Infective endocarditis in intravenous drug abusers and HIV-1 infected patients

Miró, José M.; Rı́o, Ana del; Mestres, Carlos A.

doi:10.1016/s0891-5520(01)00008-3

Cited by 136 publications

(109 citation statements)

References 88 publications

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“…For this reason, we included fungal ribosomal targets in our diagnostic strategy. 41,42 Candida endocarditis has also been associated with central-line-associated bloodstream infections, especially in patients who have received prolonged courses of intravenous fluids and antibiotics. Although C albicans represents the predominant species, the importance of non-albicans yeasts has emerged over the last decade.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Molecular Approach to Improve the Microbiological Diagnosis of Infective Heart Valve Endocarditis

et al. 2005

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Background-Even today, infective endocarditis (IE) remains a severe and potentially fatal disease demanding sophisticated diagnostic strategies for detection of the causative microorganisms. Despite the use of appropriate laboratory techniques, classic microbiological diagnostics are characterized by a high rate of negative results. Methods and Results-Broad-range polymerase chain reaction (PCR) targeting bacterial and fungal rDNA followed by direct sequencing was applied to excised heart valves (nϭ52) collected from 51 patients with suspected infectious endocarditis and from 16 patients without any signs of IE during an 18-month period. The sensitivity, specificity, and the positive and negative predictive values for the bacterial broad-range PCR were 41.2%, 100.0%, 100.0%, and 34.8%, respectively, compared with 7.8%, 93.7%, 80.0%, and 24.2% for culture and 11.8%, 100.0%, 100.0%, and 26.2% for Gram staining. Without exception, database analyses allowed identification up to the (sub)species level comprising streptococcal (nϭ13), staphylococcal (nϭ4), enterococcal (nϭ2), and other signature sequences such as Bartonella quintana and Nocardia paucivorans. Fungal ribosomal sequences were not amplified. All valve tissues of the reference group were negative for both PCR and conventional methods, except one sample that was contaminated by molds. Conclusions-Culture-independent molecular methods substantially improve the diagnostic outcome of microbiological examination of excised heart valves. Importantly, this was true not only for fastidious, slow-growing, and/or nonculturable microorganisms but also for easy-to-culture pathogens such as streptococci and staphylococci. Both patient management and empiric antibiotic therapy of IE are likely to benefit from improved knowledge of the spectrum of pathogens now causing IE.

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Section: Discussionmentioning

confidence: 99%

Impact of a Molecular Approach to Improve the Microbiological Diagnosis of Infective Heart Valve Endocarditis

et al. 2005

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“…91 The tricuspid valve is infected in Ͼ70% of cases, and the majority have no known preexisting cardiac disease. 91,92 S aureus species predominate, although unusual infections including P aeruginosa, fungi, Bartonella, Salmonella, and Listeria may also be encountered, particularly in those who are infected with the human immunodeficiency virus, for whom the outcome is inversely related to the CD4 count. 93 This group of patients presents particular management difficulties because of their drug-seeking behavior and poor compliance with treatment.…”

Section: Intravenous Drug Usersmentioning

confidence: 99%

Surgery for Infective Endocarditis

2010

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“…[8] In HIV-infected IDUs, the most common causative organism is still S. aureus. [9,10] In HIVreactive (CD4 + count >350 cells/µL) IDUs, the odds ratio (OR) of developing IE is 2.31 compared with non-HIV-infected individuals. The OR increases to 8.31 at a CD4 + count of <350 cells/uL.…”

Section: Discussionmentioning

confidence: 99%