Endocarditis in the Mediterranean Basin

Gouriet, Frédérique; Chaudet, Hervé; Pellegrin, Liliane; Santi, Vincent Pommier de; Savini, Hćlène; Texier, Gaétan; Raoult, Didier; Fournier, Pierre‐Edouard

doi:10.1016/j.nmni.2018.05.004

Cited by 13 publications

(10 citation statements)

References 57 publications

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“…It is also the largest QFE series involving bovine jugular vein grafts such as Melody valves and Contegra conduits. Among the 502 patients with endocarditis, 234 (46.6%) had BCNE, which is consistent with the rates of BCNE in the Mediterranean basin (46-69%) (Gouriet et al, 2018). The rates of Q fever in all endocarditis and BCNE patients in our study were only 3.7% and 8.0%, respectively; however, this is probably an underestimation since many of the BCNE patients did not undergo serology.…”

Section: Discussionsupporting

confidence: 87%

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Elzein

Alsherbeeni

Alnajashi

et al. 2019

International Journal of Infectious Diseases

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Background: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. Methods: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. Results: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. Conclusion: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. Key points: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.

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Section: Discussionsupporting

confidence: 87%

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Elzein

Alsherbeeni

Alnajashi

et al. 2019

International Journal of Infectious Diseases

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“…Since more than one-fourth of S. aureus strains were methicillin resistant and penicillin resistance was detected in more than one-fourth of S. viridans strains, the empirical use of vancomycin or daptomycin should be considered in accordance with the local susceptibility data. Although preliminary data stressed the importance of hospital-acquired pathogens [19], our data disclosed that as much as 18% of NVE cases were classified under hospitalacquired infection category. Furthermore, dental source, central catheters, and respiratory system appeared to be more significant sources in NVE while cardiac surgery was commonly associated to PVE.…”

Section: Discussionmentioning

confidence: 57%

Portraying infective endocarditis: results of multinational ID-IRI study

Erdem¹,

Puca

Ruch

et al. 2019

Eur J Clin Microbiol Infect Dis

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Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulasenegative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042). a Including all NVE, PVE, pacemaker, and catheter port endocarditis patients. b N indicates the denominator with any identified pathogen. c Coxiella burnetii seropositivity; anti-phase 1 IgG antibody titer ≥ 1:800 A P value of <0.05 was considered significant Eur J Clin Microbiol Infect Dis

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“…In Italy, a regional Tuscany epidemiological study over 17 years showed an incidence rate of IE of 4.6/100,000 person-years, with a higher value in people older than 65 years (11.7/100,000 person-years) [5][6]. Recently, Gouriet et al (2018) reported a tremendous epidemiologic disparity among Mediterranean countries regarding etiology and diagnosis [7]. Blood culture is proof of continuous bacteremia and is one of the significant criteria for diagnosing IE [1][2][8][9].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

Serra¹,

Colomba²,

Carlo³

et al. 2020

Cureus

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Background Infective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management. We aimed to define diagnosis parameters and delineate in-hospital management in patients with IE admitted in a tertiary hospital of Southern Italian. Materials and methods Fifty-six consecutive patients (42 males, 14 females; age range: 34-85 years) admitted for IE in the Infectious Diseases, Cardiac Surgery, and Cardiology units, between January 2011 and August 2017, were enrolled. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, and antimicrobial therapy were collected and analyzed. Any comments at the multidisciplinary team meetings were recorded in minutes of and approved. Results We found 83.9% of patients with positive blood cultures. The four most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA: 21.3%), methicillin-sensitive Staphylococcus aureus (MSSA: 17%), Streptococci (14.9%), and Enterococci (14.9%). Both in the univariate and multivariate analysis, we observed a significant positive correlation between surgery and complications. Particularly in the univariate analysis only, surgery was positively correlated to males and C-reactive protein (CPR) at baseline. Also, considering the most common bacteria, it resulted in a positive correlation between surgery and MRSA and Streptococci spp. and between complications and MSSA. Finally, the male gender was positively correlated to MSSA and heart complications, major arterial embolism, septic pulmonary emboli, splenic infarction, and cerebral embolism. Conclusions A blood culture test remains a critical factor for the diagnosis of IE and the antibiotic treatment 1 2 2,

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Endocarditis in the Mediterranean Basin

Cited by 13 publications

References 57 publications

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Portraying infective endocarditis: results of multinational ID-IRI study

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

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