Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation / 中华心血管病杂志

Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.

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.

Endocarditis infecciosa en Argentina: ¿qué aprendimos en los últimos 25 años? / Infective endocarditis in Argentina: what have we learned in the last 25 years ?

La epidemiología de la endocarditis infecciosa (EI) ha sufrido cambios debido a una serie de factores como el envejecimiento, las comorbilidades y los procedimientos médicos. El objetivo de este estudio fue evaluar las principales modificaciones clínicas, epidemiológicas y etiológicas de la EI en los últimos 25 años en Argentina. Se realizó un análisis comparativo de tres registros prospectivos observacionales en los que se incluyeron de forma consecutiva casos de EI definidas y posibles según los criterios de Duke: dos estudios multicéntricos (EIRA-1 [1992-1994] y EIRA-2 [2001-2002]) y un estudio en un centro de referencia de cardiología de tercer nivel (CRC [2007-2017]). En los 1065 episodios de EI evaluados, no existieron diferencias respecto al sexo, y los pacientes fueron más añosos en cada periodo (p < 0.001). La EI asociada a dispositivos intracardiacos fue más frecuente en la última década: infección asociada a marcapasos (5.4 vs. 23% p < 0.0001) y EI de prótesis valvulares (8.5% vs. 19.2% vs. 47.5% p < 0.0001). Por otra parte, la EI asociada a drogas endovenosas (p < 0.0001) y cardiopatías congénitas (p = 0.001) fue significativamente menos frecuente. La etiología cambió sustancialmente: Streptococcus del grupo viridans disminuyó (30.8% vs. 26.8% vs. 15.9%; p < 0.001) y la EI por Staphylococcus spp. predominó por sobre otros microorganismos, con un aumento estadísticamente significativo del Staphylococcus coagulasa negativa (SCN). El tratamiento quirúrgico fue implementado con más frecuencia en la última década y estuvo acompañado de una tendencia a menor mortalidad en el CRC (23.5%, 24.3% vs. 17.2% p = 0.058).

The epidemiology of infectious endocarditis (IE) has undergone changes due to a series of factors such as aging, comorbidities and medical procedures. The aim of this study was to evaluate the main clinical, epidemiological and etiological changes of the IE in the last 25 years in Argentina. A comparative analysis of three observational prospective registries was performed in which cases of definite and possible IE were consecutively included according to the Duke criteria: two multicentre studies (EIRA-1 [1992-1994] and EIRA-2 [2001-2002]) and one study in a reference cardiology center (CRC [2007-2017]). In the 1065 episodes of EI evaluated, there were no differences regarding sex, and the patients were older in each period (p < 0.001). Intracardiac device-associated IE was more frequent in the last decade: pacemaker (5.4 vs. 23% p < 0.0001) and prosthetic valve IE (8.5% vs. 19.2% vs. 47.5% p < 0.0001). On the other hand, IE associated with intravenous drugs (P < 0.0001) and congenital heart diseases (p = 0.001) was significantly less frequent. The etiology changed substantially: Streptococcus viridans group decreased (30.8% vs. 26.8% vs. 15.9%, p < 0.001) and IE by Staphylococcus spp. predominated over other microorganisms, with a statistically significant increase in IE due to coagulase-negative Staphylococcus. Surgical treatment was more frequently implemented in the last decade and was accompanied by a trend towards lower mortality in the CRC (23.5%, 24.3% vs. 17.2% p = 0.058).

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.

Correção endovascular de pseudoaneurisma de tronco tibiofibular secundário a endocardite ­ relato de caso / Endocarditis-related tibioperoneal trunk pseudoaneurysm managed with endovascular treatment ­ case report

Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz

ibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment

Experience of treatment of prosthetic valve endocarditis: a retrospective single-center cross-sectional study

ABSTRACT BACKGROUND: The aim of this study was to describe the experience of treatment of early prosthetic valve endocarditis at a heart center. DESIGN AND SETTING: Retrospective single-center study on data collected from electronic medical records covering the period from January 2009 to December 2015. METHODS: Over the study period, 1,557 consecutive valve operations were performed on adult patients. The study population comprised 32 patients (2%) who were diagnosed with prosthetic valve endocarditis within 12 months after the index surgery. Medical records were retrieved from electronic hospital records, retrospectively. Descriptive clinical, echocardiographic, microbiological and treatment-type data were used. Risk factors for early mortality were studied through univariate and multivariate analyses. RESULTS: The main clinical manifestation of infective endocarditis was fever, and this was present in all patients. Most of the prostheses were affected in the aortic position (40.6% of cases). The most commonly cultured microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. Twenty-six patients (81.3%) underwent surgical treatment and six (18.7%) underwent exclusive clinical treatment. The prevalence of postoperative complications was 31.3% and hospital mortality occurred in seven cases (21.9%). The mortality rate was 50% among the patients who underwent medical treatment and 15.4% among those who underwent surgery. There were no independent risk factors for mortality. CONCLUSION: Prosthetic valve endocarditis is an infrequent complication of valve replacement. Surgical treatment has mortality rates compatible with the severity of patients' conditions. Surgical indication should not be delayed when clinical treatment has been ineffective

Relevancia de profilaxis antibiótica ante procedimientos dentales generadores de bacteriemias transitorias / Antimicrobial prophylaxis for transient bacteremia during dental procedures

This review examines the evidence about the relationship between dental procedures and the incidence of transient bacteremia. One of the main obstacles was to define "invasive dental procedure" as an indication for antimicrobial prophylaxis for patients with high risk of bacteremia. A search in WorldWideScience and ScienceDirect was performed and 20 articles were selected for review. Two contradictions stood out. There is no concrete evidence that a transient bacteremia arising during a dental procedure may be a risk factor for the appearance of bacterial endocarditis. There is no certainty about the effectiveness of antimicrobial prophylaxis, due to the lack of clinical trials of good quality. There is a similitude between bacteremia resulting from invasive and non-invasive dental procedures. The importance of periodontal health as a preventive measure for bacterial endocarditis among high risk patients is highlighted.

Microbiota periodontal y microorganismos aislados de válvulas cardiacas en pacientes sometidos a cirugía de reemplazo de válvulas en una clínica de Cali, Colombia / Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia

Resumen Introducción. La periodontitis es una enfermedad infecciosa que afecta los tejidos de soporte del diente y se asocia con diferentes enfermedades sistémicas, incluida la enfermedad cardiovascular. Los estudios microbiológicos permiten detectar microorganismos a partir de muestras subgingivales y cardiovasculares. Objetivo. Describir la microbiota periodontal cultivable y la presencia de microorganismos en válvulas cardiacas de pacientes sometidos a cirugía de reemplazo valvular en una clínica de Cali. Materiales y métodos. Se analizaron 30 muestras subgingivales y de tejidos valvulares mediante cultivo en medio bifásico, agar de sangre con suplemento y agar tripticasa de soya con antibiótico. Las muestras de las válvulas se analizaron mediante reacción en cadena de la polimerasa (PCR) convencional. Resultados. Los patógenos periodontales aislados de bolsas periodontales fueron Fusobacterium ( 50 % ), Prevotella intermedia/nigrescens (40 %), Campilobacter rectus (40 %), Eikenella corrodens (36,7 %), bacilos entéricos Gram negativos (36,7 %), Porphyromonas gingivalis (33,3 %) y Eubacterium (33,3 %). Los agentes patógenos aislados de la válvula aórtica fueron Propionibacterium acnes (12 %), bacilos entéricos Gram negativos (8 %), Bacteroides merdae (4 %) y Clostridium bifermentans (4 %), y de la válvula mitral, P. acnes y Clostridium beijerinckii. La PCR convencional no arrojó resultados positivos para agentes patógenos orales y solo se detectó ADN bacteriano en dos muestras. Conclusiones. La microbiota periodontal de pacientes sometidos a cirugía de reemplazo valvular estaba conformada por especies Gram negativas que han sido relacionadas con infecciones en tejidos extraorales; sin embargo, no se encontraron agentes patógenos periodontales en los tejidos de las válvulas. Aunque hubo muestras de estos tejidos y subgingivales, positivas para bacilos entéricos Gram negativos, no es posible asegurar que tuvieran el mismo origen filogenético.

Abstract Introduction: Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. Objective: To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. Materials and methods: We analyzed 30 subgingival and valvular tissue samples by means of twophase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. Results: The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Conclusions: Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Endocarditis infecciosa por Staphylococcus aureus meticilino sensible en pediatría. Presentación de un caso y revisión de la literatura / Methicillin-sensitive Staphylococcus aureus infective endocarditis in pediatrics. A case report and literature review

Resumen: La endocarditis infecciosa es una enfermedad poco frecuente en pediatría pero con importante morbimortalidad. Si bien existen grupos de riesgo bien definidos puede presentarse en niños sin cardiopatía subyacente e inmunocompetentes, en quienes la etiología estafilocócica es la más frecuente y el diagnóstico continúa siendo un desafío. Presentamos el caso de un niño de 2 años, previamente sano, con una endocarditis a Staphylococcus aureus meticilino sensible de presentación no usual.

Summary: Infective endocarditis is rather an unusual condition in pediatrics, although it is associated with significant morbility and mortality. In spite of there being well defined risk groups the disease may present in children with no underlying heart disease who are immunocompetent, Staphylococcus aureus being the most frequent etiology. In those cases, diagnosis still constitutes a challenge. The study presents the case of a 2 year-old patient, with a healthy history, who presented methicillin-sensitive Staphylococcus aureus infective endocarditis, with rather an unusual presentation.

Adult patent Ductus Arteriosus complicated by endocarditis and hemolytic anemia / Conducto arterioso patente complicado por endocarditis y anemia hemolítica en un adulto

An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.

Un adulto con un gran ductus arterioso permeable puede presentar fatiga, disnea y palpitaciones y menos frecuentemente presentar endocarditis. El caso muestra el papel de la vegetación de la endocarditis en la anemia hemolítica con el conducto arterioso patente (CAP) en adultos. A pesar del tratamiento de la endocarditis con la terapia antibiótica completa, la normalidad en la proteína C-reactiva, la tasa de sedimentación globular y leucocitaria, y un estado de bienestar general del paciente, la ecocardiografía trans torácica reveló gran vegetación en el lumen de CAP y el cierre completo quirúrgico de PDA, sin hemólisis y la desaparición de glóbulos rojos fragmentados en frotis de sangre periférica. Los 3 meses de seguimiento revelaron oclusión completa de CAP y la desaparición de la anemia hemolítica confirmada por examen clínico y laboratorio.

Apuntes sobre la fisiopatología, etiología, diagnóstico, tratamiento y profilaxis de la endocarditis infecciosa / Notes on the physiopathology, etiology, diagnosis, treatment and prophylaxis of infective endocarditis

La endocarditis infecciosa es una afección de difícil diagnóstico en Cardiología, con características clínicas muy variadas y una epidemiología cambiante en los últimos años. En la presente revisión se tratan aspectos novedosos sobre su clasificación, etiología y fisiopatología; además, se presentan las herramientas fundamentales para su diagnóstico, punto de partida para su tratamiento médico basado primordialmente en la terapia antimicrobiana, así como los criterios quirúrgicos y la conducta actual en la profilaxis antimicrobiana de esta compleja entidad.

Infective endocarditis is a disease of difficult diagnosis in cardiology, with highly variable clinical characteristics and changing epidemiology in the last few years. The present review dealt with novel aspects on classification, etiology and physiopathology of the disease in addition to the presentation of the fundamental tools for diagnosis, which is the starting point for the medical treatment basically supported on the antimicrobial therapy. It also set forth the surgical criteria and the present performance in the antimicrobial prophylaxis of this complex disease.

Accidente cerebrovascular isquémico como manifestación inicial de endocarditis infecciosa / Stroke as an initial manifestation of infectious endocarditis

Las manifestaciones neurológicas en pacientes con endocarditis infecciosa pueden ser muy frecuentes. Presentamos un caso clínico cuya manifestación cardinal fue un accidente cerebrovascular isquémico, y revisamos la epidemiología de este fenómeno, así como algunos aspectos terapéuticos y diagnósticos a considerar en este tipo de pacientes. Se otorga énfasis a la controversia en torno a la indicación de anticoagulación, la evaluación precoz con neuroimagen en pacientes asintomáticos, y la decisión de intervención quirúrgica precoz para pacientes seleccionados...

The neurological manifestations of patients with infectious endocarditis can be very common. We present a case report in which the cardinal manifestation was a stroke, and we review the epidemiology of this phenomenon, as well as some diagnostic and therapeutic aspects to consider in this type of patients. We put emphasis on the controversy around the anticoagulation therapy, initial evaluation with neuroimaging in asymptomatic patients, and the decision of surgical intervention in selected patients...

Infective endocarditis with spondylodiscitis after prostate biopsy

Transrectal ultrasound-guided prostate needle biopsy is the ideal method of obtaining prostate specimens for histological analysis and is therefore often used in clinical practice. In most studies, prostate biopsy is considered a safe procedure with few major complications. In the present report, we describe a case of endocarditis with spondylodiscitis, two very rare complications associated with prostate biopsy. In the present report, we describe a case of infective endocarditis (IE) with spondylodiscitis (SD), two very rare complications of prostate biopsy. Only a few cases have been described in the literature reporting IE or SD as complications of prostate biopsy.

Morbimortalidad de la endocarditis infecciosa asociada a dispositivos electrónicos implantables permanentes / Morbimortality of infective endocarditis associated with permanent cardiovascular implantable electronic devices

La endocarditis infecciosa (EI) asociada a dispositivos electrónicos implantables permanentes (DEIP) es una complicación de baja frecuencia pero alta mortalidad sin el tratamiento adecuado. El avance sobre el conocimiento de esta patología y el desarrollo de estrategias terapéuticas como el diagnóstico precoz, manejo de antibióticos, técnicas de extracción, entre otras, han mejorado el pronóstico de estos pacientes. Los objetivos de este estudio fueron evaluar la morbimortalidad intrahospitalaria y alejada y analizar algunos factores que justifican las diferencias con los datos de la mortalidad publicada. Se estudiaron en forma retrospectiva pacientes entre marzo/2002 y marzo/2011 con diagnóstico de EI asociada a DEIP. Se analizaron características basales, diagnósticas, terapéuticas, evolución intrahospitalaria y alejada. Se incluyeron 26 casos atendidos en nuestro hospital, 23 de los cuales fueron remitidos desde otros centros para su diagnóstico y tratamiento. La edad promedio fue de 67,5 años. Todos los pacientes recibieron antibióticos durante seis semanas y se les retiró el sistema en forma completa; en el 95% de los pacientes por vía percutánea y en 2 pacientes se requirió estereotomía mediana, atriotomía y colocación de marcapasos epicardíaco. La mortalidad fue del 4% y en el seguimiento fue nula. La morbilidad intrahospitalaria fue del 31%. En el seguimiento alejado no hubo reinfecciones u otra complicación. Como conclusión la EI es un cuadro grave que presenta una morbilidad elevada con estadías hospitalarias prolongadas, pero la mortalidad es baja. La explicación podría estar en las técnicas percutáneas, experiencia, extracción completa, el tiempo del reimplante del nuevo dispositivo y el tratamiento precoz, entre otros factores.

Infective endocarditis (IE) associated with permanent cardiovascular implantable electronic devices (CIEDs) is a complication of low frequency, but high mortality without adequate treatment. Progress on the knowledge of this disease and the development of therapeutic strategies such as early diagnosis, antibiotic management and better extraction techniques, among others, have improved the prognosis of these patients. The objectives of this study were to evaluate the in-hospital and out-of-hospital morbidity, and analyze some factors that explain the differences among the published mortality data. Patients diagnosed with IE associated with CIEDs were studied, retrospectively, between March/2002 and March/2011. We analyzed baseline, diagnostic and therapeutic characteristics, and in-hospital and out-of-hospital courses of the disease. We included 26 cases treated in our hospital, 23 of whom were referred from other centers for diagnosis and treatment. The average age of the patients was 67.5 years. All patients received antibiotics for six weeks and underwent complete removal of the device system, in 95% of patients by percutaneous extraction and 2 patients required a median sternotomy, atriotomy and epicardial pacemaker placement. Mortality was 4% and the follow up mortality was zero. The in-hospital morbidity was 31%. In the follow-ups there were no reinfections or other complications. In conclusion, IE is a serious condition that has a high morbidity with prolonged hospital stays, but with a low mortality. The explanation may lie in the use percutaneous extraction techniques, experience, complete extraction of the device system, the time of reimplantation of the new device and early treatment, among other factors.

Endocarditis infecciosa por Rhizobium radiobacter: Reporte de un caso / Infective endocarditis by Rhizobium radiobacter: A case report

Rhizobium radiobacter es una bacteria Gram-negativa, fijadora de nitrógeno que se encuentra principalmente en el suelo. Rara vez causa infecciones en humanos. Ha sido asociada a bacteriemia secundaria a colonización de catéteres intravasculares en pacientes inmunocomprometidos. El objetivo de este trabajo es informar un caso de endocarditis infecciosa por R. radiobacter. Se trata de paciente masculino, de 47 años de edad, con diagnóstico de enfermedad renal crónica estadio 5 en tratamiento sustitutivo con hemodiálisis, quien acude a centro asistencial por presentar fiebre de dos semanas de evolución. Es hospitalizado, se toman muestras de sangre periférica para hemocultivo y se inicia antibioticoterapia empírica con cefotaxime más vancomicina. El ecocardiograma transtorácico revelo vegetación fusiforme en válvula tricúspide con regurgitación grado III-IV/IV. Al séptimo día del inicio de la antibioterapia el paciente presenta mejoría clínica y paraclínica. La bacteria identificada por hemocultivo es Rhizobium radiobacter resistente a ceftriaxona y sensible a imipenem, amikacina, ampicilina y ampicilina/sulbactam. Debido a la mejoría clínica se decide continuar tratamiento con vancomicina y se anexa imipenem. A los 14 días de iniciada la antibioterapia el paciente es dado de alta con tratamiento ambulatorio con imipenen hasta cumplir seis semanas de tratamiento. En el ecocardiograma control se evidencio ausencia de la vegetación en la válvula tricúspide. Este caso sugiere que R. radiobacter puede ser una causa de endocarditis en pacientes portadores de catéteres intravasculares.

Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/ sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.

Miocardiopatía dilatada y feocromocitoma / Dilated myocardiopathy and pheochromocytoma

El feocromocitoma, un tumor de baja incidencia con un comportamiento benigno en la mayoría de los casos, puede ser el responsable de extensas manifestaciones cardiovasculares. Las manifestaciones sobre el miocardio pueden ser de profundas consecuencias, pues llegan a producir una miocardiopatía dilatada con insuficiencia cardiaca severa. La exéresis del tumor suele ser curativa en el 90 por ciento de los casos y el manejo perioperatorio muy complejo. Se presenta un paciente joven portador de un feocromocitoma, que sometido a la larga acción de las catecolaminas llegó a desarrollar una miocardiopatía dilatada con criterio de trasplante cardiaco. La cirugía adrenal fue curativa en nuestro paciente(AU)

Pheochromocytoma, a low incidence tumor of benign behavior in most of cases, can cause extensive cardiovascular manifestations. These manifestations on the myocardium can have deep consequences since they may lead to dilated myocardiopathy with severe heart failure. The excision of tumor may be the curative solution for 90 percent of cases but the perioperative management is very complex. This is the case of a young patient who carries pheochromocytoma and after a long-acting catecholemine-based treatment, he developed dilated myocardiopathy, and the medical criterion was that he required heart transplantation. The adrenal surgery was successfully healing in our patient(AU)

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter / Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central / Incidencia de infección de la corriente sanguínea em los pacientes sometidos a hemodiálisis por catéter venoso central

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

O objetivo deste estudo foi avaliar a incidência e os fatores de risco de infecção da corrente sanguínea (ICS) em pacientes com cateter venoso central (CVC) duplo lúmen, para hemodiálise (HD) e identificar os micro-organismos isolados na corrente sanguínea. Como método, usou-se o follow up, realizado no período de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lúmen, na Universidade Federal de São Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de inserção do cateter. Dos 128 micro-organismos isolados da corrente sanguínea, 53 eram S.aureus, dos quais 30 eram sensíveis à metilcilina e 23 resistentes. Entre as complicações relacionadas à ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a óbito. A incidência de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressão para quadros infecciosos de grande magnitude e óbito.

El objetivo de este estudio fue evaluar la incidencia y los factores de riesgo de infección de la corriente sanguínea (ICS) en pacientes con catéter venoso central (CVC) doble lumen, para hemodiálisis (HD) e identificar los microorganismos aislados en la corriente sanguínea. Como método, se uso el acompañamiento, realizado en el período de un año, incluyendo todos los 156 pacientes que estaban en tratamiento de HD por CVC doble lumen, en la Universidad Federal de Sao Paulo - UNIFESP. Los resultados mostraron que de los 156 pacientes estudiados, 94 presentaron ICS, de estos, 39 tuvieron culturas positivas en el local de inserción del catéter. De los 128 microorganismos aislados de la corriente sanguínea, 53 eran S.aureus, de los cuales 30 eran sensibles a la metilcilina y 23 resistentes. Entre las complicaciones relacionadas a la ICS, hubo 35 casos de septicemia y 27 casos de endocarditis, de los cuales 15 resultaron en muerte. La incidencia de ICS en este grupo de pacientes se mostró bastante elevada así como su progresión para cuadros infecciosos de gran magnitud y de muerte.