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

Optimal antibiotic therapy for patients with Staphylococcus aureus bacteremia remains controversial. The results of two serologic tests, teichoic acid antibody and circulating immune complexes, have shown promise in detecting patients who have serious bacteremia (sustained bacteremia with endocarditis or metastatic abscess) and require longer, more intensive treatment. These tests were performed on serial samples from 38 patients with staphylococcal bacteremia prospectively categorized by severity of infection and by risk factors associated with serious disease (sustained bacteremia, valvular heart disease, absence of focus of infection, metastatic abscess). A surprisingly large group of these patients (20, or 53 percent) could not be prospectively defined as having "serious" or "benign" bacteremia. Neither test differentiated patients with serious bacteremia from those with benign bacteremia. Although it is possible that additional significant associations with risk factors might have been obtained with the teichoic acid antibody test had more patients been included, positive tests were found more frequently only in patients in whom metastatic abscesses developed. The teichoic acid antibody test was found to be a sensitive, but not specific, indicator of serious staphylococcal disease and was of value in excluding serious infection only when a negative results was supported by clinical evidence for benign disease. Other than this use, neither assay was helpful in determining optimal therapy of staphylococcal bacteremia.
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PMID:Teichoic acid antibody and circulating immune complexes in the management of Staphylococcus aureus bacteremia. 721 13

The natural history and outcome of Staphylococcus aureus bacteremia in patients with acute leukemia were studied over a 10 year period at the Baltimore Cancer Research Program. There were 370 patients at risk; 32 (9 percent) had 37 episodes. Granulocytopenia (less than 1,000/microliters) was present in 95 percent of the episodes. The sites of origin of bacteremia were identified in 32 episodes and were usually the skin and lower respiratory tract. Initially, broad-spectrum antimicrobials were used empirically in 30 episodes and specific antistaphylococcal therapy was used in the remaining seven episodes. The median duration of therapy was 14 days of intravenous therapy and seven days of oral therapy, a total of 21 days. There was improvement during therapy in 31 of the 37 episodes (83 percent) although, among the subgroup of six patients with shock, only one improved (p less than 0.001). There was no clinical or postmortem evidence of endocarditis in any patient. Since endocarditis complicating Staph. aureus bacteremia appears to be rare in patients with acute leukemia, a shorter course of therapy than that usually recommended for endocarditis may be justified.
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PMID:Staphylococcus aureus bacteremia in patients with acute leukemia. 744 46

Primary left ventricular mural abscess was detected by transesophageal echocardiography and was confirmed at necropsy in a 44-year-old woman with Staphylococcus aureus bacteremia and cerebrovascular embolism. In two occasions, transthoracic echocardiography failed to show the mural abscess in this patient. Because of the aggressive nature of primary mural endocarditis, early use of transesophageal echocardiography is recommended in patients with Staphylococcal bacteremia and suspected endocarditis even in the absence of valvular abnormalities detectable by the transthoracic approach.
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PMID:Primary left ventricular mural endocarditis diagnosed by transesophageal echocardiography. 754 95

Serious staphylococcal infections remain a significant clinical problem despite advances in antibacterial therapy. Resistance to penicillin is common and methicillin-resistant staphylococci have become troublesome nosocomial pathogens in many institutions. Penicillinase-resistant penicillins (e.g. flucloxacillin, cloxacillin and oxacillin) are the preferred drugs for all methicillin-susceptible staphylococcal infections, although first generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, clindamycin, and occasionally erythromycin and cotrimoxazole (trimethoprim/sulfamethoxazole) are alternatives. Serious infections due to methicillin-resistant staphylococci should be treated with parenteral vancomycin. Teicoplanin, where available, is a suitable alternative. Rifampicin, fusidic acid and some fluoroquinolones may be useful oral alternatives, although resistance develops rapidly if they are used as single agents. Cotrimoxazole and minocycline have also proven useful when strains are susceptible. Staphylococcal toxic shock syndrome often requires aggressive resuscitation and anti-staphylococcal therapy for generally 10 to 14 days. Staphylococcus aureus bacteraemia remains a life-threatening condition which, in all but one-third of cases, is associated with an underlying septic focus such as endocarditis, osteomyelitis or occult abscess. Differentiating between complicated and uncomplicated bacteraemia is critical to define the appropriate treatment regimen. Serious staphylococcal sepsis such as endocarditis and acute osteomyelitis generally requires prolonged (4 to 6 weeks) antibiotic treatment. Coagulase-negative staphylococci are the commonest cause of prosthetic device infection, and generally require prolonged therapy with an agent to which they have proven to be sensitive, e.g. a penicillinase-resistant penicillin or vancomycin. Removal of infected foreign or prosthetic material, and drainage of deep collections remain a critical aspect of all therapy.
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PMID:Optimum treatment of staphylococcal infections. 768 6

The number of Staphylococcus aureus bacteremia cases has increased annually in Denmark during the latest decades. This increase has occurred among older patients with hospital-acquired bacteremia. Methicillin-resistance, which earlier was a property of strains of the 83A phage-complex, has nearly disappeared, while the frequency of penicillin-resistance has increased. Today both the phage-type pattern and antibiotic resistance are nearly similar for strains from hospital-acquired and community-acquired cases. In hospitals the frequency of bacteremia after postoperative wound infections has decreased, while cases associated with intravascular catheters has increased, and these infections are now the most common cause of hospital-acquired S. aureus bacteremia. Endocarditis is most commonly found in community-acquired cases without an identified primary focus in patients between 21-50 years. Also hematogenous osteomyelitis is most common in community-acquired cases, but these infections have changed to having a high predilection for the vertebral column, and the prevalence of chronic cases has decreased.
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PMID:Epidemiology of Staphylococcus aureus bacteremia in Denmark. 783 97

Among 3394 patients with Staphylococcus aureus bacteraemia from the years 1986-89, 88 patients were found whose intravenous catheter and blood grew organisms of the same phage type. Strains of phage type 95 were more frequent among the patients with confirmed catheter-related bacteraemia than among other bacteraemia cases. Strains with particular phage-type patterns occurring with increasing frequency in Denmark during recent years also occurred with significantly higher frequencies among the confirmed catheter-related bacteraemias. No major differences in antibiotic resistance were observed. Patients with catheter-related bacteraemia had, in spite of a higher frequency of underlying diseases, a lower mortality compared with other bacteraemia patients, and endocarditis occurred less frequently (2% vs. 6%). Among 201 S. aureus isolates from catheters in 1988 only strains of group I occurred with increased frequency. The possible role of catheters as selection pressure on the S. aureus population is discussed.
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PMID:Catheter-related Staphylococcus aureus infections. 809 16

An unusual case of menstrual toxic shock syndrome (TSS) is described in which the patient had persistent Staphylococcus aureus bacteremia despite therapy with iv cloxacillin. There was no demonstrable evidence of endocarditis or an abscess as a focus for persisting bacteremia. The strain of S. aureus isolated from the blood and vagina produced toxic shock syndrome toxin 1 (TSST-1) and enterotoxin A. Bacteremia occurs uncommonly in association with TSS; however, aggressive high-dose antistaphylococcal therapy should be instituted for treating this possible complication.
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PMID:Menstrual toxic shock syndrome complicated by persistent bacteremia: case report and review. 844 9

Sixty episodes of community-acquired Staphylococcus aureus bacteremia (SaCB) were prospectively analyzed between January 1990 and December 1994. The mean age of the patients was 78 (1-180) months. Thirteen (55%) of the children had underlying disease, the most frequent one being acute lymphoblastic leukemia. In 83% of the episodes a primary site of infection was observed. Skin and osteoarticular foci were the most frequently encountered. Only two patients had endocarditis. Arterial hypotension was detected in 17% of the patients. Ninety two percent of S. aureus isolated were penicillin-resistant. Only two strains were methicillin-resistant. In 24 (40%) episodes where metastatic foci were detected, osteoarticular infections were predominant. Mortality due to SaCB was 20%. Multivariate analysis by logistic regression revealed that arterial hypotension (RR = 24.8; 4.77-128.9), leucopenia (RR = 10.3; 1.25-86.2) and non hemato-oncologic diseases (RR = 10.0; 1.09-92.2) correlated with high mortality rate (p = < 0.001).
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PMID:[Community-acquired Staphylococcus aureus bacteremia in children: analysis of mortality risk factors]. 964 Jul 60

The aim of this prospective study was to evaluate if patients with endocarditis display a more extensive endothelial activation than those with bacteraemia but without endocarditis. Sixty-five patients with blood culture-verified Staphylococcus aureus bacteraemia were included and serum samples collected on admission were analysed by enzyme immunoassays. Elevated serum concentrations of adhesion molecules were found in most of the patients with S. aureus bacteraemia. Patients with endocarditis (n = 15) showed significantly higher serum E-selectin (median 156 ng/ml) and VCAM-1 (median 1745 ng/ml) concentrations compared with those with S. aureus bacteraemia but without endocarditis (80 ng/ml and 1172 ng/ml, respectively; P = 0.01 and P = 0.003). No significant difference was found between the groups concerning ICAM-1 (median 451 ng/ml versus 522 ng/ml). In addition, serum tumour necrosis factor-alpha (TNF-alpha) concentrations were significantly correlated (P < 0.002) to serum levels of E-selectin, ICAM-1 and VCAM-1.
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PMID:Adhesion molecules (E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)) in sera from patients with Staphylococcus aureus bacteraemia with or without endocarditis. 1059 59

A total of 101 episodes of Staphylococcus aureus bacteraemia were evaluated for the factors influencing prognosis. The overall episode mortality rate and the mortality rate due to bacteraemia were 43.6 and 21.8%, respectively. Episodes with methicillin-resistant S. aureus (MRSA) bacteraemia had a significantly higher overall mortality rate (58.7 vs. 30.9%, P<0.01) and mortality rate due to bacteraemia (32.6 vs. 12.7%, P=0.02) when compared with episodes caused by methicillin-sensitive S. aureus (MSSA). The multivariate analysis revealed that the underlying disease, presence of infective endocarditis, septic shock and central intravascular catheter and methicillin resistance of S. aureus were the five independent risk factors associated with a higher mortality rate.
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PMID:Risk factors influencing clinical outcome in Staphylococcus aureus bacteraemia in a Turkish University Hospital. 1071 2


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