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

We have reviewed experience with aminoglycosides in cardiac surgical prophylaxis from 1984 to 1989. In the first two years, prospectively randomized trials (517 patients) allowed comparison of tobramycin (three-day course) with a non-toxic antibiotic, teicoplanin. A significant excess rise in serum creatinine was present at the end of the first postoperative week in patients given tobramycin (165 vs 149 patients, 95% CI 3-17 microM. P less than 0.01, which was most marked in ten oliguric patients with trough serum levels over 2 mg/l (95% CI 7-52 microM). However, no patient needed haemodialysis and only one case of possible ototoxicity was identified. During the next three years, of 912 patients given two to three days gentamicin, 29 patients were shown to have potentially toxic serum levels and oliguria. Three individual cases are described, including one of ototoxicity and one of nephrotoxicity neeeding haemodialysis. The hazards of aminoglycoside toxicity are probably small compared with the failure of other antibiotics to cover staphylococci that may later cause wound infection or endocarditis. However, surgeons should probably be advised to check the aminoglycoside level in all patients on the first post-operative day.
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PMID:Aminoglycoside toxicity following antibiotic prophylaxis in cardiac surgery. 207 53

A successfully treated case of fungal endocarditis for native aortic and mitral valves was reported. A 56-year-old male was admitted with high fever, dyspnea on exertion and oliguria. Infective endocarditis, urinary tract infection and acute renal failure were most suspected by findings of physical examination and urinalysis, but repeated blood cultures were sterile. In the course of treatment for urinary tract infection, high fever and leucocytosis recurred and then blood cultures were positive for Candida parapsilosis. Despite intensive antifungal therapy, blood cultures were consistently positive for Candida parapsilosis. Echocardiogram showed vegetation on the aortic and mitral valve. Aortic and mitral valve replacements with prosthetic heart valves were carried out on April, 1986. Cultures of the vegetation on the mitral valve revealed Candida parapsilosis. Intensive administration of antifungal drug was done postoperatively. Postoperative course was uneventful and he was discharged in excellent condition on the 84th postoperative day. During follow-up period of 1 year, the patient has been doing very well and there were no sign of recurrence of fungal infections.
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PMID:[A case report of successful surgical treatment of fungal endocarditis]. 277 72

A 77-year-old man was referred to our hospital on October 2, 1995 because of fever and left mandibular pain beginning three months before admission. His blood pressure was 90/60 mmHg. A grade III/VI pansystolic murmur was heard over the cardiac apex. The liver was palpable 4 cm below the right costal margin. Lower extremity edema was present bilaterally. White blood cell count was 7,030/mm3 and C-reactive protein was 2.54. Enterococcus faecalis was identified by the blood culture. The diagnosis was infective endocarditis associated with congestive heart failure. He was treated by administration of antibiotics and diuretics. Mitral valve replacement and tricuspid annuloplasty were performed on October 19 because of progressive congestive heart failure with oliguria. The surgical intervention was successful despite the presence of multiple risk factors: high age, emergency, congestive heart failure and active infection. His condition improved dramatically after the operation and he was discharged two months later. Surgical intervention for infective endocarditis was a significant high-risk procedure in this uncontrollable and elderly case. This successful result suggests the indication for the timing of surgery.
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PMID:[An elderly patient with infectious endocarditis complicated with congestive heart failure due to mitral and tricuspid regurgitation]. 921 Nov 14