Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The in vitro activity, pharmacokinetics, adverse effects, and clinical efficacy of cefonicid are reviewed. Also discussed are formulary considerations and bacterial resistance. Cefonicid, an investigational agent near approval, is less active than other currently available first- and second-generation cephalosporins against gram-positive cocci, particularly Staphylococcus. Cefonicid and cefamandole have similar activity that is superior to the first-generation cephalosporins against Escherichia coli, Klebsiella, Citrobacter spp., Enterobacter spp., indole-negative Proteus spp., and Providencia spp. Organisms such as Serratia marcescens, Acinetobacter, Pseudomonas, and Bacteroides fragilis are resistant to cefonicid. Despite a small volume of distribution and high protein binding, cefonicid achieves high tissue concentrations. Approximately 90% of an administered dose is excreted unchanged in the urine, and the elimination half-life is approximately four hours. Cefonicid is usually well tolerated. In treating skin infections, cefonicid was usually less effective than cefazolin against Staphylococcus aureus. In genitourinary infections, cefonicid 1 g daily (as the sodium salt) in a single dose has shown comparable efficacy to cefamandole or amoxicillin given in multiple daily doses. Based on available data, single daily dosing of cefonicid in the therapy of Staph. aureus endocarditis is not effective. In studies of patients undergoing hysterectomy, cesarean section, cholecystectomy, and colorectal surgery, cefonicid 1 g given as a single preoperative dose has produced results comparable with those of cefoxitin 1-2 g (as the sodium salt) given preoperatively and for several doses postoperatively. The major clinical uses of cefonicid will probably be as a possible cost-reducing alternative (based on a single daily dose) to currently available first- and second-generation cephalosporins for the treatment of community-acquired pneumonia and infections caused by enteric organisms. It may also be useful as a possible cost-reducing alternative to cefoxitin for prophylaxis in hysterectomy and biliary tract surgery.
 ...
PMID:Review of cefonicid, a long-acting cephalosporin. 636 14

We describe the third documented case of Listeria monocytogenes pericarditis. This occurred in a 54-year-old woman with end-stage renal failure on chronic hemodialysis. Her initial presentation was one of Listeria monocytogenes bacteremia, which apparently responded to two weeks of cefazolin sodium therapy. After cessation of therapy the patient returned with Listeria monocytogenes pericarditis, this responding completely to four weeks of erythromycin therapy. We could not rule out coexisting endocarditis, especially since we found high levels of circulating immune complexes which subsided as the patient's condition improved. Further immunological studies displayed a decrease in cellular functions. This case illustrates the importance of Listeria monocytogenes as a human pathogen in immunocompromised patients. Listeria should be included among the potential causative agents of pericarditis in such patients.
 ...
PMID:Listeria monocytogenes pericarditis in a chronically hemodialyzed patient. 646 92

Endocarditis and unilateral endophthalmitis due to Actinobacillus actinomycetemcomitans heart disease. The ocular infection was notable for its localized presentation and slow evolution. Treatment with systemic, subconjunctival, and topical gentamicin sulfate and ampicillin sodium achieved 20/20 acuity with a residual chorioretinal scar in the nasal periphery. Intravitreal injection of the organism into a rabbit confirmed its minimal pathogenicity within the eye. This organism must now be considered in patients with differential diagnosis of endogenous endophthalmitis complicating endocarditis and septicemia.
 ...
PMID:Actinobacillus actinomycetemcomitans endophthalmitis with subacute endocarditis. 660 7

Four cases of cardiac valve replacement in patients with chronic renal failure are reported. The problem of surgery under cardiopulmonary bypass in these patients are discussed with respect to 36 other previously reported cases. Of this lot of 40 cases, 33 (82,5 p.100) underwent valve replacement (21 aortic, 9 mitral, 1 mitral and aortic, and 2 unspecified), 26 (79 p.100) for valvular lesions due to infective endocarditis. Coronary revascularisation was performed in 6 cases (15 p.100) and pericardectomy in 1 case. Operative mortality was within acceptable limits (4 deaths) ; the overall mortality was 10 cases. Valvular lesions due to endocarditis were the main cause of death (9 cases). A session of haemodialysis is performed 12 hours preoperatively. Post-operative care is directed to the control of the fluid balance, the neutralisation of metabolic acidosis with alkaline fluids (sodium lactate) and the correction of hyperkalaemia by kayexalate. In addition, dialysis is required between the 24 th post-operative hour and the 3 rd day. The main indications for cardiac surgery under cardiopulmonary bypass in patients with renal failure are valve replacement for infective endocarditis where the operative decision should be made early on, and aorto-coronary bypass grafting, the selection criteria for which should be very strict.
 ...
PMID:[Cardiac surgery under extracorporeal circulation in patients with chronic renal insufficiency. Apropos of 4 cases and review of the literature]. 677 27

The role of blood monocytes in the attachment of streptococci to endocardial vegetations was investigated in an experimental Streptococcus sanguis endocarditis by depletion of blood monocytes with the cytostatic drug VP 16-213 alone and combined with anticoagulant treatment with warfarin sodium. The numbers of streptococci in the vegetations of control, monocytopenic, and monocytopenic/anticoagulated rabbits were comparable. In the vegetations streptococci were found mainly in areas free of phagocytic cells. It is concluded that streptococci do not have to be phagocytosed by monocytes in the circulation before being deposited on the surface of endocardial vegetations. Even the vegetations of intensively anticoagulated/monocytopenic rabbits showed colonies of streptococci embedded in polymerized fibrin and cellular material, this matrix possibly being held together by streptococcal dextran.
 ...
PMID:Effects of monocytopenia and anticoagulation in experimental Streptococcus sanguis endocarditis. 737 72

We have treated 35 cases of staphylococcal endocarditis in 33 patients with intravenous followed by oral antimicrobial therapy. All patients had three or more blood cultures positive for Staphylococcus aureus, and all had cardiac murmurs characteristic of valvular insufficiency. The mean total duration of antimicrobial therapy was 42.4 d, consisting of a mean of 16.4 d of intravenous therapy followed by a mean of 26 d of oral therapy. Intravenous antimicrobial therapy included sodium nafcillin (32 cases; mean dose 9.2 g daily) and clindamycin (three cases). Oral therapy included dicloxacillin or oxacillin (30 cases; mean dose 4.5 g daily), clindamycin (four cases), and potassium penicillin V (one case). Serum bactericidal titers using the blood culture isolates showed similar activity with both intravenous and oral drugs. All patients treated with this sequential intravenous and oral regimen were cured. A regimen of initial intravenous followed by oral antimicrobial therapy, monitored with serum antibacterial activity studies, is a safe, effective, well-tolerated, and economical treatment for staphylococcal endocarditis.
 ...
PMID:Intravenous followed by oral antimicrobial therapy for staphylococcal endocarditis. 744 89

Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Growth of the child and adequate anticoagulation level are the main concerns when valve replacement is performed in the pediatric age. We reviewed the case histories of 29 children who underwent valve replacement with mechanical prosthesis from 1979 to 1994 in order to evaluate the performance of mechanical valves in this age group. Age ranged from two years to 12 years (mean 8.97 +/- 3.7 years). A total of 31 valves were implanted; 17 children had atrioventricular (Av) valve replacement (15 mitral, one common Av (heterotaxia), one tricuspid (systemic ventricle)), 11 children had aortic valve replacement (one redo), and one child had double mitral and aortic valves implanted. The etiology of valvular disease was congenital in 34.5%, degenerative in 17.2%, rheumatic in 24%, infective in 13.8%, and prosthetic dysfunction in 10.3%. Of the 29 patients, eight had undergone previous procedures and eight required simultaneous repair of associated lesions. There were three hospital deaths (10.3%). The mean follow up was 5.79 +/- 5.36 years. There were four late deaths (2.66%/patient-year) at a mean of 37 months from surgery. All operative survivors received oral anticoagulation with sodium warfarin. No thromboembolic event or bleeding occurred, no endocarditis developed in any patient; one reoperation was performed for patient/prosthesis mismatch. Mechanical valves offer excellent hemodynamic performances and a low rate of thromboembolism and/or bleeding in our experience, and are our first choice for heart valve replacement in children when reparative surgery is not feasible.
 ...
PMID:Mechanical valve replacement under 12 years of age: 15 years of experience. 765 89

Certain strains of Streptococcus sanguis adhere selectively to human platelets (Adh+) and, in plasma, induce them to aggregate into in vitro thrombi (Agg+). The induction of aggregation is mediated by the platelet aggregation-associated protein (PAAP) expressed on the cell surface of the streptococcus. In endocarditis, expression of PAAP may be regulated by association with host proteins on damaged heart valves. To begin to test this hypothesis, three strains of S. sanguis were each cultured in the presence or absence of collagens (types I to X), laminin, or PAAP-derived peptide preparations. After harvesting and washing, the platelet-interactive phenotype of strains 133-79 (Adh+ Agg+), L74 (Adh+ Agg-), and 10556 (Adh- Agg-) was unchanged. The cells from each culture were then digested mildly with trypsin to isolate PAAP. PAAP isolated from strain 133-79 (Adh+ Agg+) grown in the absence of added collagen, other proteins, or peptides inhibited platelet aggregation in response to untreated cells of S. sanguis. Platelet aggregation was induced immediately, however, by PAAP from strain 133-79 isolated after growth in the presence of 300 nM type I collagen, while lower concentrations yielded protein fragments that potentiated the response to intact cells. Aggregation-inducing PAAP could be removed by anti-PAAP (PGEQGPK) immunoaffinity chromatography, but only inhibitory activity could be recovered. The agonist effect of PAAP was not associated with collagen itself, since the PAAP preparations did not contain detectable amounts of hydroxyproline. PAAP antigens isolated from cells grown in the presence and absence of collagen had similar apparent molecular weights, as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western immunoblotting. When electrophoresis was performed under nondenaturing conditions, however, PAAP isolated from cells grown in type I collagen migrated more slowly. Strain L74 grown with type I collagen yielded tryptic fragments of proteins that inhibited aggregation significantly better than control peptides (no collagen in the medium). Strain 10556 was apparently unaffected by growth in type I collagen. The effect of type I collagen was somewhat unique. Growth in the presence of collagen types II to VI (300 nM) yielded protein fragments that potentiated without inducing platelet aggregation, while other collagens, laminin, and PAAP-derived peptides did not affect platelet aggregation. These results suggest that growth in the presence of type I collagen and, perhaps, collagens II to VI alters the expression and conformation of PAAP in certain strains of S. sanguis.
 ...
PMID:Altered expression of the platelet aggregation-associated protein from Streptococcus sanguis after growth in the presence of collagen. 786 31

From December 1980 through April 1992, 20 children 2 to 18 years of age underwent valve replacement with the St. Jude Medical prosthesis. Nine children underwent aortic valve replacement, eight underwent mitral valve replacement, and the three children with corrected transposition underwent left-sided tricuspid valve replacement. Of the 20 patients, 17 underwent 23 previous procedures. All but five patients received adequate adult-sized prostheses. There was one hospital death (5%). All hospital survivors received maintenance doses of sodium warfarin. Follow-up was 100% complete with a total of 106 patient-years. There were no late deaths and no thromboembolic or anticoagulant-related bleeding. None of the patients had prosthetic valve endocarditis or a periprosthetic leak. Reoperation was not required in any patient. The great majority of the children (16 of 19) were in New York Heart Association functional class I, two were in class II, and one with complex congenital heart disease was in class III at the time this article was written. This study illustrates the excellent results of cardiac valve replacement with the St. Jude Medical prosthesis in children and confirms the safety of sodium warfarin in this age group.
 ...
PMID:St. Jude Medical prosthesis in children. 802 79

We reported 18 consecutive patients with penicillin-sensitive streptococcal IE (infective endocarditis). Twelve were successfully treated with a 2-wk course of penicillin G sodium (PGS) and gentamicin, the dosages of which were guided by minimal inhibitory concentration, minimal bactericidal concentration and serum bactericidal titer (SBT), followed by another six who were treated equally successfully with a one week PGS followed by a second week of amoxycillin together with the usual 2 wks of gentamicin. It is believed that oral therapy, after the initial 2-3 days of parenteral antimicrobial, may be adequate for penicillin-sensitive streptococcal IE.
 ...
PMID:Streptococcal endocarditis treated with two-week antibiotic regimen: preliminary report of a partial oral regimen. 808 37


<< Previous 1 2 3 4 5 6 7 8 Next >>