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

Animal models of infection are very useful tools for identifying those situations in which antibacterial drugs, including the quinolones, may play special roles, i.e., for positioning a drug correctly for its role in the treatment of human disease. Ciprofloxacin has been studied extensively in discriminative animal models of infection, and its efficacy in the treatment of these infections has been compared with that of standard therapy. In a rabbit model of staphylococcal endocarditis, ciprofloxacin was as effective as nafcillin alone, as well as nafcillin and gentamicin in combination, in treating rabbits with methicillin-susceptible Staphylococcus aureus endocarditis. Additionally, its activity was equal to that of vancomycin in reducing vegetation titers in rabbits with methicillin-resistant staphylococcal endocarditis. In a rabbit model of pseudomonal meningitis, ciprofloxacin was as effective as the combination of ceftazidime and tobramycin in lowering bacterial titers. However, in this model, serum levels of ciprofloxacin (6 micrograms/ml) necessary to achieve a bactericidal effect in the cerebrospinal fluid were slightly higher than levels targeted for humans. In a model of pseudomonal pneumonia in neutropenic guinea pigs, the efficacy of ciprofloxacin was compared with that of tobramycin and ceftazidime, both alone and in combination: ciprofloxacin was as effective in lowering bacterial counts as was the combination of ceftazidime plus tobramycin and its activity was superior to that of either drug alone. Thus, data from studies of ciprofloxacin in the treatment of endocarditis, meningitis, and pneumonia in animal models of infection suggest that this quinolone may play an important role in the therapy of these difficult-to-manage infections in humans.
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PMID:Efficacy of ciprofloxacin in animal models of infection: endocarditis, meningitis, and pneumonia. 357 31

We compared the efficacy of ciprofloxacin with that of vancomycin by using the rabbit model of methicillin-resistant Staphylococcus aureus endocarditis. Endocarditis was treated with ciprofloxacin (25 mg/kg [body weight] intravenously every 8 h) or vancomycin (17.5 mg/kg intravenously every 6 h) for 3 days. Vancomycin and ciprofloxacin were equally efficacious in clearing bacteremia. Both reduced vegetation bacterial counts by 5 log10 CFU/g and renal and splenic bacterial counts by more than 3 log10 CFU/g as compared with untreated control rabbits after 26 h of infection (P less than 0.001). Both antimicrobial agents were able to eradicate the infectious process in an equivalent proportion of animals. No methicillin-resistant S. aureus that was recovered from ciprofloxacin-treated rabbits developed resistance to ciprofloxacin during therapy. Peak concentrations of ciprofloxacin in the sera of rabbits with endocarditis were significantly higher than those predicted by single-dose studies in uninfected rabbits. This finding was likely due to changes in the pharmacokinetics of the drug with multiple dosing and in infected versus uninfected rabbits. This study demonstrated that intravenously administered ciprofloxacin is as efficacious as vancomycin is in an in vivo model of a serious systemic methicillin-resistant S. aureus infection.
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PMID:Ciprofloxacin versus vancomycin in the therapy of experimental methicillin-resistant Staphylococcus aureus endocarditis. 364 2

A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started.
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PMID:Staphylococcus aureus endocarditis presenting as acute scrotal pain. 365 70

Analysis of 17 patients with infective endocarditis and intracranial hemorrhage yielded several different mechanisms of bleeding. Nine of 15 (60%) symptomatic intracranial hemorrhages occurred within 48 hours of admission and 3 more (20%) after hospital discharge. In 7 patients with Staphylococcus aureus endocarditis, symptomatic intracranial hemorrhage occurred within 48 hours of admission and resulted from septic arteritis in all 3 examined pathologically. Secondary hemorrhagic transformation (hemorrhagic infarction) was asymptomatic in 2 nonanticoagulated patients but was associated with clinical worsening in 2 anticoagulated patients. Anticoagulation potentially contributed to intracranial hemorrhage in 4 of the 17 patients (24%). Proven mycotic aneurysms were present in only 2 patients (12%), 1 of whom presented with massive, fatal intracranial hemorrhage. Mycotic aneurysms amenable to surgery are uncommon and underlie only a fraction of intracranial hemorrhages in infective endocarditis.
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PMID:Mechanisms of intracranial hemorrhage in infective endocarditis. 368 76

Staphylococcus aureus endocarditis cases in Denmark from 1976 to 1981 were reviewed. A total of 119 patients--61 female and 58 male, with a median age of 63 years (range, 1 month to 85 years)--fulfilled the diagnostic criteria. Community-acquired infections were most common (62%), but the frequency of hospital-acquired cases (38%) was greater than in earlier reports. The clinical picture was relatively nonspecific, and 32% of the patients had no heart murmurs initially. In 65 cases (55%), endocarditis was not suspected clinically, and the diagnosis was first obtained at autopsy. The mortality was 71% and correlated with age, hospital-acquired infection, and the presence of heart failure and arterial embolism.
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PMID:Staphylococcus aureus endocarditis. A review of 119 cases. 371 98

A young intravenous drug user presented with Staphylococcus aureus endocarditis involving the tricuspid valve, which was replaced with a Hancock bioprosthesis. She presented again with fever and dyspnea five months later and was found to be cyanotic. Recurrent endocarditis involving the prosthesis with right-to-left shunting through a patent foramen ovale was documented by echo and confirmed at autopsy.
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PMID:Endocarditis of a tricuspid prosthesis causing valvular stenosis and shunting through a patent foramen ovale. 373 7

The penetration of ceftazidime, administered in a dose of 100 mg/kg intramuscularly, into cardiac vegetations and subcutaneously implanted fibrin clots was compared in rabbits with experimental Staphylococcus aureus endocarditis. Significant pharmacokinetic differences between the time-concentration curves for the two compartments were observed. Concentrations of ceftazidime in vegetations peaked at 30 min after dosing at a level slightly lower than that in plasma and thereafter declined in parallel with concentrations in plasma throughout the 8-h sampling period. Concentrations in fibrin clots increased more slowly than those in plasma and vegetations, reaching a maximum at 120 min. This was followed by a slow elimination phase yielding concentrations in excess of concurrent plasma and vegetation levels and a greater area under the curve. These features were observed for both large (2-ml volume) and small (0.1-ml volume) clots. Contrary to previous reports, these observations suggest that fibrin clots do not provide an accurate model for predicting antibiotic concentrations in cardiac vegetations produced in endocarditis and that concentrations of antimicrobial agents in vegetations can be predicted more accurately from concomitant plasma levels.
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PMID:Comparative pharmacokinetics of ceftazidime in fibrin clots and cardiac vegetations in rabbits with Staphylococcus aureus endocarditis. 389 36

Cefonicid is a parenteral cephalosporin with a half-life of 4.5 hours, which permits once-daily dosing. The efficacy of cefonicid in the treatment of established staphylococcal infections was reviewed in all patients with infections due to staphylococci who were treated with cefonicid during the US clinical development program. Two hundred evaluable cases were identified, of which 95 had other pathogens as well. Cefonicid was clinically effective in 92% of skin and soft tissue infections, 74% of bone and joint infections, 83% of respiratory tract infections, and 95% of urinary tract infections. None of the three evaluable patients with Staphylococcus aureus endocarditis responded to cefonicid. Thus, based on current evidence, cefonicid is not effective in the treatment of established staphylococcal endocarditis. However, for the treatment of staphylococcal infections at other sites, cefonicid is comparable to other cephalosporins, most of which must be administered more frequently than cefonicid and thus are less cost-effective.
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PMID:Clinical efficacy of cefonicid in the treatment of staphylococcal infections. 407 63

Patients with bacteremia, bacterial endocarditis, or acquired immunodeficiency syndrome (AIDS) were prospectively studied using monoclonal antibody reagents to assess alterations in T-lymphocyte subpopulations. Patients with endocarditis had significantly higher ratios of T-helper (OKT4+) to T-suppressor-cytotoxic (OKT8+) cells than did patients with bacteremia alone. Staphylococcus aureus endocarditis patients had a mean ratio of 8.49 (range 4.73-22.36) while S aureus bacteremia had a mean ratio of 2.75 (range 2.15 to 3.21). Similar results were found with Staphylococcus epidermidis endocarditis (mean 1.62) and bacteremia (mean 1.23). Klebsiella pneumoniae endocarditis (5.10) and sepsis (4.32), and E coli bacteremia (2.15). Nine male patients with AIDS had markedly depressed ratios (mean 0.25, range 0.04 to 0.67) while eight male homosexuals with unexplained lymphadenopathy ("pre-AIDS") had normal or increased ratios. Bacteremic infections are associated with an increased OKT4+/OKT8+ ratio with the degree of increase dependent upon virulence, location, and duration of infection. The immunomodulating effects of infection are manifested in changes in T-cell subsets, and these measurements can be useful in clinical management.
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PMID:Infection and T lymphocyte subpopulations: changes associated with bacteremia and the acquired immunodeficiency syndrome. 609 86

Thirteen children (11 African, two Indian) with infective endocarditis are described. Rheumatic heart disease was present in nine of the children and was therefore a major determinant of infective endocarditis whereas a congenital cardiac abnormality (Fallot's tetralogy) was detected in only one child. Staphylococcus aureus was the commonest infecting organism, being found in five children, and Streptococcus viridans was isolated in one. Fever, murmurs and anaemia were the most frequent clinical expression of the disease. Renal problems were trivial except in two children with endocarditis due to Staphylococcus aureus in whom they were serious. Staphylococcus aureus endocarditis was uniformly fatal. Among eight children who died neurological complications caused death in four. The patterns of infective endocarditis in developed and Third-World countries are compared.
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PMID:Infective endocarditis in thirteen children: a retrospective study (1974-1981). 618 79


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