ABSTRACT
BACKGROUND: Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear. METHODS: We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. RESULTS: We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality. CONCLUSIONS: Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.
Subject(s)
Endocarditis, Bacterial , Endocarditis , Aged , Male , Humans , Aged, 80 and over , Female , Prospective Studies , Retrospective Studies , Activities of Daily Living , Endocarditis/surgery , Hospital MortalitySubject(s)
Endocarditis, Bacterial/microbiology , Phylogeny , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Streptococcal Infections/microbiology , Streptococcus/classification , Streptococcus/genetics , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Heart Valve Prosthesis Implantation , Humans , Male , RNA, Ribosomal, 16S/genetics , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus/drug effects , Streptococcus/isolation & purification , Superoxide Dismutase/geneticsABSTRACT
BACKGROUND: Nontuberculous mycobacteria (NTM) are environmental organisms associated with a range of infections. Reports of NTM epidemiology are mainly focused on pulmonary infections and isolations, and extrapulmonary infections are less frequently described. METHODS: We conducted a retrospective study of NTM infections at the Bordeaux University Hospital, France, between January 2002 and December 2013. We used the microbiologic component of the American Thoracic Society/Infectious Diseases Society of America's pulmonary NTM disease criteria to define cases of pulmonary NTM, and patients with isolates from a normally sterile site were classified as having extrapulmonary disease. RESULTS: In our setting, 170 patients were included. Pulmonary cases predominated (54.1%), followed by skin and soft tissue infections (22.9%), disseminated cases (10.6%), lymphadenitis (7.7%), bone and joint infections (2.9%) and the remaining 1.8% catheter-related infections. Overall, 16 NTM species were isolated. Mycobacterium avium (31.8%) and M. intracellulare (20%) were the most common species identified, followed by M. marinum (13.5%), M. kansasii (10.6%), M. xenopi (9.4%), rapidly growing mycobacteria (9.4%) and other slowly growing mycobacteria (5.3%). In general, NTM isolates were largely prevalent in people older than 50 (62.4%); patients aged 1-10 year-old exclusively yielded M. avium from lymph nodes, almost cases having being diagnosed after 2007. Among the 121 patients with complete follow-up, 78 (64.5%), 24 (19.8%), and 19 (15.7%) were cured, experienced relapse, or died, respectively. CONCLUSION: In our study, extrapulmonary NTM infections represented almost half of cases, consisting mainly in skin and soft tissue infections. The increase lymphadenitis cases in children after 2007 could be linked to the cessation of mandatory BCG vaccination in France. We observed similar cure rates (64%) between pulmonary and extrapulmonary infections.
Subject(s)
Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , France/epidemiology , Hospitals, University , Humans , Infant , Lung/microbiology , Lung Diseases/microbiology , Lymphadenitis/epidemiology , Male , Middle Aged , Nontuberculous Mycobacteria/isolation & purification , Patient Outcome Assessment , Retrospective Studies , Young AdultABSTRACT
The possible systemic infectious consequences of prosthetic joint infections (PJI) are poorly documented in the literature. We assessed the frequency of postoperative prosthetic hip and knee infections leading to bacteremia and investigated their associated factors among patients treated between 2005 and 2009. Among 633 patients with PJI, 62 (9.8%) also had positive blood cultures (95% confidence interval (CI) 7.5-12.1). After complete investigations, the prosthesis was considered as the direct cause of bacteremia in 14 cases (2.2%; 95% CI 1.1-3.4). In the conditional logistic regression analysis, PJI leading to bacteremia was more frequently observed in cases of relapses of a prior PJI (adjusted odds ratio (aOR) 7.3, p = 0.07) and in patients with a C-reactive protein value upon admission ≥ 180 mg/l (aOR 4.5, p = 0.04). None of the 8 bacteremic patients treated with surgical debridement and prosthetic retention were cured from joint infection. These preliminary results raise concerns about the fact that debridement with prosthetic retention may not be an appropriate option in the context of PJI leading to bacteremia, contrary to PJI resulting from hematogenous seeding.
