Infective Endocarditis in Elderly: From Etiology to Treatment and Prevention

Ватутин, Н. Т.; Тарадин, Г. Г.; Chaus, E. A.; Смирнова, А. С.

doi:10.15829/1560-4071-2016-1-80-89

Cited by 7 publications

(2 citation statements)

References 23 publications

(51 reference statements)

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“…1,2 , Бондаренко Ю. Д. 1 1 ГОО ВПО "Донецкий национальный медицинский университет имени М. Горького". Донецк; 2 ГУ "Институт неотложной и восстановительной хирургии им.…”

Section: практические аспекты профилактики инфекционного эндокардитаunclassified

“…Инфекционный эндокардит (ИЭ) -заболевание инфекционной природы с первичной локализацией возбудителя на поверхности эндокарда, эндотелия начальных отделов крупных сосудов, а также внутрисердечных искусственных материалах, характеризующееся, как правило, быстрым развитием клапанной недостаточности и системными эмболическими осложнениями [1][2][3][4].…”

Section: Introductionunclassified

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Practical aspects of infective endocarditis prevention

Тарадин

Игнатенко

Ракитская

et al. 2021

Cardiovasc Ther Prev

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The review is devoted to the practical aspects of infective endocarditis (IE) prevention, the issues of which, as before, remain the subject of lengthy discussions. Despite repeatedly updated national and international guidelines on this topic, medical practitioners are not always fully aware of antibiotic prophylaxis of IE. After a brief consideration of the etiological, pathogenetic features and risk factors of the disease, the main provisions of 2015 European Society of Cardiology guidelines on IE prevention, which were approved by the Russian Society of Cardiology, are presented. The categories of patients with the highest risk of IE, procedures associated with an increased risk of IE (dental and other invasive procedures) are described in detail. The main practical approaches to the identification of risk groups and performing invasive procedures that influence the decision to prescribe antibiotic prophylaxis are described. Particular attention is paid to the characteristics of both first-line antibiotic drugs and alternative agents for penicillin allergy or in cases of β-lactamase secreting pathogens.

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Section: практические аспекты профилактики инфекционного эндокардитаunclassified

Section: Introductionunclassified

Practical aspects of infective endocarditis prevention

Тарадин

Игнатенко

Ракитская

et al. 2021

Cardiovasc Ther Prev

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Infective endocarditis: diagnostic difficulties

et al. 2020

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In recent decades, against the background of incidence rate increasing, infectious endocarditis (IE) remains in the category of diseases with a high mortality and a “difficult diagnosis”. According to different studies, 5.2–14.8 % of IE cases were detected only at autopsy or heart surgery, and 27–42.8 % of IE cases with fatal outcome were not diagnosed before death. In 25–66 % patients infectious endocarditis was diagnosed later than 1 month from the onset of symptoms (including later than 3 months in almost a quarter of patients). Late diagnosis, considered as one of the independent risk factors for an unfavorable prognosis of IE (relative risk 2.1), is most frequent with IE in elderly patients. The generally accepted diagnostic criteria of IE, providing a standardized approach to the diagnosis of IE, rely on laboratory and instrumental evidence of bacteremia and visualization of vegetations and signs of valve destruction, as major clinical diagnostic criteria. However, a diagnosis of IE is not suspected at an outpatient stage in 54–79 % of patients, so the necessary transthoracic echocardiographic examination and bacteriological blood tests are not performed. In 84 % cases of right heart valves IE and 27 % of left heart valves IE extracardiac manifestations of the disease due to cardiogenic emboli, immunocomplex mechanisms, or systemic inflammation were initially regarded as an independent disease and patients were hospitalized with incorrect diagnosis. Most often, such masks are associated with involvement of lungs, nervous system, and kidneys, less often rheumatological, vascular, hematological guise and the onset with myocardial infarction or acute abdominal pain are noted. The lecture analyzes the causes of IE diagnosis errors and describes clinical situations that allow suspecting IE, as well as situations in which IE must be considered with a differential diagnosis. Authors emphasize that timely clinical suspicion, with availability of modern effective heart imaging and bacteriological studies remains essential basis for early IE diagnosis.

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Global and national trends in the evolution of infective endocarditis

Кобалава

Kotova

2023

Kardiologiia

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For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians’ compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors’ own data that confirm the evolutionary trends of current IE.

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Infective Endocarditis in Elderly: From Etiology to Treatment and Prevention

Cited by 7 publications

References 23 publications

Practical aspects of infective endocarditis prevention

Practical aspects of infective endocarditis prevention

Infective endocarditis: diagnostic difficulties

Global and national trends in the evolution of infective endocarditis

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