[Infective endocarditis : In-hospital mortality predictive factors]. / Endocardite infectieuse : facteurs prédictifs de mortalité intrahospitalière.

INTRODUCTION: Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality. PATIENTS AND METHODS: A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology. RESULTS: Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90]). CONCLUSIONS: Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.

Desempenho do Escore SHARPEN e do Índice de Comorbidade de Charlson para Predição de Mortalidade durante a Internação Hospitalar e após a Alta na Endocardite Infecciosa / Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis

Resumo Fundamento O SHARPEN foi o primeiro escore desenvolvido especificamente para a predição de mortalidade hospitalar em pacientes com endocardite infecciosa (EI), independentemente da realização de cirurgia cardíaca. Objetivos Analisar a capacidade do escore SHARPEN na predição de mortalidade hospitalar e mortalidade após a alta e compará-la à do Índice de Comorbidade de Charlson (ICC). Métodos Estudo retrospectivo do tipo coorte incluindo internações por EI (segundo os critérios de Duke modificados) entre 2000 e 2016. A área sob a curva ROC (AUC-ROC) foi calculada para avaliar a capacidade preditiva. Curvas de Kaplan-Meier e regressão de Cox foram realizadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Estudamos 179 internações hospitalares. A mortalidade hospitalar foi 22,3%; 68 (38,0%) foram submetidos à cirurgia cardíaca. Os escores SHARPEN e ICC (mediana e intervalo interquartil) foram, respectivamente, 9(7-11) e 3(2-6). O escore SHARPEN mostrou melhor predição de mortalidade hospitalar em comparação ao ICC nos pacientes não operados (AUC-ROC 0,77 vs. 0,62, p = 0,003); não foi observada diferença no grupo total (p=0,26) ou nos pacientes operados (p=0,41). Escore SHARPEN >10 na admissão foi associado a uma menor sobrevida hospitalar no grupo total (HR 3,87; p < 0,001), nos pacientes não operados (HR 3,46; p = 0,006) e de pacientes operados (HR 6,86; p < 0,001) patients. ICC > 3 na admissão foi associada a pior sobrevida hospitalar nos grupos total (HR 3,0; p = 0,002), de pacientes operados (HR 5,57; p = 0,005), mas não nos pacientes não operados (HR 2,13; p = 0,119). A sobrevida após a alta foi pior nos pacientes com SHARPEN > 10 (HR 3,11; p < 0,001) e ICC > 3 (HR 2,63; p < 0,001) na internação; contudo, não houve diferença na capacidade preditiva entre esses grupos. Conclusão O SHARPEN escore foi superior ao ICC na predição de mortalidade hospitalar nos pacientes não operados. Não houve diferença entre os escores quanto à mortalidade após a alta.

Abstract Background SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery. Objectives To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI). Methods Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant. Results We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p < 0.001) patients. CCI > 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p < 0.001) and CCI > 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups. Conclusion SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.

[Delayed renal infectious aneurysm 3 months after cardiac surgery for a Streptococcus pyogenes infective endocarditis ; case report and literature review]. / Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature.

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature. We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts. He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization. This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

[A rare case of arterial thrombosis secondary to Aerococcus viridans aortic endocarditis]. / Un cas rare de thrombose artérielle secondaire à une endocardite aortique à Aerococcus viridans.

Infective endocarditis is an uncommon, yet serious disease responsible for high morbidity and mortality, its incidence is estimated at 3-10 cases per 100,000 person-years. Most infective endocarditis cases emanate from streptococcus and staphylococcus. The incrimination of Aeroccocus viridans is rarely described in the literature and it has a high rate of embolic complication. We report the case of a 31-year-old male patient, with no prior medical history, who was admitted to the cardiology department of Ibn Rochd university center due to a prolonged fever for over 6 months. At admission, his general condition was preserved, he was febrile at 38.7 °C, claudication in the right lower limb with a decrease in the peroneal artery pulse, a graded 4/6 diastolic aortic murmur on auscultation, and no signs of heart failure. The transthoracic echocardiography revealed a type I bicuspid aortic valve disease, severe aortic regurgitation, moderate aortic stenosis, and vegetation implanted on the ventricular side of the right coronary cusp. CT angiography of the lower limbs revealed a bilateral total occlusion of the tibioperoneal trunks extended to the proximal portions of the posterior tibial arteries and peroneal arteries with collateral circulation, endovascular collection, and occlusive calcified plaque of the proximal part of the right anterior tibial artery and the collateral circle. Blood tests showed an inflammatory syndrome. Blood cultures detected Aerococcus viridans. The patient was first put on ceftriaxone, gentamycin, unfractionated heparin, and analgesic-antipyretic when necessary, he was then transferred to the cardiovascular surgery department for replacement of the aortic valve and permeabilization of the lower limbs by the FOGARTY technique. Post-surgical results were satisfying. In conclusion, infective endocarditis secondary to Aerococcus viridans is rare but appears to be virulent because most often discovered at the stage of complications. Therefore, good antibiotic therapy adapted to the antibiogram results in a good prognosis.

Infectious endocarditis due to Bacillus Cereus in a patient with a pacemaker: case report and literature review / Endocardite infecciosa por Bacillus Cereus em paciente portador de marcapasso: relato de caso e revisão de literatura

Introduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism" proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures.

Introdução: A endocardite infecciosa é um processo infeccioso do endotélio cardíaco, muitas vezes relacionado ao uso de marca-passos e próteses valvares, que pode facilitar a proliferação de microrganismos. Relato de Caso: Neste artigo descrevemos o caso de um homem de 81 anos com endocardite infecciosa por Bacillus Cereus relacionada ao uso de marca-passo e realizamos uma breve revisão da literatura. Discussão: Bacillus Cereus é uma bactéria Gram-positiva, aeróbia, formadora de esporos, grande e geralmente móvel, que constitui uma causa rara de endocardite, com poucos casos descritos na literatura. Conclusão: A determinação da etiologia da EI através de métodos guiados por cultura desempenha um papel fundamental na seleção do tratamento antibiótico apropriado. Manter alta suspeita clínica de EI é fundamental, principalmente quando surge febre em pacientes portadores de dispositivos cardíacos após procedimentos cirúrgicos ou odontológicos.

[Tetralogy of Fallot with absent pulmonary valve syndrome diagnosed in adulthood by infective endocarditis : Case of report]. / Agénésie de la valve pulmonaire avec communication interventriculaire découverte à l'âge adulte suite à une endocardite infectieuse : à propos d'un cas.

Absent pulmonary valve syndrome is a rare congenital heart disease. Associated with ventricular septal defect, it is considered a rare variant of Tetralogy of Fallot "Tetralogy of Fallot with absent pulmonary valve syndrome". It is characterized by its association with aneurysmal pulmonary arteries responsible for airways compression. Survival to adulthood of this unrepaired congenital heart disease is very rare, and the case of the patient we report in this article is added to the rare cases reported in the literature. Clinical tolerance depends on the degree of severity of the malformation and in particular on the importance of the aneurysmal dilation of the pulmonary arteries, thus determining the age of the diagnosis, the severity of symptoms, and the mode of evolution. Diagnosis of Tetralogy of Fallot with absent pulmonary valve syndrome must be established by transthoracic echography. Other investigations can be of capital contribution, such as thoracic computed tomography angiography and cardiac catheterization. The treatment is surgical and includes closure of the ventricular septal defect, relieve right ventricular outflow tract obstruction, and surgical reduction of the aneurysmal pulmonary arteries.

Endocarditis Infecciosa a hemocultivos y ecocardiograma negativos: ¿Con qué otra herramienta contamos? A propósito de un caso

La endocarditis infecciosa (EI) es una enfermedad frecuente, con elevada morbi-mortalidad, cuyo diagnóstico continúa siendo un desafío en la actualidad. El abordaje de la misma debe de ser realizado por un equipo multidisciplinario. La semiología, herramienta fundamental en la medicina clínica, juega un rol preponderante, nos permite mantener una alta sospecha diagnóstica a pesar de contar con estudios paraclínicos negativos. En estas situaciones han ganado importancia las nuevas técnicas de imagen como el PET-TC. Se presenta el caso de una mujer con cardiopatía predisponente en el que se llega al diagnóstico por PET-TC.

Infective endocarditis (IE) is a frequent disease, with high morbidity and mortality, whose diagnosis continues to be a challenge nowadays. The approach must be carried out by a multidisciplinary team. Semiology, a fundamental tool in clinical medicine, plays a preponderant role, allowing us to maintain a high diagnostic suspicion despite having negative paraclinical studies. In these situations, new imaging techniques such as PET-CT have gained importance. We present the case of a woman with predisposing heart disease in whom the diagnosis was made by PET-CT.

A endocardite infecciosa (EI) é uma doença frequente, com alta morbimortalidade, cujo diagnóstico continua sendo um desafio na atualidade. Sua abordagem deve ser realizada por uma equipe multidisciplinar. A semiologia, ferramenta fundamental na clínica médica, desempenha um papel preponderante, permitindo-nos manter uma elevada suspeição diagnóstica apesar dos estudos paraclínicos negativos. Nestas situações, novas técnicas de imagem como o PET-CT têm ganhado importância. Apresentamos o caso de uma mulher com cardiopatia predisponente cujo diagnóstico foi feito pelo PET-CT.

Incidencia de endocarditis infecciosa en un servicio de neonatología centro de referencia nacional en el período 2009-2019 / Incidence of infective endocarditis in a national reference neonatology department in 2009-2019 / Incidência de endocardite infecciosa no departamento de neonatologia de referência nacional no período 2009-2019

La endocarditis infecciosa es una enfermedad rara en pediatría, principalmente en la etapa neonatal pero con una importante morbimortalidad. Existen factores de riesgo definidos, sin embargo el diagnóstico, principalmente en recién nacidos, continúa siendo un desafío. En este trabajo se presenta un relevamiento en 10 años, 5 casos de endocarditis infecciosa confirmada en recién nacidos y se analizan las características clínicas, estudios paraclínicos, agentes infeccioso, tratamiento realizado y asociación con factores de riesgo en esta población.

Infective endocarditis is a rare disease in pediatrics, mainly in neonates, even though it involves significant morbidity and mortality. There are defined risk factors; however, regarding diagnosis and mainly for the case of newborns, it continues to be a challenge. In this paper, we present a 10-year research and follow-up of 5 confirmed cases of infective endocarditis in newborns and their clinical characteristics, paraclinical studies, infectious agents, treatment and association with risk factors in this population

A endocardite infecciosa é uma doença rara em pediatria, principalmente na fase neonatal, mas apresenta significativa morbidade e mortalidade. Existem fatores de risco definidos, porém o diagnóstico, principalmente em recém-nascidos, continua sendo um desafio. Este paper apresenta uma pesquisa de 10 anos de 5 casos de endocardite infecciosa confirmada em recém-nascidos e analisa as suas características clínicas, estudos para clínicos, agentes infecciosos, tratamento e associação com fatores de risco nesta população.

Cirurgia de Endocardite Infecciosa. Análise de 328 Pacientes Operados em um Hospital Universitário Terciário / Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Resumo Fundamento A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. Objetivo Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo - Brasil. Método Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020 Resultados Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. Conclusão Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Abstract Background Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. Objective This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. Method Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020 Results The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. Conclusion For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

Infective endocarditis of a native aortic valve due to Pseudomonas aeruginosa complicated by progressive multi-drug resistance.

BACKGROUND: Treatment of infective endocarditis secondary to Pseudomonas aeruginosa can be challenging because of this organism's ability to acquire antimicrobial resistance over time. METHODS: We describe a patient with native aortic valve infective endocarditis due to P. aeruginosa who developed progressive multi-drug resistance while on therapy. The resistance mechanisms were characterized using whole-genome sequencing. RESULTS: We identified two mutations in subsequent isolates (dacB and OprD) that conferred resistance to anti-pseudomonal penicillins, cephalosporins, and carbapenems. The patient was treated with combination high-dose continuous infusion meropenem and ciprofloxacin therapy, in addition to bioprosthetic aortic valve replacement and repair of ventricular septal wall defect. Antibiotics were continued for 6 weeks post-cardiac surgery and the patient remains infection free 18 months post-completion of antibiotic therapy. CONCLUSION: Clinicians should be aware of the ability of P. aeruginosa to acquire resistance mechanisms in response to selective antibiotic pressures in high-inoculum infections such as infective endocarditis. The mutations identified in this case report correlated well with the evolving antimicrobial resistance profile observed.

HISTORIQUE: Il peut être difficile de traiter une endocardite infectieuse causée par un Pseudomonas aeruginosa en raison de la capacité de cet organisme à acquérir une résistance aux antimicrobiens. MÉTHODOLOGIE: Les chercheurs décrivent un patient atteint d'une endocardite infectieuse de la valve aortique d'origine, attribuable à un P. aeruginosa, qui a acquis une multirésistance progressive pendant son traitement. Le mécanisme de résistance était caractérisé par le séquençage du génome entier. RÉSULTATS: Les auteurs ont dépisté deux mutations dans les isolats subséquents (dacB et OprD ), responsables d'une résistance aux pénicillines, aux céphalosporines et aux carbapénèmes antipseudomonaux. Le patient a reçu une polythérapie de perfusion continue de méropénem à forte dose et de ciprofloxacine, en plus du remplacement d'une valve aortique bioprothétique et de la réparation d'une communication interventriculaire. L'antibiothérapie s'est poursuivie six semaines après l'opération, et le patient n'avait pas d'infection 18 mois après la fin de l'antibiothérapie. CONCLUSION: Les cliniciens devraient savoir que le P. aeruginosa peut acquérir des mécanismes de résistance en réponse aux pressions antibiotiques sélectives en cas d'infections comportant un titre élevé d'inoculum comme une endocardite infectieuse. Les mutations constatées dans le présent rapport de cas étaient bien corrélées avec l'évolution du profil de résistance antimicrobienne observé.

Infective endocarditis: Epidemiology and prognosis.

INTRODUCTION: Infective endocarditis (IE) is associated with high morbidity and mortality, despite advances in diagnosis and treatment. OBJECTIVE: To assess changes in the epidemiological profile of IE, to perform a time-trend analysis and to define short-term and long-term prognostic predictors of IE. METHODS: Retrospective analysis of 173 patients admitted with a diagnosis of IE to a Portuguese level II Hospital between January 1998 and December 2013. The patients were divided into two groups according to the period of occurrence of the IE episode (1998-2007 vs. 2008-2013). The clinical event studied was the occurrence of death or the need for urgent surgery during hospitalization, and death in the follow-up period. Independent predictors of short-term and long-term prognosis were identified. RESULTS: In the first portion of the study, IE occurred in younger individuals, often drug addicts, users of intravenous drugs and with gastrointestinal disease, human immunodeficiency virus and hepatitis B infection. In the second portion of the study, IE occurred more frequently in individuals of an older age with concomitant cardiovascular disease; enterococcus was isolated more frequently. The independent predictors of in-hospital death or need for urgent valve surgery were septic shock and the occurrence of peri-annular complications. The independent predictors of long-term mortality were age, chronic kidney disease and IE due to multidrug-resistant microorganisms. CONCLUSION: Differences were found in the epidemiological profile of IE during the study period. Referral for valve surgery increased slightly, but mortality remained high.

Hemangioma of the mitral valve: Following the murmur.

Cardiac hemangiomas are an exceedingly rare condition, with about 100 cases described in the literature, of which only 13 were valvular. We report the case of a 66-year-old woman, with no prior cardiovascular disease, who presented with an abdominal infection caused by Enterococcus faecalis, complicated by recrudescent fever and new-onset systolic mitral murmur. The transesophageal echocardiogram revealed a large vegetation on the posterior leaflet of the mitral valve, with a high embolic risk, leading to a diagnosis of acute endocarditis. The patient began antibiotics, with no clinical improvement, developing severe heart failure and coronary and cerebrovascular embolic phenomena, and underwent excision of the mass and placement of a biological mitral prosthesis. The histopathologic analysis revealed a cavernous hemangioma. Eight months later, the patient presented with recurrence of acute bacterial endocarditis and septic shock, and underwent replacement of the prosthetic valve. The histologic exam showed no signs of hemangioma. The rarity of this case and its complications make its presentation relevant.

Premier cas d'endocardite infectieuse sur valve aortique prosthétique dû à Prevotella Intermedia.

INTRODUCTION: Prevotella species (i. e. P. intermedia, P. nigrescens, P. pallens, P. oris) are usually responsible for abscesses of head and neck spaces after dental procedures. P. intermedia - related infective endocarditis has never been reported. CASE REPORT: A 22-year-old man, with a history of aortic valve replacement 6 years ago, presented with fever and persistent retrosternal chest pain. An empirical antibiotic therapy was started on (cefotaxime, 2gx3 - gentamicin, 5mg/kilo). Five blood cultures were positive at Prevotella Intermedia. Metronidazole was introduced (500mg X 3 by day).The oro-pharyngeal spaces were normal. The evolution was marked by a hypotension, a third degree atrio-ventricular block, and a rapidly growing aortic root abscess complicated this case of Prevotella Intermedia infective endocarditis (IE). Aortic valve redux surgery was performed at day 5 of admission. Post-operative course was unremarkable. CONCLUSION: This first reported case of Prevotella Intermedia IE presented suggestive features of anaerobic IE as the patient developed both aortic-ring abscess, third degree atrio-ventricular block and hypotension.

Plastia mitral en endocarditis infecciosa: reporte de un caso / Mitral valve repair in infective endocarditis: a case report / Plastia mitral em endocardite infecciosa: relato de um caso

La endocarditis infecciosa es una patología heterogénea con una alta mortalidad y requiere tratamiento quirúrgico en al menos la mitad de los casos. Cuando asienta en posición mitral, la reparación valvular en lugar de su sustitución, si bien representa un desafío técnico, ha ido ganando terreno en los últimos años. Describimos el caso de un paciente que se presentó con una endocarditis sobre válvula nativa mitral en quien se realizó una plastia valvular exitosa. Revisaremos la evidencia acerca de su beneficio.

Infective endocarditis is a heterogeneous disease with a high mortality and that requires surgical treatment in at least half of cases. When seated in mitral position, valve repair rather than replacement, while technically challenging, has been gaining popularity in recent years. We describe the case of a patient who presented with a mitral valve endocarditis in whom a successful valve repair was performed. Evidence supporting its use will be reviewed.

A endocardite infecciosa é uma doença heterogênea com alta mortalidade que requer tratamento cirúrgico em pelo menos metade dos casos. Quando sentado na posição mitral, o reparo da válvula, em vez da substituição da válvula, embora seja um desafio técnico, tem ganhado espaço nos últimos anos. Descrevemos o caso de um paciente que apresentou endocardite valvar mitral nativa, no qual foi realizada plastia valvar com sucesso. Vamos revisar as evidências sobre o seu benefício.