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

A study of 1000 cases of septic endocarditis served as a basis for an analysis of the natural history of the diseases (1939-1972): changes in its etiology, clinical course and therapy. The increasing frequency of hospital infection (endocarditis) is emphasized. The characteristics of Staphylococcal and fungal endocarditis are presented, those of the lesion developing on heart valve prostheses as well. The classification of septic endocarditis is analysed, the stages of its activeness are described (III, II, I) along with the clinical and laboratory signs. Schemes of etiotropic therapy are presented, as well as rational combinations of antibiotics. The role of surgery in the management of primary septic endocarditis is described, and the rationale of preventive employment of antibiotics is discussed.
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PMID:[Evolution of protracted septic endocarditis]. 115 31

Enterococci are important causes of community-acquired and nosocomial infection. They cause endocarditis, bacteremia, urinary tract infections and neonatal sepsis. As causes of intra-abdominal and pelvic infection, enterococci are more commonly associated with abscess, biliary tract infection, spontaneous bacterial peritonitis, post-operative infection, post-partum endomyometritis and chronic or recurrent infection. As causes of soft tissue infection, enterococci are more commonly identified in burns, decubitus or diabetic foot ulcers, and wounds associated with intestinal surgery. Enterococci are often cultured in association with other pathogens when identified in intra-abdominal, pelvic or skin and soft tissue infection. Enterococcal superinfection after therapy with cephalosporins has been well described, and occurs as a result of the low in vitro activity of cephalosporins against enterococci. The epidemiology of enterococcal infection is complex and includes both endogenous and exogenous acquisition of the organism. Antibiotic resistance is an ever-increasing problem complicating therapy in patients with enterococcal infection.
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PMID:Clinical manifestations of enterococcal infection. 218 Jul 6

The nervous system is frequently involved in patients with infective endocarditis. When a careful review of presenting complaints is undertaken, neurological symptoms have been found in as high as 29% of patients. Because these manifestations may be so protean in nature, for example, stroke or transient ischaemic attack (the most common), toxic encephalopathy, meningitis, brain abscess, visual loss, seizures, headache, backache, or acute mononeuropathy, the neurologist needs to consider infective endocarditis as a possible diagnosis in many patients. During the past two decades, infective endocarditis has occurred in an ever widening clinical setting. It may often be found in persons unknown to have predisposing cardiac disease. This is particularly true in certain subsets of the population, including the elderly, patients subjected to various invasive procedures leading to nosocomial infection, and drug abusers. New diagnostic studies, including refined bacteriological culture techniques, echocardiography, computed tomography, magnetic resonance imaging, and greater availability of skillful cerebral angiography, make earlier diagnosis of infective endocarditis possible. Despite this, patients with neurological complications continue to have an uncertain prognosis.
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PMID:Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges. 267 68

From 1 April 1983 to 31 October 1985, 114 episodes of Staphylococcus aureus bacteremia (SAB) were identified in 111 patients at the Buffalo Veterans Administration Medical Center. Only 14% of the episodes were community-acquired, and 29% were due to methicillin-resistant strains. The commonest foci of SAB were intravascular catheters (33%), postoperative wounds (11%), skin infections (7%), and pulmonary infections (7%). Complications were infrequent, with endocarditis in two patients and metastatic infection in one. Mortality due to SAB was 32%, with no difference in mortality between community-acquired and hospital-acquired SAB. Although not statistically significant, there was a trend of higher mortality for methicillin-resistant SAB (42%) than for methicillin-sensitive SAB (28%) and for patients with no focus of SAB (43%) than for those with a defined primary focus (28%). A review of studies of SAB published since 1940 revealed several trends. SAB is now predominately a nosocomial infection; intravascular-catheter infection has become the commonest cause of SAB; with several exceptions, the risk of endocarditis in patients with SAB is low (5%-20%); mortality due to SAB has decreased over the past 40 years but not over the past 10 years.
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PMID:Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. 331 34

Enterococcal infections are becoming increasingly prevalent, in part because of the widespread use of cephalosporins and a greater number of immunosuppressed patients. Most infections where enterococci are isolated are pelvic or intraabdominal. The actual pathogenic role of the enterococcus remains controversial, since many types of organisms are usually cultured as well. Although specific therapy directed at the enterococcus may not always be necessary, reasonable indications for specific therapy include the presence of shock, immunosuppression, or persistent or recurrent infection. Enterococcal bacteremia is associated with a mortality rate in excess of 40 percent. This entity, as well as enterococcal endocarditis and meningitis, should be treated with bactericidal, combination antibiotic therapy, which includes a penicillin and an aminoglycoside. Mixed infections probably can be treated with a penicillin alone. Penicillin-allergic patients should be treated with vancomycin. The costs of nosocomial infection or superinfection are very high; costs incurred as a result of enterococcal infection or superinfection may be prevented by avoiding prolonged prophylactic or broad-spectrum therapeutic regimens (such as cephalosporins) that lack antienterococcal activity. Extended-spectrum penicillins may be effective prophylactic regimens for intraabdominal or pelvic procedures and should serve as adequate therapy for mixed infections in these sites.
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PMID:Prevention and management of enterococcal infection: cost implications. 374 13

Staphylococcus aureus bacteremia continues to be a frequent clinical problem even in communities where intravenous drug abuse is relatively rare. One-hundred-three evaluable cases of S. aureus bacteremia that occurred in a large tertiary care facility over a four year period (1979-1982) are reviewed. A comparison of nosocomial and community-acquired S. aureus bacteremia reveals several fundamental differences. Community-acquired S. aureus bacteremia frequently develops in the absence of a primary focus of infection and is more likely to result in endocarditis and secondary metastatic foci of clinical infection. In contrast, nosocomial S. aureus bacteremia tends to be diagnosed earlier, a primary site of portal entry is usually identified and endocarditis is less frequent as are secondary foci of infection. Irrespective of the epidemiological origin of S. aureus bacteremia, the mortality remains high particularly in nosocomial infection where the presence of severe underlying disease contributes to the high mortality. Methicillin resistant S. aureus adds a new dimension to the challenge of successful treatment of staphylococcal bacteremia.
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PMID:Staphylococcus aureus bacteremia and endocarditis: comparison of nosocomial and community-acquired infection. 659 54

Kingella (Moraxella) kingae occasionally colonizes the nasopharynx and rarely causes serious infections. Three children with K kingae infections treated over a two-month period were studied. Epidemiologic investigation concluded that infection was community acquired, not pseudoinfection or nosocomial infection. Except for prompt laboratory recognition of the organism, no identifiable factors explained the observed prevalence. Five additional K kingae infections were reviewed. Affected sites included blood (two), valves (two), bone (two), joint (one), and disk space (one). Three patients had underlying disease; one was immunosuppressed. Kingella kingae resembles other members of the Neisseriaceae family and causes similar infections except meningitis. It is differentiated by colonial characteristics and standard biochemical tests. Treated infections responded to penicillin G potassium. Gram-negative bacteria uncommonly are implicated in endocarditis, arthritis, osteomyelitis, and diskitis; K kingae deserves recognition as a pathogen in these pediatric infections.
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PMID:Kingella (Moraxella) kingae infections in children. 685 76

Group B streptococcal infection has recently been recognised as an important and apparently increasingly common cause of invasive disease in nonpregnant adults. The annual incidence of invasive disease has been estimated at 4.4 per 100,000 nonpregnant adults and is highest among adults over 60 years of age. The most common clinical diagnoses include skin and soft-tissue infections, bacteraemia with no identified source, osteomyelitis, urosepsis and pneumonia. Other important but less common infections include peritonitis, infectious arthritis, meningitis and endocarditis. The majority of adults with group B streptococcal infections have underlying diseases including diabetes mellitus, malignant neoplasms and liver disease. Nosocomial infection and polymicrobial bacteraemia occur in a significant proportion of patients with invasive group B streptococcal disease. Mortality from invasive disease is particularly high in the elderly. For treatment of serious group B streptococcal infections, high doses of benzylpenicillin (penicillin G) are recommended because of the somewhat higher minimal inhibitory concentrations. In addition to parenteral antibiotic therapy surgical management may be required for successful treatment, particularly in the case of soft-tissue or bone infection. Invasive group B streptococcal infection is a major problem in elderly adults and those with chronic diseases, and efforts should be made to identify and treat such infections early. Future approaches may include vaccine prevention of serious group B streptococcal infection in adults at highest risk.
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PMID:Group B streptococcal infection in older patients. Spectrum of disease and management strategies. 761 18

A microdilution method was utilized for determining susceptibility to several antimicrobial agents in 142 bacterial blood culture isolates obtained during a one year period. Associated clinical features were also identified. Three cases of polymicrobial bacteriemia were found. Endocarditis was the most frequent source of bacteriemia (28.5%) and the viridans streptococci were the most frequently isolated microorganism (53%). Surprisingly, half of the bacteriemic episodes corresponded to a nosocomial infection most of which were due to staphylococci (25%) and Enterobacter sp (22%). Viridans streptococci group were 61.5% resistant to penicillin (MIC > 0.12 micrograms/mL). These strains also showed a 31% resistance to ceftriaxone (MIC > 8 micrograms/mL). The staphylococcal strains showed a 19% resistance to oxacillin; this resistance occurred for coagulase negative staphylococcis in 32% (6/19) and for S. aureus in 9% (2/22). All Gram-positive microorganisms were susceptible to vancomycin. The enterobacteria group were susceptible to most antimicrobial agents; nevertheless this group showed a 45% resistance to amikacin. In contrast, the non enterobacteria group were resistant to most of the antimicrobial agents tested except to imipenem, ceftazidime and ciprofloxacin. When comparing susceptibility longitudinally, no significative changes were identified, but a significant increase was found in MIC50-90 to amikacin and cephalothin when testing S. aureus, and cefoperazone in the non enterobacteria group.
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PMID:[Antibiotic susceptibility to microorganisms isolated in blood cultures of patients an the Ignacio Chavez National Institute of Cardiology]. 797 53

Candida is an increasing problem as a causal agent of nosocomial infection in neonates and infants. We report 15 cases of infective endocarditis caused by Candida spp treated at the Hospital Infantil de Mexico between 1980 and 1991. The diagnosis of endocarditis was established by the identification of Candida in at least two blood cultures and echocardiographic assessment. From 110 cases of systemic candidiasis during the eleven years period of study, fifteen patients presented endocarditis (13.6%), all had a central venous catheter. Three had antecedent of congenital heart disease. Candida isolation was obtained an average of 28 days after admission. The major clinical findings were: fever in 13 patients, respiratory distress and cardiac murmurs observed in nine respectively. Thrombocytopenia was present in eight children. The echocardiographic evaluation showed vegetations located in the superior vena cava in six, right atrium in five, tricuspid valve in two, inferior vena cava and right ventricle in one respectively. Three cases were subjected to surgical treatment. Nine patients died for a case fatality rate of 60%. The echocardiographic evaluation practiced in all patients with suspicion of systemic candidiasis is critical for the prognosis. The identification of endocardiac involvement coupled with the opportune administration of antifungal therapy and surgical treatment may improved the survival.
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PMID:[Candida endocarditis in the first year of life]. 844 79


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