Management of Septic emboli in patients with infectious endocarditis

Aalaei‐Andabili, Seyed Hossein; Martin, Tomas D.; Heß, Peter; Hoh, Brian L.; Anderson, Meshka; Klodell, Charles T.; Beaver, Thomas M.

doi:10.1111/jocs.13129

Cited by 14 publications

(20 citation statements)

References 47 publications

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“…The proportion of patients with SRL (34%) in our study is similar to other series of the postantibiotic era, [ 22 ] although relatively high compared to recent series such as Luaces et al, [ 18 ] Millaire et al, [ 5 ] or Aalaei-Andabili et al, [ 23 ] where SRL was around 10%. It is possible that the method of selection (with a large group of patients who underwent a CT scan systematically) and the time when the CT was performed result in these differences.…”

Section: Discussionsupporting

confidence: 88%

“…However, it is important to keep in mind and consider in patients with LS-IE and persistent fever, signs of sepsis or bacteremia, and appropriate antibiotic treatment, the use of an abdominal imaging study seeking SRL abscess that could require specific surgery or percutaneous drainage. [ 30 ] Although cases have been described with splenectomy performed during or after cardiac surgery, [ 23 , 30 – 32 ] this approach is generally realized previous to cardiac surgery. [ 7 , 33 ]…”

Section: Discussionmentioning

confidence: 99%

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Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

et al. 2018

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Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4–9.1), liver disease (OR = 8.3, 95% CI = 2.1–31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3–11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

et al. 2018

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“…[30,31] This could be explained that the age of patients developing septic emboli in IE seemed to be younger (mean: 37.2 years; standard deviation: 12.4 years) in our study population when compared with that reported (mean: 38.1–46.3 years; standard deviation: 14.7–19.5 years) in the previous study. [30] And whether ambient exposure to air pollutants contributed to septic embolization in IE had not been explored yet in the previous studies.…”

Section: Discussionmentioning

confidence: 64%

Short-term exposure to particulate matters is associated with septic emboli in infective endocarditis

Hsieh

Huang²,

Lin

et al. 2019

Medicine

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This survey was to investigate the short-term effect of particulate matters (PMs) exposure on clinical and microbiological variables, especially septic emboli, in infective endocarditis (IE). The study analyzed 138 IE patients in Far Eastern Memorial Hospital from 2005 to 2015 and clinical variables were retrospectively requested. The data of air quality were recorded and collected by a network of 26 monitoring stations spreading in Northern part of Taiwan. We found that IE patients with septic emboli were found to be exposed to a significantly higher level of PM2.5 (32.01 ± 15.89 vs. 21.70 ± 13.05 μg/m3, P < .001) and PM10 (54.57 ± 24.43 vs 40.98 ± 24.81 μg/m3, P = .002) on lag 0 day when compared to those without. Furthermore, multivariate regression analysis revealed that that ambient exposure to PM2.5 (odds ratio: 3.87, 95% confidence interval: 1.31–8.31; P = .001) and PM10 (odds ratio: 4.58, 95% confidence interval: 2.03–10.32; P < .001) significantly increased risk of septic emboli in IE patients. To our knowledge, this is the first study demonstrating that short-term exposure to PMs was associated with septic emboli in IE.

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“…Systemic embolization complicates about 20% to 50% of cases of infective endocarditis of left-sided heart valves [1]. In a recent retrospective study [2] of patients who underwent a cardiac operation for infective endocarditis the spleen was the most common site of systemic emboli (33/437 patients [7.6%]). Although splenic embolic events are often well tolerated, severe complications can occur, including splenic infarction, hemorrhage, rupture, and abscess [3].…”

Section: Commentmentioning

confidence: 99%

“…The treatment of infective endocarditis complicated by splenic abscess includes antibiotics, splenectomy, and valve replacement surgery [3]. Splenectomy is often preferably performed before valve replacement to prevent reinfection of the prosthetic valve [2]. However, if the patient cannot be stabilized for an abdominal operation, valve replacement may be more urgent, as in our case.…”

Section: Commentmentioning

confidence: 99%

Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis

Alnasser

Mindru

Preventza

et al. 2019

The Annals of Thoracic Surgery

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Management of Septic emboli in patients with infectious endocarditis

Abstract: Septic emboli is common in endocarditis patients. Patients with high preoperative WBC level and large valve vegetations require CT imaging of the spleen. Both spleen and brain interventions in the setting of IE can be performed safely with excellent early and mid-term outcomes.

Cited by 14 publications

References 47 publications

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

Short-term exposure to particulate matters is associated with septic emboli in infective endocarditis

Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis

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