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Clinical Medicine (London, England) Jan 2020Infective endocarditis (IE) remains a rare condition but one with high associated morbidity and mortality. With an ageing population and increasing use of implantable... (Review)
Review
Infective endocarditis (IE) remains a rare condition but one with high associated morbidity and mortality. With an ageing population and increasing use of implantable cardiac devices and heart valves, the epidemiology of IE has changed. Early clinical suspicion and a rapid diagnosis are essential to enable the correct treatment pathways to be accessed and to reduce complication and mortality rates. In the current review, we detail the latest guidelines for the evaluation and management of patients with endocarditis and its prevention.
Topics: Anti-Bacterial Agents; Endocarditis; Endocarditis, Bacterial; Humans
PubMed: 31941729
DOI: 10.7861/clinmed.cme.20.1.1 -
Journal of the American College of... Jan 2017Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the... (Review)
Review
Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
Topics: Aged; Anti-Bacterial Agents; Endocarditis; Equipment and Supplies; Humans; Male; Practice Guidelines as Topic; Stroke
PubMed: 28104075
DOI: 10.1016/j.jacc.2016.10.066 -
Journal of Cardiothoracic Surgery Aug 2022Infective endocarditis (IE) is a severe disease that is still associated with high mortality despite recent advances in diagnosis and treatment. HACEK organisms... (Review)
Review
Infective endocarditis (IE) is a severe disease that is still associated with high mortality despite recent advances in diagnosis and treatment. HACEK organisms (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) are gram-negative bacteria that are part of the normal flora of the mouth and upper respiratory tract in humans. These organisms cause a wide range of infections, of which IE is one of the most notable. In order to control and prevent endocarditis caused by HACEK, measures such as oral hygiene and the use of prophylactic drugs should be used for people at risk, including people with underlying heart disease and people with artificial valves. This review is a summary of the main aspects of IE focusing on HACEK organisms.
Topics: Eikenella corrodens; Endocarditis; Endocarditis, Bacterial; Haemophilus; Heart Diseases; Humans
PubMed: 35986339
DOI: 10.1186/s13019-022-01932-5 -
European Heart Journal Oct 2023
Topics: Humans; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Prosthesis-Related Infections; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Radiopharmaceuticals
PubMed: 37622656
DOI: 10.1093/eurheartj/ehad193 -
British Journal of Hospital Medicine... Mar 2022Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging... (Review)
Review
Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. Thus, patients with infective endocarditis may first present to the acute or general physician, who may have a variable knowledge of the condition. The diagnosis of infective endocarditis can be challenging, relying on clinical, imaging and microbiological features. Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Endocarditis; Endocarditis, Bacterial; Heart; Humans
PubMed: 35377207
DOI: 10.12968/hmed.2021.0510 -
Journal of the American Heart... Aug 2020Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE.... (Review)
Review
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
Topics: Adult; Aged; Anti-Bacterial Agents; Cardiac Surgical Procedures; Echocardiography; Electrodes, Implanted; Endocarditis; Female; Humans; Male; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous
PubMed: 32700630
DOI: 10.1161/JAHA.120.017293 -
Ugeskrift For Laeger Mar 2022Infective endocarditis (IE) is one of the most severe infectious diseases with an in-hospital mortality of 20-25%. Several studies have shown, that the incidence of IE... (Review)
Review
Infective endocarditis (IE) is one of the most severe infectious diseases with an in-hospital mortality of 20-25%. Several studies have shown, that the incidence of IE is increasing, and that patients now are older with a higher burden of comorbidities than previously. The diagnostic work-up is mainly based upon the presence of bacteraemia and echocardiography. The treatment is antibiotics and, in some cases, also cardiac surgery. In most cases, after clinical stabilization, it is safe to switch antibiotic treatment from intravenous to oral administration, as argued in this review.
Topics: Administration, Oral; Anti-Bacterial Agents; Bacteremia; Endocarditis; Endocarditis, Bacterial; Humans
PubMed: 35319455
DOI: No ID Found -
Journal of the American College of... May 2022The incidence of injection drug use-associated infective endocarditis has been increasing rapidly over the last decade. Patients with drug use-associated infective... (Review)
Review
The incidence of injection drug use-associated infective endocarditis has been increasing rapidly over the last decade. Patients with drug use-associated infective endocarditis present an increasingly common clinical challenge with poor long-term outcomes and high reinfection and readmission rates. Their care raises issues unique to this population, including antibiotic selection and administration, indications for and ethical issues surrounding surgical intervention, and importantly management of the underlying substance use disorder to minimize the risk of reinfection. Successful treatment of these patients requires a broad understanding of these concerns. A multidisciplinary, collaborative approach providing a holistic approach to treating both the acute infection along with effectively addressing substance use disorder is needed to improve short-term and longer-term outcomes.
Topics: Drug Users; Endocarditis; Endocarditis, Bacterial; Humans; Pharmaceutical Preparations; Reinfection; Retrospective Studies; Substance Abuse, Intravenous
PubMed: 35589166
DOI: 10.1016/j.jacc.2022.03.349 -
Hellenic Journal of Cardiology : HJC =... 2021Etiological, microbiological and epidemiological factors changed over time, but mortality rates remain high in infective endocarditis (IE). Healthcare-associated IE is... (Review)
Review
Etiological, microbiological and epidemiological factors changed over time, but mortality rates remain high in infective endocarditis (IE). Healthcare-associated IE is nowadays responsible for a significant proportion of cases due to increasing numbers of cardiac devices. Cardiac implantable electronic devices, transcatheter aortic valve replacement, and percutaneous valve repair are meanwhile used, especially in old and sick patients. In suspected IE modified Duke criteria, integrating clinical results, imaging, and biomarkers are traditionally applied. Newer imaging technologies such as multi-slice computed tomography, photon-emission computed tomography, and magnetic resonance imaging might add value to conventional echocardiography in diagnosis and management of IE. Treatment consists of long-term antibiotic therapy, infectiological source control and/or cardiac surgery. Recently, antibiotic parenteral outpatient regimens and partial oral treatment strategies were shown to shorten hospital stays in patients suffering from IE. However, it remains unclear how to best select patients for partial oral therapy. This review describes new trends in diagnosing, imaging, and treating IE in a changing patient collective with particular focus on patients with implantable cardiac devices.
Topics: Echocardiography; Endocarditis; Endocarditis, Bacterial; Humans; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement
PubMed: 33176209
DOI: 10.1016/j.hjc.2020.10.007 -
JAMA Network Open Jul 2023Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence.
IMPORTANCE
Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence.
OBJECTIVE
To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength.
EVIDENCE REVIEW
This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches.
FINDINGS
A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)-only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions.
CONCLUSIONS AND RELEVANCE
In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.
Topics: Adult; Humans; Consensus; Endocarditis; Endocarditis, Bacterial; Prospective Studies; Practice Guidelines as Topic
PubMed: 37523190
DOI: 10.1001/jamanetworkopen.2023.26366