Endocarditis infecciosa con compromiso bivalvular por Erysipelothrix rhusiopathiae / Infective endocarditis with bivalvular involvement due to Erysipelothrix rhusiopathiae. Report of one case

The microbiology of infective endocarditis (IE) varies in different populations and depends on public health conditions and socioeconomic status. In low-income countries, oral Streptococci affect hearts with rheumatic valve disease in patients with poor dentition. In high-income countries, Staphylococci are the most common cause, affecting elderly and immunocompromised patients, or those with invasive devices. Gram - positive bacili as IE pathogens are unusual. Erysipelothrix rhusiopathiae is a Gram positive bacili. It causes skin diseases in domestic and farm animals, but in humans, is a very unusual pathogen. This infection is considered a zoonosis, since most cases are linked to direct contact with vector animals. We report a 62 year-old male patient with a history of exposure to animals, who developed an infective endocarditis with severe bivalve regurgitation and septic shock, requiring antimicrobials and surgical resolution. Erysipelothrix rhusiopathiae was isolated from blood and valve vegetation cultures. The patient had a successful evolution and was discharged from the hospital.

Prótesis Starr-Edwards vigente y funcional por más de 40 años / Starr-Edwards prosthesis current and functional for more than 40 years

INTRODUCCIÓN. Las enfermedades valvulares cardíacas han sido un foco de estudio y de evolución continua, pues existen grupos de pacientes seleccionados en quienes el cambio valvular es parte de su terapéutica. En 1960 surgió el modelo de prótesis de válvula en forma de esfera enjaulada de Albert Starr y Lowell Edwards. El diseño fue perfeccionándose y es usado hasta la actualidad ya que muestra resultados clínicos aceptables. OBJETIVO. Describir el caso de un paciente portador, de uno de los primeros prototipos de prótesis valvular cardiaca metálica Starr-Edwards vigente y funcional por más de 40 años. CASO CLÍNICO. Paciente masculino con prótesis Starr-Edwards en posición aórtica, quien hasta la fecha lleva más de 40 años de uso, mantiene la clase funcional II de la New York Heart Association, realizando anticoagulación con Warfarina así como controles estrictos del índice internacional normalizado. DISCUSIÓN. Es primordial la evaluación y seguimiento de portadores de prótesis valvular para analizar anifestaciones clínicas (disnea) y hallazgos en los exámenes de laboratorio o de imagen (ecografía) para el control clínico y hemodinámica del paciente, con la intención de contemplar circunstancias que podrían determinar la nueva intervención valvular. CONCLUSIONES. Las válvulas metálicas, en particular las del tipo de prótesis de Starr-Edwards presentan alto riesgo trombótico por lo que es recomendable mantener anticoagulación plena evitando valores de índice internacional normalizado muy elevados que podrían crear escenarios de eventos hemorrágicos. Varios pacientes portadores de una de las prótesis más antiguas como es el modelo la prótesis Starr-Edwards, pueden llegar a tener una mejor supervivencia y resultados clínicos aceptables.

INTRODUCTION. Cardiac valve diseases have been a focus of study and continuous evolution, since there are selected groups of patients in whom valve replacement is part of their therapy. In 1960, the caged sphere valve prosthesis model of Albert Starr and Lowell Edwards was developed. The design was refined and is still used today because it shows acceptable clinical results. OBJECTIVE. To describe the case of a patient with one of the first prototypes of Starr- Edwards metallic heart valve prosthesis, which has been in use and functional for more than 40 years. CLINICAL CASE. Male patient with Starr-Edwards prosthesis in aortic position, who to date has been used for more than 40 years, maintains functional class II of the New York Heart Association, performing anticoagulation with Warfarin as well as strict controls of the international normalized index. DISCUSSION. The evaluation and follow-up of valve prosthesis carriers is essential to analyze clinical manifestations (dyspnea) and findings in laboratory or imaging tests (ultrasound) for the clinical and hemodynamic control of the patient, with the intention of contemplating circumstances that could determine the new valve intervention. CONCLUSIONS. Metallic valves, particularly those of the Starr-Edwards prosthesis type, present a high thrombotic risk and it is therefore advisable to maintain full anticoagulation, avoiding very high values of the international normalized index that could create scenarios of hemorrhagic events. Several patients carrying one of the older prostheses, such as the Starr-Edwards prosthesis model, may have better survival and acceptable clinical results.

Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

Estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo / Long-term temporary cardiac pacing with active lead and external permanent pacemaker

INTRODUCCIÓN. La estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo es una técnica recientemente incluida en las guías de manejo de bradicardias sintomáticas. CASOS CLÍNICOS. Se describen 4 casos de pacientes sometidos a estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo de la unidad de Hemodinámica del Hospital de Especialidades Carlos Andrade Marín, con indicaciones diversas. DISCUSIÓN. El tiempo medio de permanencia con el cable activo y el marcapaso externalizado fue 23 días. No hubo complicaciones del procedimiento. Un paciente falleció por causas no relacionadas con la estimulación y 2 se recuperaron en sus domicilios. CONCLUSIÓN. La técnica de estimulación temporal utilizando marcapasos permanentes recuperados se muestra extremadamente útil para mantener un marcapaso cardíaco seguro, incluso ambulatorio y por largo tiempo, hasta el implante de dispositivos definitivos. Su limitación es la factibilidad de hacerlo solo en centros de tercer nivel.

INTRODUCTION. Long-duration temporary cardiac pacing with active lead and permanent external pacemaker is a technique recently included in the guidelines for the management of symptomatic bradycardias. CLINICAL CASES. We describe 4 cases of patients who underwent long-duration temporary cardiac pacing with active lead and external permanent pacemaker at the Hemodynamics Unit of the Hospital de Especialidades Carlos Andrade Marín, with different indications. DISCUSSION. The mean length of stay with the active lead and externalized pacemaker was 23 days. There were no procedural complications. One patient died of causes unrelated to pacing and 2 recovered at home. CONCLUSIONS. The technique of temporary pacing using retrieved permanent pacemakers is extremely useful for maintaining safe cardiac pacing, even on an outpatient basis and for a long period of time, until implantation of definitive devices. Its limitation is the feasibility of doing it only in third level centers.

Infective endocarditis in pregnancy: A case report / 北京大学学报(医学版)

Infective endocarditis in pregnancy is extremely rare in clinical practice. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. Due to increased blood volume and hemodynamic changes in late pregnancy, endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism, respiratory, cardiac arrest and sudden death may occur in pregnant women, the fetus can suffer from intrauterine distress and stillbirth at any time, leading to adverse outcomes for pregnant women and fetuses. The disease is dangerous and difficult to treat, which seriously threatens the lives of mothers and babies. Early diagnosis and reasonable treatment can effectively improve the prognosis of patients. The most important method for the treatment of infective endocarditis requires early, adequate, long-term and combined antibiotic therapy. Moreover, surgical controversies regarding indication and timing of treatment exist, especially in pregnancy. In terms of the timing of termination of pregnancy, the timing of cardiac surgery, and the method of surgery, individualized programs must be adopted. A pregnant woman with 30+5 weeks of gestation is reported. She was admitted to hospital due to intermittent chest tightness, suffocation and fever, with grade Ⅲ cardiac insufficiency. Imaging revealed large mitral valve vegetation, 22.0 mm×4.1 mm and 22.0 mm×5.1 mm, respectively, and severe valve regurgitation. Mitral valve perforation was more likely, blood culture suggested Staphylococcus epidermidis infection, after antibiotic conservative treatment, the effect was poor. After the joint consultation including cardiology, neonatology, interventional vascular surgery, anesthesiology, and obstetrics, the combined operation of obstetrics and cardiac surgery was performed in time. The heart was blocked for 60 minutes, the bleeding was 1 200 mL, the newborn was mildly asphyxiated after birth, and the birth weight was 1 890 g. Nine days after the operation, the patient was discharged from the hospital, and the newborn was discharged with the weight of 2 020 g. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child. An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication, informed consent of the patient, and concerted action among the specialists involved.

Ecocardiografia Tridimensional na avaliação de endocardite de válvula nativa: um relato de caso e semelhança entre achados ecocardiográficos e cirúrgicos / Three-Dimensional transesophageal echocardiography in native valve endocarditis: a case report and similarities between echocardiography and surgical findings

A endocardite de valva nativa é uma doença incomum, complexa, e de alta morbimortalidade. Requer tratamento clínico prolongado, com várias complicações possíveis, e o seu tratamento cirúrgico é complexo e tecnicamente difícil. O ecocardiograma transtorácico e transesofágico são fundamentais na avaliação da doença, inclusive seus achados são parte dos critérios diagnósticos de endocardite. Adicionalmente, o ecocardiograma tridimensional (3D) contribui com detalhamento anatômico na avaliação das estruturas cardíacas acometidas pela doença. Mostramos um caso em que é ilustrado o papel da ecocardiografia no diagnóstico e avaliação de complicações da endocardite, comparando as imagens do ecocardiograma 3D pré-operatórias, com os achados durante o ato cirúrgico. (AU)

Native valve bacterial endocarditis is an uncommon, complex, and highly morbid disease that requires prolonged clinical treatment and challenging surgical interventions. Transthoracic and transesophageal echocardiography are paramount assessment tools whose findings are included in the diagnostic criteria. Three-dimensional echocardiography shows further realistic imaging details. Here we present a case demonstrating the role of echocardiography in the diagnosis of endocarditis and the identification of its complications to show how advanced imaging techniques may have a remarkable resemblance with in vivo surgical findings. (AU)

Tumor de colon como hallazgo incidental en un paciente con endocarditis por Streptococcus gallolyticus: experiencia desde la práctica clínica / Colon tumor as an incidental finding in a patient with endocarditis due to Streptococcus gallolyticus: experience from clinical practice

El Streptococcus gallolyticus del colon. La fisiopatología que explica este fenómeno implica el aumento local de niveles de lactato puede presentarse como el germen causal de la endocarditis infecciosa en pacientes con lesiones premalignas y malignas, colágeno, fibrinógeno y fibronectina secundario a la hiperactividad metabólica tumoral que genera un ambiente adecuado para el crecimiento y adhesión bacteriana a la pared intestinal y posterior translocación al torrente sanguíneo. Simultáneamente, se establece la presencia de infecciones secundarias por la formación de biofilms, tanto a nivel colorrectal como en válvulas cardíacas. El objetivo del manuscrito es un mapeo en la literatura médica disponible sobre la correlación entre la endocarditis por Streptococcus gallolyticus y las lesiones premalignas y malignas de colon. Simultáneamente, exponer la experiencia clínica de un hombre de 82 años con diagnóstico de endocarditis por Streptococcus gallolyticus y el hallazgo incidental de pólipos adenomatosos del colon(AU)

Streptococcus gallolyticus can present as the causative germ of infective endocarditis in patients with premalignant and malignant lesions of the colon. The pathophysiology that explains this phenomenon involves the local increase in lactate that can be presented as the causal germ of infective endocarditis in patients with premalignant and malignant lesions, collagen, fibrinogen, and fibronectin levels secondary to tumor metabolic hyperactivity, which generates a suitable environment for bacterial growth and adhesion to the intestinal wall and subsequent translocation to the bloodstream. Simultaneously, the presence of secondary infections is established due to the formation of biofilms, both at the colorectal level and in the heart valves. The objective of the manuscript is a mapping in the available medical literature on the correlation between Streptococcus gallolyticus endocarditis and premalignant and malignant colonic lesions. Simultaneously, to present the clinical experience of an 82-year-old man diagnosed with Streptococcus gallolyticus endocarditis and the incidental finding of adenomatous polyps of the colon(AU)

Melioidosis con endocarditis de válvula protésica / Prosthetic valve endocarditis in melioidosis: case report

Resumen La melioidosis es endémica en varias regiones, con predominio en el Sudeste Asiático, norte de Australia, sur de Asia, China y Taiwán. En Sudamérica, Colombia ocupa el segundo lugar de casos de melioidosis, después de Brasil. Su manifestación clínica es variable, desde una infección asintomática hasta un compromiso multiorgánico con formación de abscesos múltiples y choque séptico. El compromiso cardiaco es inusual, con una incidencia menor del 1%. Se presenta el caso de un varón de 51 años, colombiano, con antecedente de una valvula aórtica mecánica, quien presentó un absceso en la pierna derecha y en la válvula cardiaca protésica, aislándose Burkholderia pseudomallei en hemocultivos y en el cultivo de secreción de la pierna. Fue tratado con meropenem y cotrimoxazol, con una adecuada respuesta clínica, requiriendo un reemplazo valvular aórtico.

Abstract Melioidosis is an endemic disease to several regions and occurs predominantly in Southern Asia, Northern Australia, China and Taiwan. In South America, Colombia is second after Brazil in number of melioidosis cases reported. Clinical manifestation varies from asymptomatic infection to multiorgan compromise involving multiple abscesses and septic shock. Cardiac compromise is infrequent, with an incidence of <1%. We report the case of a 51-year-old patient from Colombia with a mechanical aortic valve who had an abscess in right leg and in the prosthetic valve. Burkholderia pseudomallei was isolated in blood cultures and drained pus from the leg cultures. Patient was treated with meropenem and cotrimoxazole and required aortic valve replacement, resulting in adequate improvement in clinical symptoms.

Deterioro del sensorio de un paciente con endocarditis infecciosa en sala de internados / Impairment of the sensorium in a patient with infective endocarditis in an inpatient ward

El caso expuesto a continuación demuestra que, a pesar del diagnóstico precoz de la endocarditis infecciosa, el buen pronóstico del paciente se da cuando el tratamiento es oportuno. Por lo tanto, es de suma importancia tener presente cuales son las posibles complicaciones para tratarlas a tiempo. Paciente de sexo masculino, de 72 años de edad, consultó por fiebre de ocho días de evolución. Al examen físico se constató soplo diastólico en foco aórtico. Retornaron hemocultivos positivos para streptococcus gallolyticus, se inició tratamiento con antibióticos según antibiograma; en la segunda semana de tratamiento presentó deterioro del sensorio, primero estuvo confuso y luego somnoliento. Se realizó una tomografía de cráneo simple en primera instancia y luego resonancia magnética encefálica donde se observaron lesiones compatibles con posibles complicaciones de la endocarditis infecciosa como el émbolo séptico. Se continuó con el mismo esquema de antibióticos por seis semanas con mejoría del sensorio. El germen aislado en el caso clínico se relaciona en un porcentaje no infrecuente en pacientes con patologías gastrointestinales, el dato positivo que se obtuvo dentro de sus hábitos fisiológicos era la constipación crónica como dato importante ya que se relaciona frecuentemente con pólipos intestinales o neoplasias que se descartaba con estudios complementarios. Además, que los patógenos frecuentemente implicados en complicaciones neurológicas fueron por S. aureus y Streptococcus gallolyticus, coincidiendo el último con el germen aislado en este caso clínico, además que presentaba dos de las muchas complicaciones como ictus isquémico y émbolos sépticos en un mismo paciente

The case presented below goes beyond the early diagnosis of infective endocarditis and the association of the patient's prognosis with timely treatment; It is also important to keep in mind about possible complications despite adequate clinical management. A male patient consulted for a fever of eight days of evolution, the positive finding on physical examination was the auscultation of a diastolic murmur in the aortic focus. Positive blood cultures returned for streptococcus gallolyticus, antibiotic treatment had been started according to the antibiogram, and in the second week of treatment there was deterioration of the sensorium. A simple skull tomography had been performed in the first instance and then brain magnetic resonance imaging showing lesions compatible with possible complications of infective endocarditis. The same antibiotic scheme was continued for six weeks with improvement of the sensorium. The isolated germ in the clinical case is related in a not infrequent percentage in patients with gastrointestinal pathologies, the positive data that was obtained within their physiological habits was chronic constipation as important data since it is frequently related to intestinal polyps or neoplasms that are ruled out with complementary studies. In addition, the pathogens frequently involved in neurological complications were S. aureus and Streptococcus gallolyticus, the latter coinciding with the isolated germ in this clinical case, in addition to presenting two of the many complications such as ischemic stroke and septic embolism in the same patient

Staphylococcus coagulasa negativos como causantes de endocarditis en un recién nacido pretérmino / Neonatal coagulase negative Staphylococcus as a cause of endocarditis / Staphylococcus coagulase negativa como causa de endocardite em recém-nascido prematuro

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.

Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.

Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.

Open Transcatheter Multivalve Replacement in Degenerated Valve Prostheses in High-Risk Patients with Endocarditis

Abstract Multivalve redo procedures carry a high surgical risk. We describe an alternative surgical treatment for patients presenting with severely degenerated aortic and mitral valve prostheses who have to undergo open surgery due to endocarditis. Open transcatheter multivalve implantation is a feasible bailout strategy in high-risk patients to save cross-clamp and procedural times to reduce morbidity and mortality.

Multimodal assessment in polymicrobial infective endocarditis with silent spondylodiscitis and cerebral embolism / Evaluación multimodal en endocarditis infecciosa polimicrobiana con espondilodiscitis silenciosa y embolia cerebral

Abstract Infective endocarditis (IE) is a rare but severe disease, due to an infection of the endocardial surface of the heart. The annual incidence ranging from 3 to 7 per 100 000 person-years, with an overall mortality rates of 25%. Staphylococci and Streptococci accounted for approximately 80% of IE cases. Enterococci are the third leading cause accounted for approximately 5-18% of all cases and are increasingly linked to health-care contact. The increasing number of cardiovascular electronic devices, prosthetic valves implants along with frequent invasive diagnostic or therapeutic procedures performed in elderly, may also contribute to the rise of IE in this population. Blood cultures and echocardiographic findings are the cornerstone of the IE diagnosis, confirmed or rejected according to modified Duke criteria. Other imaging modalities as Cardiac Computed Tomography, Cardiac Magnetic Resonance Imaging and 18Ffluorodeoxyglucose Positron Emission Tomography - Computed Tomography (18FDG-PET/CT) can determine a more correct diagnosis and identify many of the endocarditis-related complications. Here, we describe a patient with aortic prosthetic valve and Enterococcus faecalis (EF) IE. Cerebral and spinal MRI and 18FDG-PET/CT, performed during the hospitalization, showed multi-organ silent periferic embolization. Furthermore, the cultural examination of the valvular surgical specimen revealed a methicillin-sensitive Staphylococcus aureus suggestive for polymicrobial endocarditis. Some Authors demonstrated a possible false-positive valve culture due to a postoperative contamination. Since contaminated cultures usually yield microorganisms compatible with endocarditis, such as coagulase-negative Staphylococci, viridans group Streptococcus species, may be difficult for the physician not to treat the patient. This case represents need for high level of suspicion to diagnose IE. Multimodality assessment improves the diagnosis and allows the detection of the complications. Moreover, a multidisciplinary team and specialized centers determine a better patient’s outcome.

Resumen La endocarditis infecciosa (EI) es una enfermedad poco frecuente pero severa, dada por una infección del endocardio. La incidencia anual oscila entre 3 y 7 por cada 100 000 personas-año, con una tasa de mortalidad general del 25%. Los estafilococos y los estreptococos representaron aproximadamente un 80% de los casos de EI. Los enterococos son la tercera causa, aportando aproximadamente 5% a 18% de todos los casos, y se vinculan cada vez más al contacto con la atención médica. El número creciente de dispositivos electrónicos cardiovasculares e implantes de válvulas protésicas, junto con los frecuentes procedimientos invasivos diagnósticos o terapéuticos en las personas ancianas, también podrían contribuir al incremento de EI en esta población. Los hemocultivos y los hallazgos ecocardiográficos son la piedra angular del diagnóstico de EI, confirmado o rechazado de acuerdo con los criterios modificados de Duke. Otras modalidades de imagenología tales como la Tomografía Computarizada Cardíaca (TCC), la Resonancia Magnética Cardíaca (RMC) y la Tomografía por Emisión de Positrones - Tomografía Computarizada con 18F-fluorodeoxiglucosa (18F-FDG PET/TC) pueden determinar un diagnóstico más preciso e identificar muchas de las complicaciones asociadas a la endocarditis. Aquí describimos un paciente con una válvula aórtica protésica y EI por EF. Una RM del cerebro y la columna vertebral y una 18F-FDG PET/TC practicadas durante la hospitalización evidenciaron embolia periférica multiorgánica silenciosa. Además, el examen por cultivo de la muestra quirúrgica valvular reveló Staphylococcus aureus sensible a la meticilina (SASM), sugestivo de endocarditis polimicrobiana. Algunos autores demostraron un posible falso positivo del cultivo valvular dado por contaminación postoperatoria. Ya que los cultivos contaminados generalmente producen microorganismos compatibles con la endocarditis, tales como estafilococos coagulasa negativos y estreptococos del grupo viridans, le puede resultar difícil al médico no tratar al paciente. Este caso representa la necesidad de tener un alto nivel de sospecha para diagnosticar la EI. La valoración multimodal mejora el diagnóstico y permite detectar complicaciones. Además, un equipo multidisciplinario y los centros especializados determinan un mejor desenlace para el paciente.

Un absceso esplénico por endocarditis / Abscess due to endocardities

Este artículo se publicó solamente con imágenes.

Perfil clínico e evolução de pacientes com infecção relacionada a dispositivos cardíacos eletrônicos implantáveis / Clinical profile and outcome of patients with cardiac implantable electronic device-related infection

Resumo Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background In recent years, the incidence of infections related to cardiac implantable electronic devices (CIED) has increased sharply, impacting mortality. Objective To verify the proportion of patients with CIED infection; to analyze their clinical profile and the variables related to the infection and its progression. Methods Retrospective and longitudinal observational study including 123 patients with CIED infection among 6406 procedures. Parametric tests and a level of significance of 5% were used in the statistical analyses Results The mean age of patients was 60.1 years and mean length of stay in hospital was 35.3 days; most (71) patients were male, and the system was completely removed in 105 cases. Infectious endocarditis (IE) and sepsis were observed in 71 and 23 patients, respectively. Intra-hospital mortality was 19.5%. IE was associated with extrusion of the generator (17.0% vs 19.5% with and without IE, respectively, p = 0.04, inverse association) and sepsis (15.4% vs 3.2%, p = 0.01). Intra-hospital death was associated with IE (83.3% vs 52.0% with and without intra-hospital death, respectively, p = 0.005) and sepsis (62.5% vs 8.1%, p < 0.0001). Ninety-nine patients were discharged. During a mean follow-up of 43.8 months, mortality rate was 43%; among patients with sepsis, it was 65.2% (p < 0.0001). By applying a Kaplan-Meier survival curve, we did not indicate significant associations with sex, etiologic agent, ejection fraction, IE, or treatment modality. The death rate was 32.8% for patients subjected to endocardial electrode reimplantation and 52.2% for epicardial reimplantation (p = 0.04). Chagasic etiology (44.7% of the baseline heart diseases) did not influence clinical and laboratory variables or disease progression. Conclusion The infection rate was 1.9%, mostly in men. We observed an association of intra-hospital mortality with IE and sepsis. After discharge, the annual mortality rate was 11.8%, influenced by sepsis during hospitalization and epicardial implantation. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Endocarditis infecciosa asociada al cuidado de la salud. Estudio de prevalencia en un hospital de alta complejidad / Infective endocarditis associated with health care. Prevalence study in a high complexity hospital

Resumen Introducción: Los procedimientos vasculares invasivos ocasionan infecciones sanguíneas asociadas a cuidados de la salud, entre ellas endocarditis infecciosa. Este evento adverso conlleva mayor morbimortalidad que la endocarditis infecciosa adquirida en la comunidad. Objetivo: Evaluar la prevalencia de endocarditis infecciosa asociada al cuidado de la salud y describir las características demográficas de esta población, así como los agentes etiológicos. Método: Estudio de corte transversal, en el que se incluyó población mayor de 18 años con endocarditis infecciosa asociada al cuidado de la salud, documentada entre enero de 2013 y junio de 2018 en la Fundación Cardioinfantil. Se realizó un análisis estadístico con distribución de variables de edad, sexo, procedimientos invasivos asociados, mortalidad y microorganismo aislado. Resultados: Se incluyeron 41 pacientes con una edad promedio de 60,6 años. No hubo distinción entre hombres (22, 53.6%) y mujeres (19, 46.3%). Los pacientes se agruparon, según el procedimiento realizado, en implantación de dispositivos intravasculares de alto flujo (16, 39.02%), catéter venoso central (12, 29.26%) y dispositivos intracardiacos (11, 26.82%). La prevalencia general en los procedimientos evaluados fue del 0.21%, siendo del 1.42% en dispositivos intravasculares de alto flujo, del 0.72% en dispositivos intracardiacos y del 0.08% en catéteres centrales. La mortalidad registrada fue del 4.9% (2 pacientes). En el 78.05% de los pacientes se obtuvo aislamiento microbiológico. Conclusiones: Los pacientes sometidos a procedimientos invasivos pueden tener un riesgo elevado de endocarditis infecciosa, conferido por el procedimiento. La baja tasa de mortalidad intrahospitalaria puede estar relacionada con la notable tasa de aislamiento positivo en hemocultivos, lo cual facilitó la terapia antibiótica dirigida.

Abstract Introduction: Invasive procedures the vascular tract cause health, are related to blood stream infections, among them, infective endocarditis. This adverse event leads to greater morbidity and mortality compared with community acquired infective endocarditis. Objective: To evaluate the prevalence of healthcare-associated infective endocarditis, describe the demographic characteristics of this population and the etiological agents. Method: Cross-sectional descriptive, prevalence study of prevalence. It included patients ≥18 years old with healthcare-associated infective endocarditis, documented at Fundación Cardioinfantil. Statistical analysis with distribution of variables of age, gender, invasive procedure associated and isolated microorganism was made. Results: 41 patients were obtained. The average age was 60.6 years. There was no distinction between men (22, 53.6%) and women (19, 46.3%). The patients were grouped according to the procedure performed in: implantation of high-flow intravascular devices (16, 39.02%), central venous catheter (12, 29.26%) and intracardiac devices (11, 26.82%). The general prevalence in the evaluated procedures was 0.21%, being 1.42% in high-flow intravascular devices, 0.72% in intracardiac devices and 0.08% in central catheters. The registered mortality was 4,9% (2 patients). In 78.05% of the patients, microbiological isolation was obtained. Conclusions: patients who has invasive procedures may have an incremented risk of infective endocarditis because of the procedure. The low intrahospital mortality could be related with the remarkable number of microbiological identification which facilitated a directed antimicrobial therapy.