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

Operative mortality, recurrence and late survival were analyzed in 64 patients operated for prosthetic valve endocarditis (PVE) between 1980-1992: age, sex, drug addiction, early vs. late PVE, micro-organism, sepsis at the time of surgery, indication for surgery, prosthesis type and site were assessed as potential risk factors. PVE developed after replacement for native valve endocarditis in 23 cases (Group A) and after replacement for other valvular disease in 41 patients (Group B). The overall operative mortality was 28.1% (18/64); 16 operative survivors underwent a second reoperation with eight operative deaths (50%), four of them a third procedure with two operative deaths (50%), and one patient had a successful fourth intervention. Female sex (p = 0.015) and sepsis at the time of surgery (p = 0.013), were found statistically significant independent predictors of operative mortality. Age (p:0.002), mechanical valves (p:0.05) and mitral position (p:0.03) were significant predictors of PVE recurrence. None of the risk factors considered were significant for late survival. Twelve-year actuarial survival for all patients was 52.11 +/- 10%; it was 33.3 +/- 13% for Group A and 73.4 +/- 14% for Group B (p:0.04). Patients with mechanical valves and bioprostheses had an actuarial survival of 39.5 +/- 15% and 48.5 +/- 14% respectively with no significant difference. PVE is still a challenging complication of heart valve replacement; patients with PVE after native valve endocarditis have a very poor outcome. Prompt prosthetic replacement is recommended whenever the antibiotic treatment is unsuccessful and/or the hemodynamic status deteriorates.
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PMID:Long term results of surgery for prosthetic valve endocarditis. 801 34

The aim of antibiotic therapy in bacterial endocarditis is to sterilize infected cardiac structures and vegetations. Pathogenic organisms are present in great numbers within vegetations and abscess-formations. They exist in a state of reduced metabolic activity so that they are able to tolerate even therapeutic levels of bactericidal antibiotic concentrations. Because vegetations are normally devoid of blood vessels, impregnation with antibiotic agents is poor. Effective therapy is greatly improved by identification of the pathogenic organism involved. With very few exceptions isolation is possible prior to initiation of antibiotic therapy. In acute cases with signs of septicemia, however, therapy cannot await results of bacterial testing. In these patients selection of antibiotic agents is based on associated evidence such as the presence of a prosthetic heart valve or intravenous drug addiction. Once the pathogen has been identified antibacterial therapy should be tailored according to the test results. Bactericidal antibiotics should always be preferred over bacteriostatic agents; in many cases adequate bactericidal levels can only be achieved by combining various agents, such as ampicillin and gentamycin for treatment of enterococcal endocarditis. Dosing intervals must take into account the resulting trough levels, which should always exceed the minimal inhibitory concentrations for a specific bacterial strain. In cases with inadequate control of infection, congestive heart failure resulting from valve dysfunction, and abscess formation, surgery as the only means of eradicating the infection and restoring cardiac performance should not be delayed.
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PMID:[Antibiotic therapy of infectious endocarditis (when, with what drug, how long?]. 814 65

Reoperation after a surgical procedure for prosthetic valve endocarditis (PVE) is often required due to the existence of either septic recurrence or sterile para-prosthetic leak (PL). The aim of this study was to assess the risk to patients of undergoing a second operation after PVE. Thirty-six patients underwent operation for active PVE at our institution. The operative mortality rate was 11.2%. Among the 32 patients discharged, six underwent a second operation (in two cases due to persisting sepsis) and two underwent a third procedure. Multivariate analysis demonstrated increased probability of further operation for: inability to identify the infecting organism (p = 0.005); drug addiction (p = 0.007); existence of annular abscess (p = 0.016); and early occurrence of PVE (p = 0.018). In the case of mechanical prostheses, PVE was not an independent risk factor (p = 0.206). Nonetheless, 58.3% of patients with mechanical prostheses compared with 5.3% of those with bioprostheses showed annular abscesses, while 41.7% of the former versus 5.6% of the latter suffered one or more recurrences.
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PMID:Risk of recurrence after reoperation for prosthetic valve endocarditis. 904 86

A case of right-sided endocarditis due to Salmonella typhi is described involving a native tricuspid valve in a child who was human immunodeficiency virus negative with no evidence of intravenous drug addiction. The patient had classic features of typhoid and tricuspid regurgitation without clinical evidence of bacterial endocarditis. Transthoracic echocardiography confirmed the tricuspid regurgitation. However, transesophageal echocardiography was necessary to demonstrate the vegetations affecting the tricuspid valve leaflets that made possible the diagnosis of endocarditis. The infection was cured with intravenous ceftriaxone and oral amoxicillin.
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PMID:Right-sided endocarditis due to Salmonella typhi. 932 94

All series of infective endocarditis had a variable proportion of cases without an etiologic agent because all cultures were negative. New microbiologic techniques have permitted the discovery of the role of many microorganisms in infective endocarditis. C. burnetii is an increasing causative agent of subacute infective endocarditis. In the diagnosis, to the detection of antiphase-I antibodies, immunohistochemical, molecular techniques and cellular cultures have been added. Total cure is difficult to obtain. The combination of doxicicline plus ciprofloxacin for at least 3 years has been proposed as the treatment of choice. Surgery must be reserved for patients with cardiac insufficiency. Less than 2% of cases of acute brucellosis are complicate with infective endocarditis. Infective endocarditis produces serious and rapid valvular destruction with high mortality rates if valve surgery is not performed. For medical treatment at least 3 active agents are required. Bartonella has recently been described as an etiologic agent of infective endocarditis. It mainly affects to homeless people living in poor hygienic conditions. The aortic valve is most commonly involved and, frequently, valve insufficiency requires valve replacement. Blood culture isolation needs long incubation periods. Parenteral nutrition, immunosuppression, wide spectrum antibiotic regimens, intravenous drug addiction and cardiovascular surgery are risk factors previously described in the development of fungal endocarditis. C. albicans and Aspergillus spp. are most frequent etiologic agents. Infective endocarditis should be suspected in any patient with systemic fungal disease. Blood cultures are often negative except for Candida spp. Peripheral emboli and large vegetations are frequent. Mortality is high, antifungal therapy combined with surgery is the treatment of choice. Legionella, Mycoplasma, Chlamydia, Mycobacteria, viruses are potential agents of infective endocarditis, and difficult to diagnose because of special culture requirements. Epidemiological clues, serologic and molecular techniques and blood cultures could identify them.
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PMID:[Infective endocarditis caused by unusual microorganisms]. 965 53

During the years 1980-1994, 84 patients were treated in our institution due to suspected infective endocarditis (IE). Seventy-one of these episodes occurring in 71 patients, classified definite or possible according to the Duke criteria, were retrospectively analyzed in this study. There were 52 cases of native valve endocarditis, 7 cases of early prosthetic valve endocarditis, and 12 cases of late prosthetic valve endocarditis. The incidence of IE did not change significantly during the study period. The overall mortality rate was 15%. Only one case of drug addiction appeared in our series despite its growing frequency in Israel. Rheumatic heart disease remained the main underlying cardiac condition and Streptococcus viridans remained the most common pathogen. Streptococcus bovis was found to be a significant pathogen causing IE in our patient population, while Staphylococcus aureus appeared to be less frequent. The Duke criteria significantly classified a greater proportion of cases as definitive, as opposed to the von Reyn criteria. Fewer cases were rejected by the Duke criteria, especially culture-negative cases, and those without histopathological confirmation. Application of the Duke criteria permits a more consistent approach to the diagnosis of IE, even in a non-drug-addict patient population.
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PMID:Infective endocarditis in a tertiary-care hospital in southern Israel. 1064 29

This report describes a successful operative case of tricuspid infective endocarditis in a drug addict. A 24-year-old man with a history of drug addiction (6 months) complained of general fatigue and high fever. Echocardiography showed a large vegetation attached to the tricuspid valve and severe tricuspid regurgitation. Blood cultures revealed septicemia due to methicillin sensitive Staphylococcus aureus. He was treated for about 1 week with intravenous antibiotics. However, subsequent severe heart failure necessitated emergency operation. The tricuspid valve was replaced with Carpentier-Edwards bioprosthesis because of severe destruction of the tricuspid valve. The postoperative course was uneventful and he has remained free from endocarditis for 15 months after surgery.
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PMID:[A case of tricuspid infective endocarditis in a drug addict]. 1071 5

Isolated native non-rheumatic fungal tricuspid valve endocarditis is rarely described in the absence of intravenous drug addiction or use of intracardiac catheters or concomitant cardiac anomalies. Herein, we report a case of tricuspid valve endocarditis in a non-addict, which was successfully treated with valve replacement. The cultures of blood and vegetations revealed Candida Pichia Etschelsii. Candida tricuspid endocarditis must be considered in any patient with tricuspid vegetation, regardless of predisposing factors. </hea
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PMID:Candida Tricuspid Endocarditis in a Non-addict. 1117 87

The authors observed 68 drug addict in-patients, who received treatment for the pneumonia at the Primorski Regional Clinical Hospital and Vladivostok Municipal Clinical Hospital No. 1. The article details the specific features of the pneumonia of these in-patients. It was distinguished the 3 groups of hospital patients with the following characteristic features: patients with the respiratory distress syndrome of the adults; patients with the primary infective endocarditis mainly with the damage of respiratory (right) heart; patients with non-specific pneumonia. The peculiarities of the clinical process with the X-Ray pictures of the disease were also presented. The article identifies the acute beginning of the disease; the strongly pronounced intoxication syndrome; the usual cases of the late going to hospital of those patients; the extensiveness of the damage; the occurrence of the following complications at the early stage: pulmonary destruction, exudative pleurisy, empyema; the long period of the disease process; the development of the extensive pulmonary fibrosis. It was identified the 33.7% lethality for these groups of in-patients, while the average lethality of the in patients treated for pneumonia was 3.3% for the same period of time. The complicated pneumonia process of young patients with the infective endocarditis with damages of respiratory (right) hearts let us suppose their drug addiction.
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PMID:[Clinical and X-ray features of pneumonia in drug addicts]. 1133 71

A 21-year-old man who had a history of intravenous drug addiction was admitted with complaints of high fever and a productive cough. Chest CT on admission showed multiple consolidations, and pneumonia was initially diagnosed and treated. Because echocardiography after admission showed vegetation, with no bacteriological findings, attached to the tricuspid valve, right-sided infective endocarditis was diagnosed. After antibiotic therapy was changed, his fever was reduced and the inflammatory findings were eliminated. In the western world, most cases of right-side infective endocarditis are caused by drug addicts, but in Japan, this disease is very rare. Right-side infective endocarditis in drug addicts causes a high rate of pulmonary complications, in particular, septic pulmonary embolism. Many drug addicts suffering from pulmonary complications may consult doctors, but if the latter are not well-informed about this disease, it may not be possible to give an accurate diagnosis or proper treatment.
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PMID:[A case of infective endocarditis accompanied with pulmonary complications in a drug addict]. 1232 40


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