Endocarditis infecciosa de válvula nativa: factores asociados a resultados adversos / Mortality predictors in patients with native valve infec tive endocarditis

Resumen Introducción : La mortalidad de la endocarditis infec ciosa (EI) en Argentina continúa siendo elevada. El obje tivo del trabajo fue describir las características clínicas e identificar factores asociados a mortalidad en pacientes con EI de válvula nativa. Métodos : Estudio de cohorte retrospectiva que inclu yó pacientes adultos con diagnóstico de EI de válvula nativa internados durante 2011-2021. Resultados : Se incluyeron 129 pacientes con una edad promedio de 66±17 años. El organismo responsa ble más frecuente (38.8%, n = 50) fue el Staphylococcus aureus (SA). El 63.6% presentó criterios de indicación quirúrgica. La mortalidad durante la internación fue del 22.5%. En el análisis multivariado que incluyó índice de comorbilidad Charlson, infección por SA y la presencia de criterios de indicación quirúrgica, se observó un OR ajustado de mortalidad de 1.32 (IC95% 1.10-1.57; p = 0.003), 2.75 (IC95% 1.11-6.8; p = 0.028) y 4.14 (IC95% 1.34-12; p = 0.013), respectivamente. En el análisis mul tivariado para mortalidad alejada que agregó el criterio quirúrgico y la realización de cirugía durante la inter nación, se observó un OR ajustado de 1.62 (IC95% 1.31- 2.00; p < 001), 0.77 (IC95% 0.31-1.93; p = 0.58), 7.49 (IC95% 2.07-27.07; p = 0.002) y 0.21 (IC95% 0.06-0.70; p = 0.01), respectivamente. Conclusiones : La mortalidad de la EI se asoció al grado de comorbilidad previa, a la forma de presenta ción y, en relación inversa, a la realización oportuna del tratamiento quirúrgico.

Abstract Introduction : Mortality of infective endocarditis (IE) in Argentina continues to be high. The aim objective was to describe the clinical characteristics and identify factors associated with in-hospital and long-term mortality in patients with native valve IE. Methods : Retrospective cohort study including adult patients with diagnosis of native valve IE, hospitalized during 2011-2021. Results : A total of 129 patients with a mean age of 66±17 years were included. The most frequent respon sible organism was Staphylococcus aureus (SA) (38.8%). Surgical indication criteria were present in 63.6% of the patients. Mortality during hospitalization was 22.5% .In the multivariate analysis that included Charlson comorbidity index, SA infection and the presence of surgical indication criteria, an adjusted OR of mor tality of 1.32 (95%CI 1.10-1.57; p = 0.003), 2.75 (95%CI 1.11-6.8; p = 0.028) and 4.14 (95%CI 1.34-12; p = 0.013), respectively, was observed. In the multivariate analysis for long term mortality, that added surgical indication criteria and the performance of surgery during hospitalization, an adjusted OR of 1.62 (CI95% 1.31-2.00; p<001), 0.77 (95%CI 0.31-1.93; p = 0.58), 7.49 (95%CI 2.07-27.07; p = 0.002) and 0.21 (95%CI 0.06-0.70; p = 0.01), respec tively, was observed. Conclusions : Mortality in IE was associated with the degree of previous comorbidity, with the presence of surgical indication criteria and, inversely, with the timely completion of surgical treatment.

Concomitant Transcatheter Transfemoral Double Native Valve Replacement for Severe Aortic Stenosis and Severe Mitral Stenosis with Mitral Annular Calcification

Concomitant mitral and aortic valve stenosis in a patient with mitral annular calcification and porcelain aorta poses a unique problem to the surgical team. Transcatheter aortic and mitral valve replacements in native valves offer a viable option for such selected group of patients. We present the case of a 54-year-old male who presented with severe aortic stenosis (AS) and severe mitral stenosis (MS) but was deemed high risk for surgery owing to intense calcification of the aorta and mitral annular calcification, and successfully underwent transcatheter double native valve replacement.

Antibiotic management of native mitral valve infectious endocarditis in patient with unaffected prosthetic aortic valve: A case report

Infectious endocarditis is a rare but feared condition, most frequently caused by Staphylococcus aureus. We describe the case of an 81-year-old male patient presenting with intermittent fever and dyspnea. Cardiac evaluation with transthoracic echocardiogram showed the presence of heart failure with suspicion of endocarditis. Consequently, a transesophageal echocardiogram demonstrated vegetation on the native mitral valve with an unaffected prosthetic aortic valve. Blood cultures were positive for S. aureus. Literature concerning endocarditis originating from a native valve in patients with a prosthetic valve is limited. We applied a new treatment scheme consisting of intravenous floxapen 12 g/24 h in a continuous infusion combined with intravenous rifampicin 2×300 mg daily for a duration of 6 weeks resulting in complete regression of the vegetation. In addition, we were successful in preventing disease propagation to the prosthetic valve. There is a need for more adequate research to prove the prophylactic benefit of this treatment.valve

Tratamiento quirúrgico de la endocarditis infecciosa activa / Active infective endocarditis: surgical treatment

Resumen: La endocarditis infecciosa, la infección cardiovascular en general, es una enfermedad médico-quirúrgica compleja que requiere un tratamiento multidisciplinario precoz, específico y agresivo. A pesar de los avances médicos, ésta sigue siendo una enfermedad con una morbi-mortalidad elevada, por lo que el tratamiento antibiótico se complementa en un 40-50% de los pacientes mediante intervención quirúrgica. Por lo tanto, es necesario conocer las opciones que pueden llegar a ser utilizadas para extirpar el tejido infectado. El objetivo de este trabajo es discutir aspectos de interés en la cirugía de la endocarditis infecciosa.

Abstract: Infective endocarditis (IE) is a complex disease that requires a multidisciplinary approach and early and aggressive treatment. Despite médical and surgical advances, this disease still has high morbidity and mortality. The antibiotic treatment is complemented in 40-50% of the cases with surgical intervention. Thus, it is useful to be aware of the possibilities that might be contemplated in order to excise the infected tissues. The aim of this work is to discuss current surgical aspects of interest in the surgery IE.

Características clínicas, bacteriológicas y demográficas de las endocarditis infecciosas / Clinical, bacteriological and demographic characteristics of infective endocarditis

RESUMEN Introducción: la endocarditis infecciosa, es una enfermedad con una diversidad de presentación clínica, de elevada morbimortalidad, a pesar de los adelantos en el diagnóstico y en la eficacia de antibióticos. Objetivos: describir las características clínicas, bacteriológicas, demográficas y mortalidad asociada de los pacientes con endocarditis infecciosa, internados en el Hospital Nacional, Itauguá-Paraguay de 2016 a 2018. Metodología: estudio observacional descriptivo de corte transverso, de pacientes con endocarditis infecciosa, según los criterios de Duke modificados. Resultados: se incluyeron 50 pacientes; edad 43 ± 16 años, 70 % fueron varones, la procedencia (38 %) del Departamento Central, ingresaron por fiebre 42 (84 %); se encontró que 44 (88 %) de los casos sobre válvulas nativas, las más afectadas la mitral 20 (46 %) seguida de la aórtica 16 (36 %) siendo en este grupo Staphylococcus aureus (36 %) el germen prevalente, además 6 (12 %) de los casos sobre válvulas protésicas, siendo en este grupo Staphylococcus spp (46 %) el germen prevalente, se encontró que eran portadores de catéter para hemodiálisis 8 (16 %) de los pacientes, 17 (39 %) con hemocultivos negativos. Presentaron complicaciones (52 %) de estas fueron cardíacas (24 %), neurológicas (18 %), embolia pulmonar (6 %), renal (4 %) se constató desenlace fatal (44 %) de los casos, siendo las de peor pronóstico las complicaciones neurológicas. Conclusiones: la endocarditis infecciosa según los hallazgos, continúa siendo una enfermedad frecuente con complicaciones graves y de elevada mortalidad, un desafío; identificación de factores de riesgo abriendo un escenario en el que sería importante trabajar y promover las medidas de prevención, insistir en el uso de fístulas arterio venosas para hemodiálisis en pacientes ambulatorios. El germen más frecuente el Staphylococcus spp.

ABSTRACT Introduction: infective endocarditisis a disease with a diversity of clinical presentation, high morbidity and mortality, a weight of advances in diagnosis and in the efficacy of antibiotics. Objectives: to describe the clinical, bacteriological, demographic and associated mortality characteristics of patients with infective endocarditis, admitted to the Hospital Nacional, Itauguá-Paraguay from 2016 to 2018. Methodology: observational, descriptive, cross-sectional study of patients with infective endocarditisis, according to modified Duke criteria Results: 50 patients were included; age 43 ± 16 years, 70 % were men, the origin (38 %) of the Departamento Central, 42 entered for fever (84 %); It was found that 44 (88 %) of the cases on native valves, the most affected were the mitral 20 (46 %) followed by the aortic 16 (36 %), with Staphylococcus aureus (36 %) being the prevalent germ in this group, in addition 6 (12 %) of the cases on prosthetic valves, being in this group Staphylococcus spp (46 %) the prevalent germ, it was found that they were catheter carriers for hemodialysis 8 (16 %) of the patients, 17 (39 %) with blood cultures negatives. They presented complications (52 %) of these were cardiac (24 %), neurological (18 %), pulmonary embolism (6 %), renal (4 %) and a fatal outcome (44 %) of the cases was found, being those with the worst prognosis neurological complications. Conclusions: infective endocarditisis, according to the findings, continues to be a frequent disease with serious complications and high deaths, a challenge; Identification of risk factors to open a scenario in which it would be important to work and promote preventive measures, insist on the use of arteriovenous fistulas for hemodialysis in outpatients. The most frequent germ Staphylococcus spp.

Fever work-up unfolds a rare diagnosis of native valve endocarditis caused by Mycobacterium abscessus

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

Endocarditis infecciosa nativa en pediatría: enfoque clínico cardiológico / Native valve infective endocarditis in children: From the focus of clinical cardiology

Objetivos: Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y métodos: Se evaluaron 176 p con EIN, divididos en grupo I: <3meses (27p) y grupo II: >3meses (149p). Resultados: Grupo I: el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal: infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II: el 57% presentaba cardiopatía previa. Microorganismos prevalentes: S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos: embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR:7,50 ­IC95%:1,77­31,69) y a INC (OR:4,2-IC95%:1,16­15,29). Conclusiones: La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.

Objectives: To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and methods: 176 p with NVE were evaluated and divided into group I: <3 months (27p) and group II: >3 months (149p). Results: Group I: 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event: Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II: 57% had previous heart disease. Prevalent microorganisms: S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events: systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR:7.50 ­ 95% CI:1.77­31.69) and UCI (OR:4.2 -95% CI:1.16­15.29). Conclusions: NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)

Endocarditis infecciosa por bacilos gram negativos no HACEK. Experiencia en un centro de alta complejidad de la República Argentina (1998-2016) / Infective endocarditis due to non-HACEK gram-negative bacilli in a Level III cardiovascular center in Argentina (1998-2016)

Los bacilos gram negativos (BGN) que no pertenecen al grupo HACEK son una causa infrecuente de endocarditis infecciosa. Los aspectos epidemiológicos, diagnósticos y pronósticos de esta entidad son poco conocidos y la experiencia aún es limitada. Nuestros objetivos fueron analizar las características clínicas y microbiológicas de las endocarditis infecciosas (EI) por BGN no HACEK diagnosticadas en un centro de alta complejidad de Argentina en el período 1998-2016 y conocer su evolución hospitalaria, a fin de compararlas con las EI debidas a otros microorganismos.

Non-HACEK Gram-negative bacilli are a rare cause of infective endocarditis. Epidemiological, diagnostic and prognostic aspects of this entity are little known, and there is limited experience. The aim of this study was to analyze the clinical, microbiological and in-hospital outcomes of non-HACEK Gram negative bacilli endocarditis and to compare them with those due to other microorganisms.

Endocarditis por Escherichia coli de válvula nativa asociada a dispositivos cardíacos implantables / Endocarditis due to Escherichia coli of a native valve associated with implantable cardiac devices

Resumen La endocarditis bacteriana es una enfermedad con alta morbimortalidad, causada principalmente por cocos gram positivos, menos frecuentemente por organismos del grupo HACEK e inusualmente por otras enterobacterias. La Escherichia coli es la principal causa de bacteriemia nosocomial, pero en la literatura existen reportes de no más de 50 casos de endocarditis por este microorganismo. El tracto genitourinario es la fuente usual del compromiso infeccioso favorecido por factores de riesgo como diabetes mellitus, cardiopatía estructural, antecedente de malignidad, uso de drogas intravenosas, material protésico y edad avanzada. La E. coli en válvulas nativas presenta tropismo por válvulas del lado izquierdo. Así mismo, se han descrito presentaciones inusuales en relación con material protésico y organismos resistentes, aunque es mucho más frecuente encontrar cepas silvestres. La endocarditis por E. coli se asocia fuertemente con complicaciones locales y necesidad de manejo quirúrgico. La filogenética de las cepas de E. coli aisladas en infecciones endocárdicas y los factores de virulencia que le permiten adherirse a este tejido en presencia o no de material protésico, han sido bastante discutidas. Se expone un caso de endocarditis asociada a electrodo de marcapasos por E. coli y posteriormente se hace una revisión de la literatura disponible sobre esta enfermedad.

Abstract Bacterial endocarditis is a disease with high morbidity and mortality, and is mainly caused by gram positive cocci, less frequently due to organisms of the HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella), and unusually by other bacteria. Escherichia coli is the principal cause of nosocomial bacteraemia, but there are no more than 50 cases reported in the literature of due to this microorganism. The genitourinary tract is the usual sources of infectious compromises favoured by risk factors such as, diabetes mellitus, structural heart disease, history of malignancy, use of intravenous drugs, prosthetic material, and advanced age. E. coli in native valves have tropism for valves of the left side. Furthermore, unusual presentations have been described as regards prosthetic material and resistant organism, although it is much more common to find wild strains. Endocarditis due to E. coli is strongly associated with local complications, and a need for surgical management. The phylogenetics of the E. coli isolated in endocardial infections, and the virulence factors that enable it to adhere to this tissue whether in the presence or not of prosthetic material, has been widely discussed. A case is presented of endocarditis associated with a pacemaker electrode due to E. coli, followed by a review of the available literature on this disease.

Long-term outcomes following mitral valvuloplasty versus replacement for native valve endocarditis: A case control study / 中国胸心血管外科临床杂志

@#Objective    To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE). Methods    Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results    There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006). Conclusion    MVP is associated with better outcomes than MVR in the patients  with NVE; generalizing MVP technique in the patients with NVE is needed.

Native-valve endocarditis caused by Achromobacter xylosoxidans: a case report and review of literature

Achromobacter xylosoxidans is a Gram-negative aerobic bacterium first described by Yabuuchi and Ohyama in 1971. A. xylosoxidans is frequently found in aquatic environments. Abdominal, urinary tract, ocular, pneumonia, meningitis, and osteomyelitis are the most common infections. Infective endocarditis is rare. As far as we know, until now, only 19 cases have been described, including this current report. We report the case of community-acquired native valve endocarditis caused by A. xylosoxidans in an elderly patient without a concomitant diagnosis of a malignancy or any known immunodeficiency. The patient presented with a 2-month history of fever, weight loss, and progressive dyspnea. On physical examination, mitral and aortic murmurs were present, along with Janeway's lesions, and a positive blood culture for A. xylosoxidans. The transesophageal echocardiogram showed vegetation in the aortic valve, which was consistent with the diagnosis of infective endocarditis

Clinical analysis of therapies for native valve endocarditis / 军事医学

Objective To summarize experience in treating patients with native value endocarditis ( NVE) , and discuss the effect of timing of surgery on the infection control , cardiac function recovery and long-term mortality among patients . Methods Eighty NVE cases with antibiotic treatment were recruited between January 2006 and May 2013 .According to the timing of surgery, the subjects were divided into the early surgery group (38 cases) and the late surgery group (42 ca-ses) .The infection-related markers and cardiac function indexes before and after surgery , and 1-year, 3-year and 5-year mortality after surgery were analyzed .Results The infection control and recovery of cardiac function in the early surgery group were better than in the late surgery group (P<0.05).The difference in 3-year and 5-year mortalities between the two groups was significant .Conclusions For NVE patients with routine antibiotics treatment , the surgical effect and long-term survival rate are much better in the early surgery group than in the late surgery group .

Acute Upper Limb Ischemia Suspected to Have Originated from Staphylococcus Epidermidis Native Valve Endocarditis / 대한내과학회지

We report a case of acute upper limb ischemia suspected to have originated from methicillin-resistant Staphylococcus epidermidis native valve endocarditis in a 57-year-old man who had complained of sudden-onset fever and pain in the right hand. 3D computed tomography of the right upper extremity detected a thrombus occluding the brachial artery. Echocardiography showed a large vegetation on the aortic valve. Thus, we suspected, clinically, brachial artery occlusion by septic emboli originating from a large vegetation of the aortic valve. The patient was treated with intravenous antibiotics for the suspected methicillin-resistant Staphylococcus epidermidis-native valve endocarditis with a combination of percutaneous aspiration thromboembolectomy and selective intra-arterial thrombolysis for acute thromboembolic occlusion in the right upper limb. The large vegetation of the aortic valve resolved without surgery and aortic regurgitation improved. The patient recovered uneventfully with no complications, including septic embolism, over the following 11 months.

A Case of Native Valve Infective Endocarditis Caused by Bacillus cereus

Bacillus cereus is a ubiquitous organism that often contaminates microbiological cultures but rarely causes serious infections in humans. It is the causative organism of infective endocarditis (IE), a disease typically associated with intravenous (IV) drug abusers. Thus, almost all reported cases have involved the tricuspid valve. We report a case of native mitral valve (MV) IE caused by B. cereus in a 54 year-old man with moderate MV regurgitation but no apparent history of IV drug use. He presented with fever and dyspnea on exertion, symptoms which had been ongoing for 2 months. B. cereus infection was determined by blood culture examination. A transthoracic echocardiography revealed that mobile vegetations had attached to the MV. He was treated with IV antibiotics for a total of 6 weeks and received MV replacement surgery. He has maintained a good clinical recovery without complications since discharge.

A Case of Native Valve Endocarditis due to Staphylococcus epidermidis

Although Staphylococcus epidermidis is a frequent cause of prosthetic valve endocarditis (PVE), it is regarded as a rare pathogen of native valve endocarditis (NVE). We report a case of NVE caused by methicillin-resistant S. epidermidis in a 62-year-old man. The bacterium was isolated from blood and tissue culture. The patient underwent valve replacement due to heart failure and was successfully treated by surgery and vancomycin administration for 7 weeks.

A Case of Native Valve Endocarditis due to Staphylococcus epidermidis

Although Staphylococcus epidermidis is a frequent cause of prosthetic valve endocarditis (PVE), it is regarded as a rare pathogen of native valve endocarditis (NVE). We report a case of NVE caused by methicillin-resistant S. epidermidis in a 62-year-old man. The bacterium was isolated from blood and tissue culture. The patient underwent valve replacement due to heart failure and was successfully treated by surgery and vancomycin administration for 7 weeks.

Analysis of Bacterium and Clinical Feature in Prosthetic Valve Endocarditis and Native Valve Endocarditis / 中国循环杂志

Objective: To analysis the clinical characteristic and pathogenic bacterium of infective endocarditis (IE),and to compare the pathogenic microorganism and vegetation localization between the prosthetic valve endocarditis (PVE) and the native valve endocarditis (NVE).Methods: The data was collected from 266 in-patients who fulfilled Duke Criteria for IE from May 2003 to May 2008 in our hospital.The demographics and clinical data were analyzed retrospectively.Results: There were 243/266 of IE patients suffered from basic heart disease,among them,101 patients with congenital heart disease,77 patients with non-rheumatic valvular heart disease,62 with rheumatic heart disease and 3 with other heart disease.There were 218 (82%) patients with identified vegetation,and the most common vegetation localized at aortic valve,mitral valve,and aortic plus mitral valve in turn.Bacterial cultures were positive in 49.5% of patients.The proportion of Gram-Negative bacillus and Fungi infection had risen in IE.Detection rate of vegetation was lower in PVE patients than that in NVE patients (P<0.01).However,the positive bacterial culture rate was higher in PVE than in NVE (P<0.01).Streptococcus,coagulase negative staphylococcus,gram-negative bacteria showed significant difference between the two groups (P<0.05).The spectrum of microorganism was different between the early and the late PVE patients.The in-hospital mortality rate of PVE was higher than NVE.Conclusion: The spectrum and pathogenic bacterium of IE had changed obviously during the past years.Early diagnosis,bacterial culture with correct antibacterial treatment,transesophageal echocardiography,and active prevention of nosocomial infection should be essential for the disease control.

Enterococcus gallinarum native valve endocarditis in an immunocompetent patient / 대한내과학회지

Motile Enterococci, including Enterococcus gallinarum and Enterococcus casseliflavus/flavescens are rarely encountered in human clinical specimens. Enterococcus gallinarum is intrinsically resistant to low levels of vancomycin and causes bacteremia or infection among immunosuppressed or chronically ill patients, sometimes through nosocomial acquisition. We report a case of native valve endocarditis caused by Enterococcus gallinarum in an immunocompetent patient without any medical history.

Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide / Nocardia endocarditis in aortic and tricuspid native valves

La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrobiana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses.

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-yearold man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.

Comparison of Epidemiological and Clinical Characteristics of Native Valve Endocarditis between 1979~1984 and 1991~1996 / 감염

BACKGROUND: The changes in the epidemiology of native valve endocarditis have been known in western countries recent years due to the decrease in the inci-dence of rheumatic heart disease, increased longevity of patients with valvular or congenital heart diseases, and the increase in degenerative heart disease due to the in-crease in the average life span of the general popula-tion. In this study, we analyzed and compared the epide-miological and clinical characteristics of patients with na-tive valvular endocarditis fro two different time periods. METHODS: We compared native valve endocarditis patients diagnosed from 1979 - 1984(group I) with those diagnosed from 1991 - 1996(group II). We used modified Duke' s criteria for the diagnosis and statistical analysis was done using SPSS window program. RESULTS: In our study, mean age of the population was higher in group II and significantly larger number of patients were over the age of 50 in group II. Involve-ment of multiple valves with vegetations and peri-valvular abscess were found more frequently in group II. Also, significantly higher percentage of patients from group II underwent surgical treatment. CONCLUSION: The results of this study suggest that the epidemiolocaland clinical characteristics of infective endocarsitis in Korea may change to resemble those in western countries. Further studies regarding this subject are needed.