Management of Gram-negative and fungal endocarditis

Abstract

Infective endocarditis is infrequently caused by Gram-negative bacteria or fungi.Gram-negative organisms are responsible for <4% of cases, while fungal endocarditis accounts for <1.5% of culture-positive cases worldwide. Endocarditis due to Gram-negative organisms or fungi is a rare but severe disease. It often has a nosocomial origin, is caused by virulent and often resistant organisms and presents a high rate of complications and high mortality. In this article we present the most recent literature data and address the current management of Gram-negative and fungal infective endocarditis. We also discuss the major challenges of antimicrobial treatment and discuss some issues related to surgical decision-making in difficult-tomanage cases. We finally present our centre's experience with Gram-negative infective endocarditis, with a special focus on the demanding issues that the management of these complex and severely ill patients raise.

Infective endocarditis due to multidrug resistant gram-negative bacilli: Single centre experience over 5years

“…Gram-negatives have traditionally been an uncommon cause of IE [5]. Most cases and studies thereof relate to HACEK organisms [2,[6][7][8].…”

“…In contrast, gram-negative bacilli account for only a small number of cases of IE [2][3][4]. Hence, contemporary published experience on gram-negative IE (GNIE) is limited [5]. The larger body of data derives from studies on IE due to the so called 'HACEK' group, that includes the genuses Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella and Kingella [6][7][8].…”

Community-acquired multidrug-resistant Gram-negative bacterial infective endocarditis

“…Standard parenteral combination antibiotic therapy with ceftriaxone and an aminoglycoside is acceptable for susceptible strains albeit in higher dosing 8. On the other hand, ESBL producing strains require a carbapenem with or without an aminoglycoside 1 .…”

Un brote epidémico de endocarditis por Pseudomonas aeruginosa secundario a angiografía coronaria

“…La endocarditis por Pseudomonas aeruginosa es una entidad clínica inusual, frecuentemente hallada en pacientes consumidores de drogas intravenosas (CDIV) 13 . La EI por P. aeruginosa es típicamente una infección nosocomial esporádica, de muy difícil tratamiento y elevada morbilidad y letalidad 14 . El estudio de una cohorte multinacional, prospectiva, de EI por bacilos gramnegativos no-HACEK (Haemophilus sp, Aggregatibacter actinomycetemco-www.sochinf.cl…”

“…También nosotros efectuamos una búsqueda bibliográfica incluyendo todos los artículos publicados en inglés desde el 2000 al 2011 y encontramos 10 casos que cumplían los mismos requisitos 14,[18][19][20][21][22][23][24] . Ninguno de estos 27 pacientes tenía como foco primario una infección urinaria, una fístula arterio-venosa con infección del injerto, o factores predisponentes como: quemaduras, cirrosis hepática, hemodiálisis, diabetes mellitus, o procedimientos médicos o quirúrgicos recientes para desarrollar una EI por P. aeruginosa.…”