Infective Endocarditis in the Antibiotic Era

Lerner, Phillip I.; Weinstein, Louis

doi:10.1056/nejm196602102740606

Cited by 146 publications

(61 citation statements)

References 80 publications

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“…5 16 In spite of emergence of intravenous drug use as an increasingly important risk factor for infective endocarditis, the mean age of our patients (53 years) has tended to increase during the two periods investigated; this reflects the ongoing trend towards increasing age at presentation of infective endocarditis during this century, [17][18][19][20] and is consistent with other reports (mean 46-64 years). 8 11 14 15 21 22 As in other studies, 16 23 24 in our series the diagnosis of infective endocarditis was made relatively late in the course of the disease, and this feature has not been changed by the introduction of new diagnostic tools, such as transoesophageal echocardiography in 1987 or new diagnostic criteria in 1981 (Beth Israel) 12 and 1994 (Duke) 13 .…”

Section: This Retrospective Evaluation In 212 Patientssupporting

confidence: 86%

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Coronary artery calcification

Farzaneh‐Far¹

2000

Heart

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Objective-To evaluate recent changes in the spectrum and clinical presentation of infective endocarditis and to determine predictors of outcome. Design-A retrospective case study. Methods-Demographic, clinical, and echocardiographic characteristics were examined in 212 patients who fulfilled the Duke criteria for infective endocarditis between January 1980 and December 1995 to assess changes in clinical presentation and survival. Results-Clinical presentation and course did not change significantly during the study period despite the concurrent introduction of new diagnostic tools (for example, transoesophageal echocardiography). In-hospital mortality was 15% and remained unchanged. Neurological symptoms on admission, arthralgia, and weight loss were all independent risk factors for adverse outcome (odds ratios 26.1, 6.2, and 4.2, respectively). Age, prosthetic valve disease, previous antibiotic treatment, renal insufficiency, surgical treatment, and the type of valve involved were not predictive of mortality. In contrast to all other major reports, Streptococcus viridans was the most common causative organism in intravenous drug users (52%). Conclusions-Despite the introduction of new diagnostic tools, the course of infective endocarditis has remained unchanged over a period of 16 years. Evidence of early dissemination of the disease to other sites was associated with adverse outcome. Even in elderly patients, early aggressive treatment seems to be eVective. (Heart 2000;84:25-30)

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Section: This Retrospective Evaluation In 212 Patientssupporting

confidence: 86%

“…1 4 5 However, the annual incidence (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) cases/million) [6][7][8][9] and the morbidity and mortality are still relatively high. In-hospital mortality from infective endocarditis is currently reported to be between 16% and 27%, 10 while it was 40-60% in the 1950s, 4 11 and more than 30% in the 1970s and 1980s.…”

mentioning

confidence: 99%

Coronary artery calcification

Farzaneh‐Far¹

2000

Heart

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“…2). Substantial adherence is observed as early as 1 min after exposing the surface to the inoculum and the AR increased with time, reaching a plateau at [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] ip of organism removal to number of unaggregated bacteria in the standard bacterial suse effect of the number of sequential 5-min pensions. In addition, the following ratio was calecuhe removal of organisms adherent to the lated for all experiments: (number of bacteria in inievaluated.…”

Section: Techniquesmentioning

confidence: 99%

Bacterial adherence in the pathogenesis of endocarditis. Interaction of bacterial dextran, platelets, and fibrin.

Scheld¹,

Valone²,

Sande³

1978

J. Clin. Invest.

233

142

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A B S T R A C T The role of' dextrani in the pathogeniesis of' bacterial endocarditis was investigated by studying the adhereniee of' dextran producing oral streptococci to the constituenits of' nonl)acterial thrombotic endocarditis (NBTE) in vitro and in vivo. The adherence of' Streptococcus saniguis to fibrin and platelets was determinedl in an in vitro assay system simulating non-I)acterial thrombotic endocarditis. Adherence was increased when the organismiis were grown in sucrosesuipplemented media (adherence ratio x 104, 177+6 in 5% suicrose vs. 140±7 in 0.5% sucrose, P < 0.001), and decreased by incubating the organisms in dextranase (adherence ratio x 104, 117+ 16, P < 0.001), an effect which was nullified by heat inactivating this enzyme (adherence ratio x 104, 192+7, P < 0.001). The amount of dextran produced in broth by three different oral streptococci correlated directly with the adherence observed to fibrin and a fibrin-platelet matrix in vitro (P < 0.001). These organisms adhered more readily to a fibrin-platelet matrix than to fibrin alone (adherence ratio x 104, 455±30 vs. 177±6, respectively, P < 0.001).The role of dextran formation was also examined in vivo in rabbits with preexisting NBTE. After injection of 107 S. sangguis, 12 of 17 animals developed endocarditis. In contrast, when the organisms were pretreated with dextranase (an enzyme that removes dextran from the bacterial cell surface), the same inoculum resulted in endocarditis in only 5 of' 19 animals (P < 0.05). In addition, a fresh strain of' S. sanguis that produiced high levels of dextran (1,220+50 ,Ag/ml) and adhered avidly to fibrin (adherence ratio x 104, 220 ±11) prodtuced endocarditis in 12 of' 18 rabbits after injection of 107 organisms. Another isolate of the same

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“…In spite of an increasing incidence of gram-negative bacillary bacteremia (4), aerobic gram-positive cocci remain in the most frequently isolated bacteria associated -with endocarditis in man (5,6). Gram-negative bacillary endocarditis has remained unusual except in drug addicts (7,8) and in prosthetic valve infections (9).…”

Section: Introductionmentioning

confidence: 99%

Adherence of bacteria to heart valves in vitro.

Gould¹,

Ramírez-Ronda²,

Holmes³

et al. 1975

J. Clin. Invest.

199

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A B S T R A C T The abilities of 14 strains of aerobic gram-positive cocci and gram-negative bacilli to adhere in vitro to human or canine aortic valve leaflets were compared. 2-mm sections of excised valve leaflets were obtained by punch biopsy and were incubated under standardized conditions in suspensions of bacteria. Valve sections were subsequently waslhed and homiogeniized, and quantitative techniques were used to determine the proportions of bacteria from the initial suspensions that had adhered to the valve sections. Comparable results were obtained when these adherence ratios were determined by two independent methods based either on measurements of bacterial viability or of radioactivity in 5"Cr-labeled bacteria. For each bacterial strain, the adherence ratio was constant over a wide range of concentrations of bacteria in the incubation mediuiml. Strains of enterococci, viridans streptococci, coagulase-positive and coagulase-negative staphylococci and Pscudoim oinas aeruginosa (adherence ratios 0.003-0.017) were found to adhere more readily to valve sections than strains of Escherichia coli and Klbsiella pfeum;oniiac (adherence ratios 0.00002-0.00004). The organisms that most frequently cause bacterial endocarditis Nwere found to adhere best to heart valves in vitro, suggesting that the ability to adhere to valvular endothelium may be an important or essential characteristic of bacteria that cause endocarditis in man.

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Infective Endocarditis in the Antibiotic Era

Cited by 146 publications

References 80 publications

Coronary artery calcification

Coronary artery calcification

Bacterial adherence in the pathogenesis of endocarditis. Interaction of bacterial dextran, platelets, and fibrin.

Adherence of bacteria to heart valves in vitro.

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