Challenges in Infective Endocarditis.

Published on Jan 24, 2017in Journal of the American College of Cardiology20.589
· DOI :10.1016/J.JACC.2016.10.066
Thomas J. Cahill5
Estimated H-index: 5
(University of Oxford),
Larry M. Baddour90
Estimated H-index: 90
(Mayo Clinic)
+ 5 AuthorsBernard Prendergast60
Estimated H-index: 60
(St Thomas' Hospital)
Abstract Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus , which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
Figures & Tables
📖 Papers frequently viewed together
2,090 Citations
16 Authors (Larry M. Baddour, ..., Tau)
722 Citations
4 Authors (Connaughton Mark, ..., 杜昕)
688 Citations
#1Karsten Keller (University of Mainz)H-Index: 15
#2Ralph Stephan von Bardeleben (University of Mainz)H-Index: 23
Last. Mareike Lankeit (Charité)H-Index: 37
view all 7 authors...
Infective endocarditis (IE) is a potentially life-threatening disease. Little is known about temporal trends in its prevalence in Germany. In 2009, recommendations for antibiotic prophylaxis were deescalated in the revised European Society of Cardiology guideline to include only patients at high risk of IE. We selected patients with the discharge diagnosis of IE based on the International Classification of Diseases code I33 in the nationwide database of the Federal Statistical Office of Germany....
44 CitationsSource
#1Andrew S. MackieH-Index: 35
#2Wei LiuH-Index: 5
Last. Padma KaulH-Index: 38
view all 5 authors...
7 CitationsSource
#1Ander Regueiro (Laval University)H-Index: 21
#2Axel Linke (Leipzig University)H-Index: 85
Last. Josep Rodés-Cabau (Laval University)H-Index: 95
view all 65 authors...
Importance Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). Objective To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. Design, Setting, and Participants The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers fro...
144 CitationsSource
#1Deborah RhodesH-Index: 3
#2Allen C. Cheng (Monash University)H-Index: 76
Last. Leon J Worth (University of Melbourne)H-Index: 30
view all 9 authors...
Summary Background Healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) results in morbidity, mortality, and increased healthcare costs, and these infections are frequently regarded as preventable. Aim To implement a multi-modal prevention programme for improved processes regarding peripheral intravenous cannula (PIVC) insertion and maintenance, in order to reduce PIVC-associated HA-SAB events in a large Australian health service. Methods Baseline clinical practice was evaluated for ...
27 CitationsSource
Aims After the introduction of the European Society of Cardiology (ESC) guidelines on prevention, diagnosis, and treatment of infective endocarditis (IE) in 2009, prophylaxis for patients at risk became less strict. We hypothesize that there will be a rise in IE after the introduction of the guideline update. Methods and results We performed a nationwide retrospective trend study using segmented regression analysis of the interrupted time series. The patient data were obtained via the national h...
37 CitationsSource
#1Andrew S. Mackie (U of A: University of Alberta)H-Index: 35
#2Wei Liu (U of A: University of Alberta)H-Index: 5
Last. Padma Kaul (U of A: University of Alberta)H-Index: 38
view all 5 authors...
Abstract Background In 2007, the American Heart Association (AHA) published revised guidelines for infective endocarditis (IE) prophylaxis. Population-based data with respect to the potential impact of these revised guidelines are lacking. Methods The Canadian Institute for Health Information Discharge Abstract Database was used to identify all hospitalizations between April 2002 and March 2013 having IE as a primary diagnosis. Hospitalization rates were determined using age-specific population ...
51 CitationsSource
Studies of infective endocarditis (IE) in transcatheter aortic valve replacement patients are limited by univariate analysis of predictors [(1)][1], incomplete patient data (particularly non-IE cases [[2]][2]), or low number of endpoints [(3)][3]. We aimed to investigate the incidence, treatment,
44 CitationsSource
#1Angeles EstellesH-Index: 4
#2Anne-Kathrin Woischnig (University Hospital of Basel)H-Index: 7
Last. Lawrence M. KauvarH-Index: 15
view all 16 authors...
ABSTRACT Many serious bacterial infections are difficult to treat due to biofilm formation, which provides physical protection and induces a sessile phenotype refractory to antibiotic treatment compared to the planktonic state. A key structural component of biofilm is extracellular DNA, which is held in place by secreted bacterial proteins from the DNABII family: integration host factor (IHF) and histone-like (HU) proteins. A native human monoclonal antibody, TRL1068, has been discovered using s...
27 CitationsSource
#1Haytham Elgharably (Cleveland Clinic)H-Index: 13
#2Syed T. Hussain (Cleveland Clinic)H-Index: 15
Last. Gösta B. Pettersson (Cleveland Clinic)H-Index: 55
view all 5 authors...
Despite recent advances in diagnostics and treatments, infective endocarditis is still associated with substantial morbidity and mortality. Even prolonged courses of broad-spectrum antimicrobials often fail to eradicate the infection, making surgical intervention necessary in many cases. In this review, we present recent advances in molecular microbiology techniques that have uncovered a plausible explanation for this resistance to treatment: the recently discovered social behavior of some micro...
40 CitationsSource
#1Hai-Xia Fu (Zhengzhou University)H-Index: 3
#1Hai-Xia Fu (Zhengzhou University)H-Index: 1
Last. Yong-Mei Cha (Mayo Clinic)H-Index: 13
view all 15 authors...
Background Removal of an entire cardiovascular implantable electronic device is associated with morbidity and mortality. We sought to establish a risk classification scheme according to the outcomes of transvenous lead removal in a single center, with the goal of using that scheme to guide electrophysiology lab versus operating room extraction. Methods Consecutive patients undergoing transvenous lead removal from January 2001 to October 2012 at Mayo Clinic were retrospectively reviewed. Results ...
34 CitationsSource
Cited By209
#1Rachael R. Kirkbride (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 2
#2Bhavin RawalH-Index: 1
Last. Diana Litmanovich (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 24
view all 7 authors...
Infections of the cardiovascular system may present with nonspecific symptoms, and it is common for patients to undergo multiple investigations to arrive at the diagnosis. Echocardiography is central to the diagnosis of endocarditis and pericarditis. However, cardiac computed tomography (CT) and magnetic resonance imaging also play an additive role in these diagnoses; in fact, magnetic resonance imaging is central to the diagnosis of myocarditis. Functional imaging (fluorine-18 fluorodeoxyglucos...
2 CitationsSource
#1Larry M. Baddour (Mayo Clinic)H-Index: 90
#2Thomas Cahill (NewYork–Presbyterian Hospital)H-Index: 1
Last. Bernard Prendergast (St Thomas' Hospital)H-Index: 60
view all 3 authors...
#1Emese Kanyo (Cleveland Clinic Lerner College of Medicine)
#2Amy S. Nowacki (Cleveland Clinic)H-Index: 24
Last. Nabin K. Shrestha (Cleveland Clinic)H-Index: 24
view all 4 authors...
Abstract Objective The purpose of this study was to compare survival, relapse, and stroke for patients with methicillin-resistant Staphylococcus aureus (MRSA) versus methicillin-susceptible S. aureus (MSSA) infective endocarditis (IE). Methods In this retrospective study, the primary outcome of death and secondary outcomes of stroke and relapse were compared using multivariable Cox proportional hazards regression. Surgical treatment was adjusted for as a time-dependent variable. Results In total...
#1Anabel Pinter‐Högerle (University Hospital Heidelberg)
view all 0 authors...
Abstract null null Infective endocarditis (IE), a heart valve infection primarily caused by bacteria such as streptococci or staphylococci, causes significant morbidity and mortality. Despite the long-term use of broad-spectrum antimicrobials, the infection is often difficult to manage. The latest diagnostic modalities for IE are discussed in this study. Blood culture use in pathogen identification can lead to loss of precious time as well as generation of false negative reports. The first steps...
#1Darko Pucar (Yale University)H-Index: 2
#2H William Strauss (Yale University)
#1Eluwana A Amaratunga (St. Luke's University Health Network)H-Index: 1
#2Jason A Hoggard (Boston Children's Hospital)
Last. Richard Snyder (St. Luke's University Health Network)H-Index: 1
view all 6 authors...
Infective endocarditis (IE) is a challenging condition to diagnose, given its protean clinical signs and symptoms, Elevation in serum aminotransferases in IE is associated with valvular regurgitation, acute heart failure, or congestive hepatopathy. Studies show co-existing liver failure portends worsening outcomes in IE and poses a challenge for successful surgical management. Here we report a diagnostic challenge in a 35-year-old man with IE presenting predominantly with gastrointestinal sympto...
#1Emily M. Eichenberger (Duke University)H-Index: 7
#2Michael M Dagher (Duke University)H-Index: 2
Last. Jerome J. Federspiel (JHUSOM: Johns Hopkins University School of Medicine)
view all 6 authors...
Abstract null null Introduction null The epidemiology, and outcome of infective endocarditis (IE) among solid organ transplant (SOT) recipients is unknown. null null null Methods null We used data from the 2013-2018 Nationwide Readmissions Database (NRD). IE- and SOT-associated hospitalizations were identified using diagnosis and procedure codes. Outcomes included inpatient mortality, length of stay, and inpatient costs. Adjusted analyses were performed using weighted regression models. null nul...
#1Kamran Siddiqi (UK: University of Kentucky)
#2Patricia R. Freeman (UK: University of Kentucky)H-Index: 15
Last. Svetla Slavova (UK: University of Kentucky)H-Index: 15
view all 4 authors...
PURPOSE In 2016, the US rate of opioid use-associated infective endocarditis (OUA IE) hospitalizations was 3.86/100,000 for rural and 3.49/100,000 for urban residents. This study estimates the Kentucky OUA IE hospitalization rates, 2016-2019, describing differences in rural-urban residency trends, demographics, relevant comorbidities, and discharge disposition. OUA IE hospitalization rates between counties with and without syringe services programs (SSPs) are also compared. METHODS We used Kentu...
#1Bartosz Ditkowski (Katholieke Universiteit Leuven)H-Index: 4
#2Martyna Bezulska-Ditkowska (Katholieke Universiteit Leuven)H-Index: 2
Last. Bart Meyns (Katholieke Universiteit Leuven)H-Index: 38
view all 11 authors...
Abstract Objective Although recent advances in pulmonary valve replacement have enabled excellent hemodynamics, infective endocarditis remains a serious complication, particularly for implanted bovine jugular vein (BJV) conduits. Methods We investigated contributions by platelets and plasma fibrinogen to endocarditis initiation on various grafts used for valve replacement. Thus, adherence of Staphylococcus aureus (S. aureus) and platelets to 5 graft tissues were studied quantitatively in perfusi...
4 CitationsSource