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

Rarely is endocarditis attributed to the species of Hemophilus. Most frequently implicated are H aphrophilus and H parainfluenzae, but H influenzae also is seen. We report six cases of endocarditis due to H aphrophilus or H parainfluenzae and review the literature. Emboli to skin, lungs, kidneys, spleen, brain, and other organs are common complications, and acute glomerulonephritis and meningitis often occur. Ampicillin is the mainstay of antimicrobial therapy for patients whose isolates are sensitive to it, but the duration of antimicrobial therapy necessary for eradication of the infection is not clear. Studies of antimicrobial synergism are warranted in instances of endocarditis caused by ampicilin- or penicillin-resistant strains of Hemophilus, or when patients are allergic to penicillin; in these instances, combination antimicrobial therapy must be given when bactericidal synergism can be demonstrated. Intensive management of complications caused by embolization is crucial to patient survival.
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PMID:Hemophilus endocarditis: new cases, literature review and recommendations for management. 30 87

A case of Haemophilus parainfluenzae bacterial endocarditis is described. This is the first reported case of endocarditis caused by ampicillin resistant H parainfluenzae. Resistance was not mediated by a beta lactamase. Ampicillin therapy had not controlled the infection, but a four-week course of chloramphenicol was curative. Several general therapeutic points are discussed.
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PMID:Ampicillin resistant Haemophilus parainfluenzae endocarditis. 51 70

The pharmacokinetics of ampicillin and sulbactam, a new beta-lactamase inhibitor, were investigated in 16 patients undergoing prosthetic cardiac valve insertion. The combination of 2 g of ampicillin and 1 g of sulbactam was administered as perioperative prophylaxis intravenously over 3 to 6 days. Several serum pharmacokinetic parameters were similar for the two drugs after three intravenous doses were given to patients following surgery. The half-lives of elimination of ampicillin and sulbactam were 79 +/- 4.9 and 88 +/- 5.9 min, the volumes of distribution were 15.6 +/- 1.4 and 17.7 +/- 1.2 liters/70 kg, and the total plasma clearances were 144.4 +/- 14.5 and 147.2 +/- 14.5 ml/min, respectively. The peak concentrations of ampicillin and sulbactam in serum were calculated to be 134.3 +/- 1.3 and 58.3 +/- 1.2 micrograms/ml, respectively. Ampicillin and sulbactam rapidly penetrated from the blood into various tissues collected during heart surgery, such as sternum, pericardium, myocardium, and endocardium. The concentrations of ampicillin in tissue ranged from 17.8 +/- 9.9 to 50 +/- 29.5 micrograms/g, and those of sulbactam in tissue ranged from 8.8 +/- 6.2 to 19.6 +/- 10.1 micrograms/g. The concentrations of ampicillin and sulbactam in serum and tissue also apparently exceeded the MICs against most beta-lactamase-producing bacteria usually involved in postoperative wound infections and prosthetic valve endocarditis. The ratio of the two compounds was approximately 2:1 in serum and in the various tissues affected by the operation. The pharmacokinetics of ampicillin and sulbactam in serum and investigated tissues suggest that the combination of the two beta-lactams will be effective in the perioperative prophylaxis of patients undergoing heart surgery.
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PMID:Pharmacokinetics of ampicillin and sulbactam in patients undergoing heart surgery. 195 46

Several antimicrobial regimens were evaluated in the treatment of experimental enterococcal endocarditis due to a beta-lactamase-producing, highly gentamicin-resistant strain of Enterococcus faecalis. Ampicillin alone cleared bacteremia in the majority of rats and reduced titers of bacteria within vegetations (6.84 versus 8.80 log10 CFU/g in controls) but did not sterilize valves. Ampicillin-sulbactam combinations, vancomycin, daptomycin, and imipenem each reduced residual bacterial titers within vegetations to 4.01 log10 CFU/g or less; in 26 to 43% of animals receiving 5 days of therapy, titers of bacteria were reduced to undetectable levels. In a separate experiment, rats received ampicillin-sulbactam, daptomycin, or vancomycin for 10 days and were then observed for 10 days after termination of therapy for evidence of relapse. In surviving rats, valves remained sterile in four of five rats treated with ampicillin-sulbactam, in five of seven treated with daptomycin, but in only one of eight receiving vancomycin.
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PMID:Treatment of experimental endocarditis caused by a beta-lactamase-producing strain of Enterococcus faecalis with high-level resistance to gentamicin. 250 3

Thirty cases of Listeria monocytogenes septicaemia occurred in Denmark between 1981 and 1986. The aim of this study was to consider the treatment of these patients, 18 males and 12 females aged from 20 to 87 years: average (AV) 65 years. One or more predisposing factors (PF) were found in 90% of the patients, mainly cancer (16), steroid treatment (12), cirrhosis and/or alcoholism (8), and diabetes mellitus (3). Follow-up varied from 3 months to 5 years. Ampicillin (AMP) alone or with an aminoglycoside (AMI) was the treatment in 9 and 16 cases, respectively. One patient was successfully treated with penicillin G and another received oral co-trimoxazol after recovered with carbenicillin plus AMI. AMP doses were lower than used in listerial meningitis (AV 5 g/day vs. 16 g/day), and the duration was variable: from one to 21 days (AV 8 days). The mortality rate was 50%. No significant differences between survivors and non-survivors were observed either in the antibiotic treatment (doses, duration, administration, and use of AMI), or the number and kind of PF found. The cause of septicaemia could not be established in most cases but 3 endocarditis, 2 perianal abscesses and one pericarditis were found in the non-survivors. Pulmonary involvement was present in 13 patients and CNS infection suspected in 10. Early diagnosis, adequate doses and duration of antibiotic treatment, and the use of drugs capable to penetrate purulent collections (microabscess and abscess formations) should improve the prognosis of L. monocytogenes septicaemia.
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PMID:The treatment of Listeria monocytogenes septicaemia. 263 5

We reviewed the clinical and laboratory presentation of Haemophilus species bacteremia at our institution, with special attention to predisposing and prognostic factors. Of 36 cases, 18 presented with pneumonia, 1 with cellulitis, and another with sinusitis. No cases of meningitis or endocarditis were detected. Most episodes were caused by Haemophilus influenzae, and the overall response rate to treatment was 72%. Factors including chronic obstructive pulmonary disease, alcoholism, prior splenectomy, and neutropenia did not play an important role in these patients' infections. Most of the isolates serotyped were found to be nontypable. The occurrence of ampicillin resistance was 6% throughout the study. Ampicillin, chloramphenicol, and second-generation cephalosporins were all effective therapeutic regimens. Bacteremia due to Haemophilus species remains an uncommon infection in patients with cancer, despite the predominance of traditional predisposing factors.
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PMID:Haemophilus species bacteremia in patients with cancer. A 13-year experience. 273 Feb 52

Intermittent administration of ampicillin alone has resulted in high failure rates in previously described animal models of enterococcal endocarditis. We developed a rat model of enterococcal endocarditis which permits comparison of continuous intravenous infusion of ampicillin with intramuscular therapy. Continuous low-dose ampicillin infusion (450 mg/kg [body weight] per day) was compared with the same dose given intramuscularly in three divided doses and with high-dose infusion (4.5 g/kg per day) of the drug. For the infecting strain of Streptococcus faecalis, the MIC and MBC were 1 microgram/ml. Mean ampicillin levels in serum were 53.9 +/- 4.8 (peak) and less than 1 (trough), 8.7 +/- 1.4, and 244 +/- 29 micrograms/ml for intramuscular, low-dose, and high-dose regimens, respectively. Ampicillin infusion therapy significantly increased the survival rate and sterilization of blood cultures. Continuous infusions were superior to intermittent therapy in eradicating bacteremia. After 5 days of treatment, low-dose ampicillin infusion was more effective than intermittent therapy in sterilizing cardiac vegetations (P less than 0.01). Continuous-infusion therapy at either dose was significantly more effective than intramuscular injection in reducing bacterial titers in cardiac vegetations (5.4 +/- 1.0 log10 CFU/g [low dose], 4.8 +/- 0.3 log10 CFU/g [high dose], and 7.7 +/- 0.3 log10 CFU/g [intramuscular]). However, no statistically significant advantage was found for high-dose compared with low-dose ampicillin infusion in lowering bacterial titers in vegetations (P greater than 0.3).
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PMID:Continuous-infusion ampicillin therapy of enterococcal endocarditis in rats. 310 45

Three fatal cases of listerial endocarditis were studied. The first case occurred in an apparently healthy 58-year-old man, who presented with symptoms of pneumonitis. The second case developed in a 75-year-old woman with adenocarcinoma of the lung and aortic stenosis. In the third patient, an 83-year-old woman, aortic valve vegetations with perforations were found at necropsy. A colonic adenocarcinoma was found in the first and third cases. Ampicillin, alone or with an aminoglycoside, was the antibiotic used. Urgent valve replacement was performed in the first case. Listeria monocytogenes was isolated from blood cultures in all three cases. A review of 41 other patients with listerial endocarditis showed a nonspecific clinical picture, but septic complications occurred in one-half of the cases. Thirty-nine patients had at least one predisposing factor, which was underlying heart disease in 25 cases. The mortality rate was 48%.
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PMID:Fatal endocarditis due to Listeria monocytogenes. 329 64

Despite the availability of numerous beta-lactam antibiotics, benzylpenicillin remains the most important beta-lactam antibiotic in the treatment of bacterial endocarditis. Penicillin alone and in combination with an aminoglycoside is effective in the treatment of endocarditis due to all streptococci, Streptococcus pneumoniae, penicillin-susceptible Staphylococcus aureus, Haemophilus aprophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Listeria monocytogenes. Oral phenoxymethylpenicillin in combination with streptomycin is effective in treating endocarditis due to viridans streptococci. Ampicillin is effective in endocarditis due to Haemophilus influenzae, H. parainfluenzae, H. paraphrophilus, Listeria monocytogenes and Escherichia coli. Oral amoxicillin with gentamicin has been used to treat enterococcal endocarditis. The penicillinase-resistant penicillins are effective in treating S. aureus endocarditis. Carbenicillin or ticarcillin in combination with tobramycin or gentamicin are used to treat endocarditis due to Serratia marcescens and Pseudomonas aeruginosa. The use of piperacillin in combination with tobramycin against P. aeruginosa endocarditis has been associated with failure and increased resistance. The cephalosporins have been used to treat endocarditis caused by susceptible organisms. There have been few data on the efficacy of the newer cephalosporins in treating endocarditis. They have been used to treat septicaemia due to susceptible organisms with good results.
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PMID:The use of beta-lactam antibiotics in the treatment of septicaemia and endocarditis. 644 9

A case of acute aortic valve Erysipelothrix rhusiopathiae endocarditis is reported in a 48 year old fisherman with no history of initial erysipelar and requiring emergency aortic valve replacement 48 hours after starting antibiotic therapy with Ampicillin and Gentamicin. The outcome was favourable. In the light of 32 of the 40 previously published cases, the authors discuss the difficulty in identifying the causal organism, the main epidemiological features, the occupational association of these infections, the incidence of primary infections, the involvement of the aortic valve and the more serious nature of the disease compared to non-D streptococcal endocarditis, despite high sensitivity to Penicillin G.
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PMID:[Erysipelothrix rhusiopathiae endocarditis. A case report and review of the literature]. 668 53


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