group 2). Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly). However, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with MRSA (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in Group 1 (p<0.05). The most common causes of PF were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). On the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with RF. The overall mortality was 39.5%, distributed as follows: 52.2% of Group 1 and in 22.9% of Group 2 (p=0.007). The presence of comorbidities, major vessel embolization, heart failure, MRSA infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in Group 1 (p<0.05). We propose an evaluation method during the treatment of patients affected by this type of fever.
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PMID:[Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis]. 1523 31

Behcet's disease is a multisystem disorder and classified as "vasculitic syndrome with a wide variety of clinical manifestations." Cardiac involvement is very rare but can occur with different presentations including: pericarditis, cardiomyopathy, endocarditis, endomyocardial fibrosis, intracavitary thrombosis, and coronary artery disease. Great vessel involvement is more common. Recurrent Phlebitis, commonly involving large vessels (superior vena cava, inferior vena cava, hepatic veins) and cerebral veins are the sole presentation in this regard. Arterial involvement is expressed by aneurysm or pseudoaneurysmal formation. Due to the wide variety of cardiovascular manifestations and the resulting high mortality, cardiac surgeons should be familiar with this disease. In this paper we review the articles and introduce our four cases presenting with aneurysm of ascending aorta with free aortic insufficiency, aneurysm of descending aorta, pulmonary artery aneurysm, and pseudoaneurysm of aortic arch.
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PMID:Cardiac and great vessel involvement in "Behcet's disease". 1901 8

Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin.
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PMID:Kodamaea ohmeri fungemia in an immunocompetent patient treated with micafungin: case report and review of the literature. 2044 70

Three patients, two women aged 54 and 84 years, and a man aged 76 years, had serious complications during a stay in an internal medicine ward. The complications were discussed at monthly multidisciplinary complication meetings, which we organise from 2007 and which are aimed at improving care processes. The first patient developed urinary tract infection, fever and delirium and an arm fracture as a result of a fall after she had been given a routine urinary catheter in order to monitor her fluid balance. The complication discussion indicated that a urinary catheter should not be routinely installed. The second patient developed phlebitis and endocarditis after a venous infusion had been present for several days. As a result of the complication discussion it was decided that venous access was to be renewed after 96 h. The third patient, who was treated for atrial fibrillation, had fatal intracerebral bleeding due to INR > 5. A result of the complication discussion was that active antagonism of anticoagulants is warranted in these cases, not just discontinuation of the anticoagulants. The monthly multidisciplinary complication discussions in our department have led to a change in culture, facilitating the expression of doubts and criticisms, and a readiness to change policies.
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PMID:[Regular discussion of serious complications during admission to an internal medicine department]. 2045 71

Candida catheter-related bloodstream infection (CRBSI) is a biofilm-related disease, which is usually refractory because antifungals show limited effect. With medical development and increase in number of compromised hosts, CRBSI became more frequent. Candida, which is one of the opportunistic pathogens, ranks the fourth causative organism of bacteremia. The onset of bacteremia is greatly associated with the presence of catheter. Repeated blood cultures and the central venous catheter (CVC) tip culture are done for the definitive diagnosis of Candida CRBSI. Additionally serological examinations such as (1 --> 3)-beta-D-glucan and mannan antigen are also useful for early diagnosis. It is important for the appropriate treatment to remove CVC, which is an artificial contaminated material, and administer antifungals promptly. As to the choice of antifungals, we should also take into account the ability of antibiofilm effect of antifungals as well as immunological state of host including neutropenia, prior administration of azoles, isolated or estimated Candida species, sensitivity against antifungals, administration route, pharmacokinetics (bioavailability, metabolic and excretion pathway, distribution) and drug interaction. As to complication of Candida bacteremia, first we should check endophthalmitis, which occurs frequently and leads to the loss of eyesight, as well as infective endocarditis, arthritis, metastatic infections such as embolic pneumonia and suppurative thrombotic phlebitis of catheter insertion site. Lastly we emphasize that the appropriate treatment based on the character of Candida bacteremia and biofilm leads to favorable prognosis.
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PMID:[Candida catheter related-blood stream infection]. 2480 4

Antibiotic treatment of native valve infective endocarditis (IE) traditionally consists of 4-6 weeks of intravenous (IV) antibiotic therapy. Oral (PO) antibiotic therapy is being used more frequently, for part or all of treatment for IE but experience in treating IE with PO antibiotics is limited. Preferable agents for oral therapy of IE are antibiotics with a high degree of activity against the IE pathogen and that have high bioavailability (>90%) so that achievable serum and tissue levels are the same as with equivalent IV antibiotics. Oral antibiotic therapy of IE has several advantages over IV therapy given the long duration of treatment, i.e., 4-6 weeks for IE. Firstly, outpatient oral therapy for IE is easily administered over 4-6 weeks and decreases hospital length of stay (LOS). Secondly, oral antibiotics (administered at the same dose, frequency and duration) costs much less than their IV counterparts. Thirdly, with PO therapy for IE there are no central venous catheter (CVC) associated complications, e.g., phlebitis, bacteremia, fungemia. Compared to native valve IE, prosthetic valve endocarditis (PVE), depending on the IE pathogen, requires prolonged therapy and usually valve replacement. Haemophilus sp. IE is relatively virulent and often complicated by heart failure and/or embolic phenomena. We describe the first reported case of Haemophilus parainfluenzae aortic PVE successfully treated with oral levofloxacin without aortic valve replacement.
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PMID:Haemophilus parainfluenzae aortic prosthetic valve endocarditis (PVE) successfully treated with oral levofloxacin. 2599 92

Cases of cranial superficial epigastric vein (CSEV) phlebitis with subsequent septicemia were observed in dairy farms in Minas Gerais, Brazil. Autopsy on 4 affected cows, from 2 farms, revealed CSEV thrombophlebitis with perivascular abscesses, pulmonary abscesses, valvular endocarditis, arthritis, thromboembolic nephritis, and renal infarcts. Microscopic examination revealed fibrosing and lymphoplasmacytic phlebitis with occasional endothelial loss, subendothelial areas of necrosis, and abundant fibrin deposition. Trueperella pyogenes, Escherichia coli, and Staphylococcus aureus were isolated from lesions of 3 different cows. Thrombophlebitis of the CSEV is a rare condition in dairy cows; however, it has become more frequent in dairy farms in southeastern Brazil after repeated venipuncture of this vein, likely with contaminated needles used for administration of oxytocin.
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PMID:Cranial superficial epigastric vein phlebitis and septicemia in dairy cows in Brazil. 3102 48


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