Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário

Alegria, Sofia; Marques, Ana; Cruz, Inês; Broa, Ana Luísa; João, Isabel; Simões, Otília; Pereira, Hélder

doi:10.36660/abc.20190586

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…As a limitation, the smaller size of our population could have affected the power of our study, which does not allow significant correlations to be found, even in the presence of differences in rates. The findings from our study highlight the critical prognostic role of septic cerebral emboli in IE patients [ 22 , 23 , 24 , 25 ]; in particular, the association between cerebral embolic phenomena and 6-month mortality may suggest the important role of the late neurological sequelae in determining a negative outcome. In our study, extra-cerebral embolization was present in 29.4% of IE cases, a percentage higher than previous data from the literature, i.e., 17% according to ICE-PCS [ 22 ].…”

Section: Discussionmentioning

confidence: 55%

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Ucciferri

Auricchio

Cutone

et al. 2022

Infectious Disease Reports

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Background: Nowadays, infective endocarditis (IE) is still burdened by a high mortality. In the absence of an adequate prognostic stratification system, it is important to assess new predictors of poor outcomes. The aim of our study is to evaluate which factors were associated with higher mortality in IE patients. Methods: A retrospective cohort study enrolled patients with an IE diagnosis at the Infectious Diseases Clinic of the University ‘G. D’Annunzio’, Chieti, Italy from January 2013 to December 2019. For each patient, demographic, anamnestic and clinical information, embolic phenomena, laboratory and microbiologic data, treatment, and outcomes were collected and analyzed. A correlation analysis was performed. Results: Sixty-eight patients with EI were studied; among them, the mortality was 17.6%, 20.6%, and 23.5%, intra-hospital, at 1 month from discharge and at 6 months from discharge, respectively. Mortality was significantly correlated with age, estimated glomerular filtration rate, and procalcitonin values when considering either basal values (r = 0.266, p = 0.029), or values at 48–72 h from the start of an antibiotic therapy (r = 0.222; p < 0.05), cerebral embolization for 6-month mortality (r = 0.284; p = 0.019), and inadequate antibiotic therapy (r = 0.232, p < 0.05). Conclusions: Procalcitonin values, at EI diagnosis and at 48–72 h after starting antibiotics, are prognostic factors useful for stratifying patient risk, and for setting up a personalized treatment. Of note, cerebral embolization and an inappropriate empirical treatment were associated with a higher mortality in the short- and long-term.

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Section: Discussionmentioning

confidence: 55%

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Ucciferri

Auricchio

Cutone

et al. 2022

Infectious Disease Reports

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“…Tricuspid valve IE comprises 5–10% of all cases of infectious endocarditis, typically linked to intravenous drug use, medical interventions, venous catheters, or hemodialysis [ 14 ]. Another at-risk group for right heart IE includes those with congenital heart disease, such as interventricular septal defects.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-Resistant Streptococcus thoraltensis: A Case Report of Bacterial Endocarditis and Review of Literature on Infections Caused by This Pathogen

Chiorescu,

Buksa,

Botan

et al. 2024

Microorganisms

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Streptococcus thoraltensis is a rare species, part of the viridans streptococcus group, found initially in rabbits and pigs, which can be vancomycin-resistant. We present the case of a 65-year-old patient, a smoker and chronic alcohol consumer with chronic obstructive pulmonary disease (COPD) and multiple dental foci who had been diagnosed with bacterial endocarditis caused by Streptococcus thoraltensis. The particular elements of the case consisted of an atypical clinical presentation with diarrheal stools, abdominal pain, concomitant damage to the aortic and tricuspid valves, the presence of large vegetations (>2 cm), and a vancomycin-resistant strain of Streptococcus thoraltensis. The evolution of the patient was unfavorable due to septic embolisms, respiratory failure requiring orotracheal intubation, and septic and cardiogenic shock. Infections with Streptococcus thoraltensis are challenging to treat because of the severity of the clinical form it causes and the pattern of antibiotic resistance in this germ. Based on our brief review, Streptococcus thoraltensis is an extremely rare human pathogen previously described as the etiologic agent of infectious endocarditis in only one case.

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“…In a majority of studies, the incidence of NCs in patients with IE who are referred to surgery is reported to range from 20% to 30% [12,[18][19][20][21], with some studies reporting rates as high as 63% [14]. Additionally, ischemic events have been identifed as the most common presenting complication [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis

Al-Tawil,

Friedrich,

Mandler

et al. 2024

Journal of Cardiac Surgery

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Background. Infective endocarditis (IE) is considered a life-threatening cardiac infection with a predilection to involve heart valves. One of the most feared complications of IE is the development of new-onset neurological complications (NCs). The aim of this study is to compare the short- and long-term outcomes of surgery in patients with IE presenting with vs. without NCs. Methods. We retrospectively reviewed patient records which were regularly collected in our institutional database. Between January 2002 and August 2020, 438 consecutive patients who underwent open cardiac surgery in our university hospital due to IE were included in the retrospective study. Results. Of the total cohort, 89 patients (20.3%) had preoperative NCs. Patients in the NC group were more likely to be female (33.7% vs. 23.5%; P=0.049), had more acute kindly injury at presentation (22.5% vs. 10.0%; P=0.002), were more likely to be admitted to ICU (36.0% vs. 18.3%; P<0.001), and had significantly more vegetations (84.3% vs. 69.8%; P=0.006) and overall higher preoperative embolization (92.1% vs. 11.7%; P<0.001). Staphylococcus aureus as causative organism of IE was significantly higher in the NC group (35.2% vs. 16.1%; P<0.001). Patients in the NC group had significantly higher affection of the mitral valve. There was no difference in postoperative outcomes between the two groups. The long-term survival was also similar in both groups. Preoperative atrial fibrillation (adjusted odds ratio (aOR): 2.03; 95% CI [1.04–3.93]; P=0.037) and Staphylococcus aureus IE (aOR: 2.60; 95% CI [1.4–4.8]; P=0.002) were independent risk factors of developing NCs, while previous endocarditis was a protective factor (aOR: 0.33; 95% CI [0.11–0.99]; P=0.048). Conclusion. Our study emphasizes the shared risk factors between mortality and developing NCs. NCs are critical in IE’s clinical presentation, but they do not independently predict short- or long-term survival following surgery for IE.

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Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário

Cited by 5 publications

References 40 publications

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Vancomycin-Resistant Streptococcus thoraltensis: A Case Report of Bacterial Endocarditis and Review of Literature on Infections Caused by This Pathogen

The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis

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