Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 52-yr-old man who had a bioprosthetic aortic valve developed Staphylococcus aureus bacteremia. Despite antibiotic therapy he had persistent pyrexia and developed new conduction system disturbances. Echocardiography did not demonstrate vegetations on the valve or an abscess, but gallium scintigraphy using SPECT clearly identified a focus of intense activity in the region of the aortic valve. The presence of valvular vegetations and a septal abscess was confirmed at autopsy. Gallium scintigraphy, using SPECT, provided a useful noninvasive method for the demonstration of endocarditis and the associated valve ring abscess.
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PMID:Gallium-SPECT in the detection of prosthetic valve endocarditis and aortic ring abscess. 188 May 82

The clinical features of 101 Melanesian patients with Staphylococcus aureus bacteraemia observed during two 2-year periods (1977-1979 and 1985-1987) in a university teaching hospital in Papua New Guinea are reviewed. The age of the patients ranged from 12 to 70 years. There were 69 males and 32 females. Diabetes mellitus, found in 15 patients, was the most common predisposing factor. Most of the patients (87%) had community-acquired infection. Soft-tissue infection, pneumonia, arthritis, osteomyelitis, intravenous-site thrombophlebitis, cerebral abscess, endocarditis and cavernous sinus thrombosis were among the clinical entities observed. Soft tissues and lungs were the most common sites of primary and secondary foci of infection, respectively. All but 1 of the 101 blood isolates were resistant to penicillin G and none was resistant to methicillin. The overall case fatality rate was 24%. These data demonstrate that staphylococcal bacteraemia in adult Papua New Guineans is mostly community acquired and has a high mortality. Skin and soft tissues are the major primary foci of infection leading to staphylococcal bacteraemia.
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PMID:The clinical spectrum of staphylococcal bacteraemia: a review of 101 Melanesian patients from Papua New Guinea. 208 Jun 75

In 1980, we reported an association between the use of fusidic acid (particularly the intravenous formulation) and jaundice in patients who had received the drug for the treatment of Staphylococcus aureus bacteraemia during the previous 10 years. We have continued to use fusidic acid for severe staphylococcal infections, but have recommended oral administration whenever possible. In the earlier study the incidence of jaundice in patients given intravenous fusidic acid was 48%, but in the recent study of 145 patients it was 17%. Whereas 71% of patients receiving fusidic acid in the earlier series were given the intravenous drug (with or without oral) only 25% of patients were given the intravenous drug in the recent series. The incidence of jaundice in those patients treated only with the oral formulation was 13% in the earlier study and 6% in the recent study. Although jaundice was usually reversible, it is nevertheless an unwanted side effect. Resistance of S. aureus to fusidic acid remains at around 1%; it may be present on primary isolation or arise during treatment. This seems to occur particularly in patients with endocarditis or bone infection despite the use of fusidic acid in combination with another antibiotic. After some 25 years of clinical use, fusidic acid remains a most useful anti-staphylococcal antibiotic; the intravenous preparation should be avoided when possible.
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PMID:Staphylococcal bacteraemia and endocarditis and fusidic acid. 231 44

Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.
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PMID:Indium-111 leukocyte localization in infected prosthetic graft. 239 Aug 30

Nineteen patients hospitalized for serious gram-positive infections were treated with teicoplanin, a new glycopeptide antibiotic. A variety of infections were treated, including endocarditis, septic thrombophlebitis, osteomyelitis, pyogenic arthritis, and soft tissue infection. Of 13 infections that could be evaluated in 12 patients, there were 8 clinical cures, 2 improvements, 1 recurrence, and 2 failures. Of the eight patients with Staphylococcus aureus bacteremia, seven were clinically cured or improved with teicoplanin therapy. Of the nine patients in whom the bacteriological response to treatment could be fully evaluated, six were cured; there was recurrence of infection in one, and treatment failed in two patients. In vitro testing showed the 13 bacterial isolates (9 S. aureus, 3 S. epidermidis, and 1 group B streptococcus) to be uniformly susceptible to teicoplanin, with MICs ranging from 0.12 to 0.5 microgram/ml. Every isolate was more susceptible in vitro to teicoplanin than to vancomycin. Three of the staphylococcal isolates were resistant to methicillin. Pharmacokinetic studies demonstrated that after an initial drug-accumulation period, a single daily dose adequately maintained the teicoplanin concentrations in serum within therapeutic ranges. Teicoplanin also penetrated well into synovial fluid. The drug was well tolerated by either intravenous or intramuscular administration. The most significant adverse reaction was an urticarial rash which required discontinuation of therapy in one patient; a second patient experienced a modest decrease in high-frequency auditory threshold. Asymptomatic eosinophilia and mild elevation of serum transaminases were noted as well. The results of this study suggest that teicoplanin is a safe and effective new agent for treatment of serious infections caused by gram-positive organisms.
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PMID:Clinical evaluation of efficacy, pharmacokinetics, and safety of teicoplanin for serious gram-positive infections. 295 62

Seventy-two adult patients with Staphylococcus aureus bacteremia were prospectively studied clinically, serologically, and echocardiographically. Multivariate analysis identified four parameters that significantly predicted endocarditis in staphylococcemic patients at time of initial evaluation: absence of a primary site of infection; community acquisition of infection; metastatic sequelae; and valvular vegetations detected by echocardiography. Echocardiography was most predictive of endocarditis in patients with community-acquired S aureus bacteremia from an obvious primary focus. In 11 (69%) of 16 patients with endocarditis and vegetations on two-dimensional echocardiography, this technique also revealed other important findings, including ventricular dilatation, and/or underlying valvular lesions. In 18% of patients with S aureus bacteremia without stigmata of endocarditis, echocardiography provided information that led to a diagnosis of endocarditis and a subsequent change in therapy. Our findings support the routine use of two-dimensional echocardiography in all cases of community-acquired S aureus bacteremia to identify occult endocarditis in patients without classic stigmata of disease, and to provide important prognostic data in clinically apparent endocarditis.
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PMID:Staphylococcus aureus bacteremia. Clinical, serologic, and echocardiographic findings in patients with and without endocarditis. 310 61

A total of 6,253 cases of Staphylococcus aureus bacteremia, including 274 (4.4%) endocarditis cases, were registered in Denmark in the period 1975-1984. Patients with hematological malignancies and/or agranulocytosis accounted for 479 of the bacteremia cases. The incidence of endocarditis in this group of patients was only 0.4% as compared to 4.7% in other patients with staphylococcal bacteremia (p less than 0.01). The lower incidence of endocarditis complicating bacteremia in these patients may justify a shorter course of therapy than usually recommended for suspected endocarditis. Patients with hematological malignancies and other patients with agranulocytosis had a higher mortality (49 and 46%, respectively) than other patients with S. aureus bacteremia (33%). The highest mortality was found in patients with multiple myeloma (71%, p less than 0.01), the lowest in patients with acute lymphocytic leukemia (28%, p less than 0.01). The higher mortality in these patients may indicate that empiric antibiotic regimens in granulocytopenic patients should include a specific anti-staphylococcal agent.
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PMID:Staphylococcus aureus bacteremia in patients with hematological malignancies and/or agranulocytosis. 312 27

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

A randomized cooperative study of therapy for Staphylococcus aureus bacteremia was conducted in which nafcillin was given for four or six weeks to patients with clinical endocarditis and for two or four weeks to those without evidence of endocarditis. Eighty-four patients were enrolled, and 32 completed treatment, all of whom had bacteriologic cures. Three patients, treated for two weeks, had complications that were undetectable by assay of serum teichoic acid antibody. Data were insufficient to allow conclusions regarding the optimal duration of therapy for patients with or without endocarditis. However, the results suggest that neither clinical nor immunologic methods can reliably detect complications in patients treated for two weeks only. In addition, patients infected with tolerant organisms remained febrile longer than those infected with nontolerant strains but did not require additional antibiotics for cure. Peak serum bactericidal activity at a dilution of 1:8 or greater was present in all patients. Serum bactericidal activity of 1:8 prior to an antibiotic dose was not necessary for cure.
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PMID:Relationship of staphylococcal tolerance, teichoic acid antibody, and serum bactericidal activity to therapeutic outcome in Staphylococcus aureus bacteremia. 352 25

A prospective study of all cases of Staphylococcus aureus bacteremia (SAB) has been ongoing at our institution since April 1983. Data collected as of December 1984 reveal that of 79 episodes of SAB identified, 28 (35%) were caused by infected intravenous catheters; 14 of these were peripheral catheters and 14 were subclavian catheters. Endocarditis or metastatic infection was not recognized; two patients, one with a prosthetic heart valve and the other with recurrent SAB, did not meet the criteria for these complications but the clinical circumstances were strongly suggestive. Six of the 28 patients (21%) died of their infection, and local complications (inflammation or purulent drainage at the insertion site) were common. Only four of 22 patients who recovered were administered antibiotics for greater than 14 days. We conclude that patients with SAB caused by an infected intravenous catheter have a low risk of endocarditis or metastatic infection when the infected catheter is promptly removed and no risk factors (valvular heart disease or a prosthetic valve) are present that favor development of endocarditis. The duration of antimicrobial therapy need not exceed 2 weeks in this situation. The mortality related to SAB, however, was high and emphasizes the need to develop methods to prevent this infection.
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PMID:Staphylococcus aureus bacteremia caused by infected intravenous catheters. 364 72


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