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Objective: The mortality rate from Staphylococcus aureus endocarditis remains as high as 20-30% despite better medical and surgical treatment. This study evaluates the efficiency and tolerance of a combination of trimethoprim-sulfamethoxazole and clindamycin (T&C) +/rifampicin and gentamicin, with rapid switch to oral T&C. Methods: Before-after intervention study to compare the outcome of 170 control patients before the introduction of the T&C protocol (2001 to 2011) to 171 patients in the T&C group (2012 to 2016). All patients diagnosed as S. aureus-infective endocarditis, and referred to our center between 2001 and 2016 were included. Between 2001 and 2011, the patients were given a standardized antibiotic treatment: oxacillin or vancomycin, for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol includes high dose of T&C (intravenously, switched to oral at day 7). Rifampicin and gentamicin can be added (if blood culture positive after 48 hours or cardiac abscess). Results:The two groups were slightly different. In intention to treat, the global mortality rate was lower in the T&C group (19.3% vs 30% -p=0.024), as well as the in-hospital mortality (9.9% vs 18.2% -p=0.03), and the 30-days mortality (7.1% vs 14.2% -p=0.05). The mean duration of hospital stay alive was significantly shorter in the T&C group (30 vs 39 days -p=0.005) Conclusions:The management of S. aureus IE in our multidisciplinary team, using a rapid shift to oral antibiotic with T&C, shows promising results reducing length of hospital stay and the mortality rate.

Background:18 F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria Objectives:1. Primary objective: To assess the value of the ESC criteria including 18 F-FDG-PET/CT in prosthetic valve infective endocarditis (PVE). 2. Secondary objectives i: to assess the reproducibility of 18 F-FDG-PET/CT, ii: to compare its diagnostic value with that of echocardiography, and iii: to assess the diagnostic value of the presence of a diffuse splenic uptake Methods :Between 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable 18 F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert Consensus. Results :Cardiac uptake by 18 F-FDG PET/CT was observed in 67/91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% 95%CI: 63.3 to 82.3%, specificity 75% 53.3% to 90.2%). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% 46.3 to 67.5% to 83.5% 74.3% to 90.5%, (p< 0.001) but decreased its specificity from 95.8%  78.9% to 99.9% to 70.8% 48.9% to 87.4%. Intraobserver reproducibility of 18 F-FDG PET/CT was good (kappa= 0.84) but inter observer reproducibility was less satisfactory (kappa= 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p=0.024). Conclusion :18 F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria compared to Duke criteria. However, 18 F-FDG PET/CT also presents important limitations concerning its feasibility, specificity and reproducibility. Our study describes for the first time a new endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18 F-FDG PET/CT.

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.MethodsProspective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.ResultsPatients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4–L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.ConclusionsPS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

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We present here the first case of N. macacae infective endocarditis in a 65-year-old man with a native aortic valve infection complicated by a peri-aortic abscess. N. macacae was isolated from blood culture and was found on the cardiac valve using 16S rDNA detection. Despite an appropriate antibiotic therapy, and aortic homograft replacement, and mitral repair, the patient died 4 days after surgery from a massive hemorrhagic stroke.