Prognostic implications of a negative echocardiography in patients with infective endocarditis

Vicent, Lourdes; Saldivar, Hugo González; Bouza, Emilio; Muñóz, Patricia; Cuerpo, Gregorio; Alarcón, Arı́stides de; Vidal, Bárbara; Cobo, Manuel; Goenaga, Miguel Ángel; Carrasco-Chinchilla, Fernando; Montejo, Miguel; Gálvez-Acebal, Juan; Hidalgo-Tenorio, Carmen; Vinuesa-García, David; Martínez‐Sellés, Manuel; investigators, Games

doi:10.1016/j.ejim.2018.01.033

Cited by 14 publications

(7 citation statements)

References 34 publications

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“…The reasons for that association are unclear. However, others have noted that echocardiogram-positive IE is associated with more complications and higher risk of death than echocardiogram-negative IE [33] and that mortality is associated with the size of the vegetations in right-sided infective endocarditis (RSIE) in PWID [34]. Thus, in PWID, another consequence of demonstrable TV vegetations via TTE may be an increased risk for rIE.…”

Section: Discussionmentioning

confidence: 99%

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Huang

Barnes

Peacock

2018

Open Forum Infectious Diseases

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BackgroundInjection drug use (IDU) is a major risk factor for infective endocarditis (IE). Few data exist on repeat IE (rIE) in persons who inject drugs (PWID).MethodsPatients ≥18 years old seen at Wake Forest Baptist Medical Center from 2004 to 2017 who met Duke criteria for IE and who self-reported IDU in the 3 months before admission were identified. The subset of PWID who developed rIE, defined as another episode of IE at least 10 weeks after diagnosis of the first episode, was then reviewed.ResultsOf the 87 PWID who survived their first episode of IE, 22 (25.3%) experienced rIE and 77.3% had rIE within a year of the first episode. All patients who experienced rIE resumed IDU between episodes of IE. Of the patients with rIE, 54.5% had an infection caused by S. aureus and 22.7% required surgical intervention. Mortality at 1 year was 36.3%. Compared with their first IE episode, patients with rIE had fewer S. aureus infections (P = .01). Compared with PWID who experienced single-episode IE, intravenous prescription opioid use (P = .01), surgery (P < .01), tricuspid valve involvement (P = .02), and polymicrobial infection (P = .03) occurred more often during first episodes of IE in individuals who then developed rIE.ConclusionsrIE is common among IDU-related IE and confers a high 1-year mortality rate. The microbiology of rIE is varied, with S. aureus being less frequently isolated. More studies on modification of social and clinical risk factors are needed to prevent rIE.

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Section: Discussionmentioning

confidence: 99%

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Huang

Barnes

Peacock

2018

Open Forum Infectious Diseases

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“…We have made several assumptions within the structure of the model that generally favor the performance of echocardiography, including that occult NVIE never manifests clinically other than by relapse after the cessation of parenteral antimicrobial therapy (crossovers to endocarditis treatment would be expected to reduce any differences in survival) and that no patient with apparently uncomplicated SAB receives more than 14 days of parenteral therapy for any indication other than echocardiographically documented endocarditis (en passant treatment of unrecognized endocarditis would reduce the expected incidence of relapse). We also assumed that echocardiography results have no prognostic impact (ie, that patients with endocarditis have the same prognosis regardless of the echocardiographic demonstration of endocardial involvement), although recent evidence would suggest that this may not be the case [68]. These assumptions are clinically unrealistic but have been used in the model to maximize the apparent benefit of echocardiography over clinical observation alone; there are few available data to guide how often these assumptions may be violated in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Heriot

Tong

Cheng

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe risk of endocarditis among patients with Staphylococcus aureus bacteremia is not uniform, and a number of different scores have been developed to identify patients whose risk is less than 5%. The optimal echocardiography strategy for these patients is uncertain.MethodsWe used decision analysis and Monte Carlo simulation using input parameters taken from the existing literature. The model examined patients with S aureus bacteremia whose risk of endocarditis is less than 5%, generally those with nosocomial or healthcare-acquired bacteremia, no intracardiac prosthetic devices, and a brief duration of bacteremia. We examined 6 echocardiography strategies, including the use of transesophageal echocardiography, transthoracic echocardiography, both modalities, and neither. The outcome of the model was 90-day survival.ResultsThe optimal echocardiography strategy varied with the risk of endocarditis and the procedural mortality associated with transesophageal echocardiography. No echocardiography strategy offered an absolute benefit in 90-day survival of more than 0.5% compared with the strategy of not performing echocardiography and treating with short-course therapy. Strategies using transesophageal echocardiography were never preferred if the mortality of this procedure was greater than 0.5%.ConclusionsIn patients identified to be at low risk of endocarditis, the choice of echocardiography strategy appears to exert a very small influence on 90-day survival. This finding may render test-treatment trials unfeasible and should prompt clinicians to focus on other, more important, management considerations in these patients.

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“…Staphylococcus epidermidis was the most frequent micro-organism in heart surgery, where the unsaturation of different diagnostic and therapeutic measures taken by a multidisciplinary team had a favorable influence on the patients' prognosis (23) . Other studies (24) show the same results.…”

Section: Methodsmentioning

confidence: 99%

Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery

Oliveros

2020

Rev. Latino-Am. Enfermagem

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Objective: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. Method: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. Results: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.

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Prognostic implications of a negative echocardiography in patients with infective endocarditis

Cited by 14 publications

References 34 publications

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery

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