Infective Endocarditis in the Antibiotic Era

Lerner, Phillip I.; Weinstein, Louis

doi:10.1056/nejm196602032740506

Cited by 126 publications

(37 citation statements)

References 34 publications

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“…We identified no significant gender difference in IE with a male to female ratio of 1:1. Previous studies have demonstrated a higher male to female ratio ranging from 2:1 to 9:1 4 5…”

Section: Discussionmentioning

confidence: 98%

Morbidity and Mortality of Infective Endocarditis in a Hospital System in New York City Serving a Diverse Urban Population

Alkhawam

Sogomonian

Zaiem

et al. 2016

Journal of Investigative Medicine

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Infective endocarditis (IE) is a severe illness associated with significant morbidity and mortality. The primary purpose of this study was to evaluate morbidity and mortality of IE in a hospital serving the most diverse area in New York City. An analysis of 209 patients admitted to the hospital from 2000 to 2012 who were found to have IE based on modified Duke criteria. Among the 209 patients with IE, 188 (88.8%) had native heart valves and 21 (11.2%) had prosthetic valves. Of the patients with native heart valves, 3.7% had coronary artery bypass graft, 4.3% were active drug users, 6.3% had permanent pacemakers, 12.2% had a history of IE, 25.7% were diabetic, 17% had end-stage renal disease (ESRD), 9% had congestive heart failure, 8% had abnormal heart valves, and 13.8% had an unknown etiology. Mortality rates of the patients with prosthetic heart valves were 27.7% compared to 8.11% in patients with native heart valves (OR 3, p<0.0001). Since we identified diabetes mellitus and ESRD to be significant risk factors in our population, we isolated and compared characteristics of patients with and without IE. IE among patients with diabetes mellitus was 23% compared with 13.8% in the control group (p=0.016). Cases of IE in patients with ESRD were 15.3%, compared with 4% in the control group (p<0.0001). We identified an overall mortality rate of 20.1% in patients with IE, a readmission rate within 30 days of discharge of 21.5%, and an average age of 59 years. Among 209 patients, 107 were males and 102 females. The most common organisms identified were Staphylococcus aureus (43.7%), viridans streptococci (17%) followed by Enterococcus (14.7%). Despite appropriate treatment, high rates of morbidity and mortality remained, with a higher impact in patients greater than 50 years of age. Such discoveries raise the importance of controlling and monitoring risk factors for IE.

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“…We identified no significant gender difference in IE with a male to female ratio of 1:1. Previous studies have demonstrated a higher male to female ratio ranging from 2:1 to 9:1 4 5…”

Section: Discussionmentioning

confidence: 98%

Morbidity and Mortality of Infective Endocarditis in a Hospital System in New York City Serving a Diverse Urban Population

Alkhawam

Sogomonian

Zaiem

et al. 2016

Journal of Investigative Medicine

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“…Occasionally, a clinical event of flank pain or macrohaematuria may give a hint about infarction; however, haematuria can also be present in glomerulonephritis and drug induced interstitial nephritis 7. Our patient had a right hypochondrial pain but no haematuria.…”

Section: Discussionmentioning

confidence: 63%

Endocarditis presenting as acute abdomen

Hatab

Wahab²,

Elmahy³

2010

Case Reports

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Infective endocarditis remains an interesting and challenging disease in which the presenting features have been modified by medical progress. We report a case of a 63-year-old woman who presented with pyrexia, weight loss, night sweats and fatigue over a period of 7 weeks, at the end of which she developed severe right hypochondrial pain, mimicking acute abdomen. She was provisionally diagnosed with and treated for acute cholecystitis to no avail. An abdominal computed tomography scan was performed and revealed the presence of right kidney infarction, the source of which was later proven to originate from aortic valve endocarditis. The patient made a remarkable recovery following 6 weeks of treatment with intravenous antibiotics. This case demonstrates that endocarditis can present as an acute abdomen which is caused mainly by embolism in various organs (the kidney in our patient).

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“…The use of anticoagulants is widely accepted in the treatment of rapid atrial fibrillation (Wood, 1968). Although it has been suggested that anticoagulants are contra-indicated in bacterial endocarditis, Lerner and Weinstein (1966) have recently suggested that this is not so.…”

Section: Discussionmentioning

confidence: 99%

“…In 1966, this view was challenged by Lerner and Weinstein (1966), who state that 'These drugs should be used for the same reasons that they are administered to persons who do not have endocarditis.' However, the following case reports a patient with bacterial endocarditis who was given anticoagulants and who died from an intracranial haemorrhage, suggesting that this more recent viewpoint may be in error.…”

Section: Introductionmentioning

confidence: 99%

The use of anticoagulants in bacterial endocarditis

Kanis

1974

Postgraduate Medical Journal

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Summary Early experience in the treatment of bacterial endocarditis with penicillin suggested that the addition of anticoagulants might improve results. This paper reports a patient with bacterial endocarditis who died from embolic cerebral damage after initiation of treatment with heparin. The evidence suggests that anticoagulants were responsible for her death and that bacterial endocarditis is a relative contra-indication to anticoagulant therapy.

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Infective Endocarditis in the Antibiotic Era

Cited by 126 publications

References 34 publications

Morbidity and Mortality of Infective Endocarditis in a Hospital System in New York City Serving a Diverse Urban Population

Morbidity and Mortality of Infective Endocarditis in a Hospital System in New York City Serving a Diverse Urban Population

Endocarditis presenting as acute abdomen

The use of anticoagulants in bacterial endocarditis

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