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

Antibody responses to staphylococcal alpha-toxin, cell wall teichoic acid, and cell wall peptidoglycan were measured in 259 serum samples from 74 consecutive patients with Staphylococcus aureus bacteremia. All patients with complicated bacteremia were seropositive in at least one of three tests, and 18 (72%) of 25 were positive in two or three assays; six (75%) of eight patients with endocarditis were positive for all three tests. In contrast, 15 (75%) of 20 patients with uncomplicated bacteremia were positive in only one or none of the tests. These differences in antibody response patterns were statistically significant (chi 2 = 18.33, P less than .001). Patients with complicated bacteremia had peak antibody titers that were significantly higher than those of patients with uncomplicated bacteremia. The assay for antibody to alpha-toxin was as sensitive as the assays for antibody to cell wall antigens but had less specificity for complicated bacteremia. The clinical severity of the bacteremia did not correlate with a complicated vs. uncomplicated nature of the infection but was predictive of early death due to staphylococcemia. The calculated predictive values suggest that the serology of S. aureus bacteremia may be clinically valuable when multiple tests are performed in paired serum samples.
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PMID:Distinguishing complicated from uncomplicated bacteremia caused by Staphylococcus aureus: the value of "new" and "old" serological tests. 394 Dec 74

Staphylococcus aureus bacteremia occurred 96 times in 58 of 671 patients on chronic hemodialysis during a nine-year period. Seventy-one instances of bacteremia originated in the vascular access site and resulted in the loss of the access device in 45 episodes. The overall mortality was 8%, and the incidence of infective endocarditis was 4%. Death occurred more often when bacteremia arose from an identifiable site other than the vascular access device (P less than .02). Patients who developed one or more metastatic foci of infection had a higher incidence of primary treatment failure (P less than .001) and a higher mortality (P less than .001) than did those with no metastatic infection. Although meaningful comparisons of differing antibiotic regimens could not be made, patients receiving antibiotic therapy for 28 days or longer relapsed less frequently (P less than .05). These data suggest that chronic hemodialysis patients with S aureus bacteremia have a relatively low mortality and a low risk of infective endocarditis. Antibiotic treatment, however, should be given for at least 28 days in order to minimize the risk of relapse.
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PMID:Staphylococcus aureus bacteremia in patients on chronic hemodialysis. 407 20

In the period 1975-1981, 4060 cases of Staphylococcus aureus bacteremia were recorded in Denmark, and the corresponding strains were examined. The percentage of strains, resistant to penicillin only, rose to 82, and the percentage of multiply-resistant strains fell to five. Newer phage types (94, 96 and 95) increased from 10% to 27% of the material. These strains were usually resistant only to penicillin, but produced large amounts of penicillinase. The ample penicillinase production has also been characteristic for previous epidemic strains, and it is furthermore correlated to mortality. The overall mortality of 34.6% was lower than that of the preceding period. Mortality rates were highest in elderly patients, nosocomial cases, patients with serious primary diseases and endocarditis cases.
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PMID:Frequency, phage types and antibiotic resistance of Staphylococcus aureus isolated from blood cultures in Denmark 1975-1981. 623 75

Four hundred episodes of Staphylococcus aureus bacteraemia occurred in St Thomas's Hospital from 1969 to 1983, accounting for 17.5% of all episodes of bacteraemia. The mortality was 24%, half attributable to underlying disease, and was highest in patients over 50. Almost 60% of the bacteraemias were acquired in hospital, and the source of the organism was generally obvious, with vascular access sites the most common (37%). Bone and joint infections accounted for 11.5% of episodes and endocarditis for 7%. Most staphylococci were resistant to penicillin only; three isolates were resistant to methicillin and five to fusidic acid. Microbiologists seldom influenced directly the choice of initial antibiotic treatment (though this usually conformed to the hospital's antibiotic prescribing policy) but had considerable influence over definitive treatment, usually cloxacillin or flucloxacillin alone or in combination with fusidic acid. S aureus bacteraemia is easy to identify and treat, though underlying disease may influence the outcome. Efforts should be made to prevent the largely iatrogenic disease.
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PMID:Staphylococcus aureus bacteraemia: 400 episodes in St Thomas's Hospital. 641 7

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

During a 22-month period, 47 patients with 49 consecutive episodes of Staphylococcus aureus bacteremia were identified and observed prospectively for the development of endocarditis and metastatic infection. Eighteen (37%) of the episodes were community-acquired and 31 (63%) were nosocomial. The mean patient age was 55 years, and all but nine patients had one or more underlying diseases. A primary focus was identified for 38 episodes (78%) most often an intravenous catheter, and 21 episodes (43%) were associated with a removable focus of infection. In this group, no patient had endocarditis after a mean duration of 20 days of therapy. Overall, two of 47 patients had endocarditis by clinical criteria; one was a drug abuser and one had no known heart disease. Forty-five of 49 episodes were treated with a single antimicrobial agent. There were 12 (24%) deaths in this series, seven (14.2%) directly due to staphylococcal infection. In this prospective study we found a low but definite risk of endocarditis associated with S aureus bacteremia. The mortality was similar to that in other recently published studies. All deaths occurred within two weeks of initiating therapy, indicating the potential importance of host factors in the outcome.
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PMID:Staphylococcus aureus bacteremia: a prospective study. 661 91

Thirty-nine consecutive Staphylococcus aureus bacteremias were reviewed with particular attention to complications. Thirty-four (87%) of the bacteremias were nosocomial, with intravascular catheters (20 episodes) and dialysis-access sites (six episodes) the most common sources. Complications developed in 36% (14/39) of all bacteremias and in 30% (6/20) of those that were catheter-associated. Acute complications (shock, adult respiratory distress syndrome, disseminated intravascular coagulation) occurred in six patients and were fatal in four. In nine patients metastatic suppurative complications developed, six at sites of preexisting abnormalities. There were no episodes of endocarditis. Most patients received prolonged antibiotic therapy, and the majority of all suppurative complications required surgical intervention. Staphylococcus aureus bacteremia, even when not associated with endocarditis, is a cause of considerable morbidity and mortality in hospitalized patients.
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PMID:Complications associated with Staphylococcus aureus bacteremia. 670 26

We studied 390 consecutive episodes of Staphylococcus aureus bacteremia in the four nonuniversity hospitals of one metropolitan area between 1977 and 1981. Overall mortality was 31%, with 52% of deaths being attributed to the infection. The 4.9% incidence of recognized endocarditis was lower than that previously reported. Although 41% of deaths occurred by the end of the third day after positive blood cultures had been obtained, choice of antimicrobial therapy bore no apparent relationship to eventual clinical outcome.
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PMID:Staphylococcal bacteremia: current patterns in nonuniversity hospitals. 672 44

Humoral reactions to native culture filtrates of Streptococcus bovis were studied in patients with endocarditis by means of two-dimensional crossed immunoelectrophoresis. Serum from patients with S bovis endocarditis produced eight different precipitin arcs. Lex antigen cross-reacted with sera from patients with viridans streptococcal endocarditis, and TA antigen cross-reacted with ribitol teichoic acid-positive sera from patients with Staphylococcus aureus bacteremia. One antigen, common (c), was immunoreactive with all 10 sera from S bovis-infected patients. Antibody to this antigen was not found in sera from 77 patients with gram-positive bacteremia or in 29 other control sera. Common (c) antigen was found in all strains of S bovis isolated from patients. Rabbits immunized with formalinized S bovis cells of human origin also produced antibody to common (c) antigen. Common (c) may be an important antigen of S bovis and may in fact define this organism serologically.
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PMID:Humoral reactions in human endocarditis due to Streptococcus bovis: evidence for a common S bovis antigen. 688 90

The presentation and course of Staphylococcus aureus bacteremia in 27 diabetic patients (18 insulin-dependent) were compared with those in 34 nondiabetic patients. The groups were comparable in age, proportion with pre-existing cardiac valvular disease, community-acquired bacteremia, fever, and leukocytosis. Endocarditis (vegetation or new regurgitant murmur) was present in eight (30 percent) diabetics and four (12 percent) nondiabetics (p = 0.16). A primary focus of infection was present in 67 percent of diabetics and 65 percent of nondiabetics. Among those with a focus, six of 18 diabetics and none of 22 nondiabetics had endocarditis (p less than 0.005). Fifteen of 54 (28 percent) patients who received appropriate antibiotic therapy died. After stratificaton for underlying illness, there was no mortality difference between those with and without endocarditis (three endocarditis deaths versus 1.78 expected), or between those with and without diabetes (four diabetic deaths versus 4.8 expected). Diabetics with staphylococcal bacteremia were more likely than nondiabetics to have endocarditis in the presence of a primary focus. They had no increase in mortality.
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PMID:Staphylococcus aureus bacteremia in diabetic patients. Endocarditis and mortality. 713 2


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