Management of infective endocarditis: challenges and perspectives

Thuny, Franck; Grisoli, Dominique; Collart, Frédéric; Habib, Gilbert; Raoult, Didier

doi:10.1016/s0140-6736(11)60755-1

Cited by 384 publications

(316 citation statements)

References 102 publications

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“…In addition, challenges in IE diagnosis and management result in higher IE related morbidity and mortality in LMICs compared to HICs. 64 Setting-specific data is therefore required to track the clinical characteristics, diagnostic and management practices, and outcomes for patients with IE in order to foster investment in improving microbiological, echocardiographic and cardiovascular surgery capacity.…”

Section: Future Directions In Researchmentioning

confidence: 99%

Infective Endocarditis in Low- and Middle-Income Countries

et al. 2017

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Key Points Staphylococcus is an increasingly important cause of IE in LMICs, and is the leading cause of IE in UMICs  RHD remains the major underlying cardiac pathology of IE in LMICs, identified in almost half of reported cases  The rate of microorganism non-identification is high, reaching up to 60% of IE cases in LMICs, and hampering diagnosis and treatment  Rates of access to surgery in UMICs for complicated IE are as high as in HICs, but remain dismal in lower-middle income countries SynopsisInfective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs.

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Section: Future Directions In Researchmentioning

confidence: 99%

Infective Endocarditis in Low- and Middle-Income Countries

et al. 2017

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“…D espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1,2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality.…”

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confidence: 99%

Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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“…An incidence of 1.4 per 1000 device-years of definite CDRIE has been reported [3]. As for PV, 99m Tc-WBC SPECT/ CT and [ 18 F]FDG PET/CT are able to differentiate CDRIE from post-implantation changes (i.e., pocket hematoma) and to characterize the extension of the infectious process (Fig.…”

Section: Cardiac Device-related Iementioning

confidence: 99%

“…Infective endocarditis (IE) remains a deadly disease despite continuous advances in medical and surgical management [1][2][3]4••]. In the recent years, epidemiology of IE has undergone significant changes with increasing number of elderly patients presenting with degenerative valvular disease, nosocomial infections, or device-related IE (prosthetic valves (PV), cardiac implantable electronic devices (CIED)).…”

Section: Introductionmentioning

confidence: 99%

“…However, this technique has a sensitivity and specificity of approximately 80% for native valve endocarditis (NVE) [2]. The diagnostic accuracy is even lower for PVE [3] or CIED infection [4••], in which echocardiography gives uncertain results in up to 30% of cases. The major drawbacks of transthoracic (TTE) and transoesophageal (TOE) echocardiography are related to patient morphology, instrumental settings, transducer position, operator skill, artefacts secondary to calcifications and reverberations of This article is part of the Topical Collection on Cardiac Nuclear Imaging metallic structures, and the disease course (less accurate in the early stage) [5].…”

Section: Introductionmentioning

confidence: 99%

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Radionuclide Imaging of Infective Endocarditis: State of Art and Future Perspective

Marchetta

Withofs

Erba

et al. 2017

Curr Cardiovasc Imaging Rep

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Purpose of Review Infectious endocarditis is a serious disease requiring rapid diagnosis and accurate risk stratification to offer the best therapeutic strategy. Infection of prosthetic valve (PV) and cardiovascular implantable electronic device (CIED) is increasing due to the ageing of the population and the growing number of implants. Foreign material infection remains clinically challenging given the limitation of ultrasound techniques in this context whereas the diagnosis must be precocious. Recent Findings 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) and radiolabelled leukocytes single-photon emission computed tomography/computed tomography (SPECT/CT) are commonly used for this purpose.Summary In the present article, we summarized the available evidence for the use of nuclear imaging for the evaluation of infectious endocarditis.

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Management of infective endocarditis: challenges and perspectives

Cited by 384 publications

References 102 publications

Infective Endocarditis in Low- and Middle-Income Countries

Infective Endocarditis in Low- and Middle-Income Countries

Laboratory Diagnosis of Infective Endocarditis

Radionuclide Imaging of Infective Endocarditis: State of Art and Future Perspective

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