Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of t...Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])展开更多
Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogen...Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.展开更多
Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Live...Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.展开更多
Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term ...Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 416 consecutive patients diagnosed with IE and sepsis at Guangdong Provincial People's Hospital were enrolled.The patients were divided into three groups according to the tertiles of NT-pro-BNP level of the first blood collection within 24 hours after admission:<2000 pg/mL(n=138),2000-7167 pg/mL(n=140),and>7167 pg/mL(n=138).Univariate and multivariate regression analysis were used to explore the predictive value of NT-pro-BNP for short-term mortality,and the best cut-off value was determined by receiver operating characteristic(ROC)curve.Results In-hospital and 6-month death occurred in 65 and 94 patients,respectively.Higher in-hospital mortality was found in patients with higher serum NT-pro-BNP levels(9.4%vs.13.6%vs.23.9%,P=0.003).ROC curve analysis identified an optimal NT-pro-BNP cutoff level of 1357 pg/mL[area under curve(AUC):0.652,95%CI:0.588-0.717,P<0.001].Multivariate regression analysis showed that both log-transformed NT-pro-BNP(in-hospital mortality:OR:1.987,95%CI:1.045-3.778,P=0.036;6-month mortality:HR:1.714,95%CI:1.072-2.7400,P=0.025)and NT-pro-BNP>1357 pg/mL(in-hospital mortality:OR:8.059,95%CI:1.813-35.818,P=0.006;6-month mortality:HR:5.193,95%CI:1.806-14.938,P=0.002)were both independent risk factors for in-hospital and 6-month mortality.Conclusions Serum NT-pro-BNP could serve as an independent predictor of in-hospital and 6-month mortality in patients with IE complicated with sepsis.展开更多
BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with N...BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with NVIE;and(2)the impact of DM on NVIE outcomes.METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample,of which 22284(28%)had DM.We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test.We compared baseline comorbidities,microorganisms,and in-patients procedures between those with vs without DM.Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality,stroke,acute heart failure,cardiogenic shock,septic shock,and atrioventricular block.RESULTS Crude rates of DM increased from in 22%in 2004 to 30%in 2014.There were significant differences in demographics,comorbidities and NVIE risk factors between the two groups.Staphylococcus aureus was the most common organism identified with higher rates in patients with DM(33.1%vs 35.6%;P<0.0001).After propensity matching,in-hospital mortality(11.1%vs 11.9%;P<0.0001),stroke(2.3%vs 3.0%;P<0.0001),acute heart failure(4.6%vs 6.5%;P=0.001),cardiogenic shock(1.5%vs 1.9%;P<0.0001),septic shock(7.2%vs 9.6%;P<0.0001),and atrioventricular block(1.5%vs 2.4%;P<0.0001),were significantly higher in patients with DM.Independent predictors of mortality in NVIE patients with DM include hemodialysis,congestive heart failure,atrial fibrillation,staphylococcus aureus,and older age.CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes.Further studies are crucial to identify the clinical,and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.展开更多
AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with I...AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.展开更多
Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during ...Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.展开更多
AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas(ACF)secondary to iatrogenic or infectious disorders.METHODS From a Pub Med search using the term"aorto...AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas(ACF)secondary to iatrogenic or infectious disorders.METHODS From a Pub Med search using the term"aortocameral fistula",30 suitable papers for the current review were retrieved.Reviews,case series and case reports published in English were considered.Abstracts and reports from scientific meetings were not included.A total of 38 reviewed subjects were collected and analyzed.In addition,another case-an adult male who presented with ACF between commissures of the right and noncoronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV-is added,the world literature is briefly reviewed.RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed,analyzed and stratified into either congenital(47%)or acquired(53%)according to their etiology.Of all subjects,11%were asymptomatic and 89%were symptomatic with dyspnea(21×)as the most common presentation.Diagnosis was established by a multidiagnostic approach in 23(60%),single method in 14(37%)(echocardiography in 12 and catheterization in 2),and at autopsy in 2(3%)of the subjects.Treatment options included percutaneous transcatheter closure in 12(30%)with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24(63%).CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV.The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.展开更多
Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Di...Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model.Results By 2030,the incidence of IE will increase uncontrollably on a global scale,with developed countries having the largest number of cases and developing countries experiencing the fastest growth.The affected population will be predominantly males,but the gender gap will narrow.The elderly in high-income countries will bear the greatest burden,with a gradual shift to middle-income countries.The incidence of IE in countries with middle/high-middle social-demographic indicators(SDI) will surpass that of high SDI countries.In China,the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030,respectively.IEassociated deaths and heart failure will continue to impose a significant burden on society,the burden on women will increase and surpass that on men,and the elderly in high-SDI countries will bear the heaviest burden.High systolic blood pressure has become the primary risk factor for IE-related death.Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade.The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled.Gender,age,regional,and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.展开更多
Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvu...Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-yearold male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.展开更多
BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis pat...BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis patients and to identify potential risk factors for disturbed sleep quality after surgery.METHODS The Pittsburgh Sleep Quality Index(PSQI)and the Epworth Sleepiness Scale were used to assess patient sleep quality.Logistic regression was used to explore the potential risk factors.RESULTS The study population(n=139)had an average age of 43.40±14.56 years,and 67.6%were men(n=94).Disturbed sleep quality was observed in 86 patients(61.9%)during hospitalization and remained in 46 patients(33.1%)at 6 mo after surgery.However,both PSQI and Epworth Sleepiness Scale scores showed significant improvements at 6 mo(P<0.001 and P=0.001,respectively).Multivariable logistic regression analysis showed that the potential risk factors were age(odds ratio=1.125,95%confidence interval:1.068-1.186)and PSQI assessed during hospitalization(odds ratio=1.759,95%confidence interval:1.436-2.155).The same analysis in patients with PSQI≥8 during hospitalization suggested that not using sleep medication(odds ratio=15.893,95%confidence interval:2.385-105.889)may be another risk factor.CONCLUSION The incidence of disturbed sleep after infective endocarditis surgery is high.However,the situation improves significantly over time.Age and early postoperative high PSQI score are risk factors for disturbed sleep quality at 6 mo after surgery.展开更多
Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective ...Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.展开更多
BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted ...BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.展开更多
Infective endocarditis （IE） occurs at a rate of approximately 1-7/100 000 people per year, and has a high morbidity and mortality despite advances in antibiotic and surgical treatments.
Legionella pneumophila infection can cause Legionnaires’disease,a severe form of pneumonia.Extrapulmonary manifestations of Legionella infections include myocarditis,pericarditis,and endocarditis.We present a rare ca...Legionella pneumophila infection can cause Legionnaires’disease,a severe form of pneumonia.Extrapulmonary manifestations of Legionella infections include myocarditis,pericarditis,and endocarditis.We present a rare case of pneumonia caused by Legionella pneumophila with a possible etiologic link to a recently recovered culture-negative infective endocarditis.展开更多
BACKGROUND： Infective myositis is rare. The retrospective report of clinical data and symptoms from one patient with infective myositis will hopefully provide more information for clinicians in the diagnosis of this ...BACKGROUND： Infective myositis is rare. The retrospective report of clinical data and symptoms from one patient with infective myositis will hopefully provide more information for clinicians in the diagnosis of this disease. METHODS： A male patient, 65 years old, was admitted with ＂fever and muscle pain since four days ago, accompanied by inertia of all limbs for one day＂, to the First Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine on April 25th, 2005. Following admission, a history of diseases was record, and detailed physical and neurological examinations were performed. During the examination, symmetrical myasthenia appeared, tendon reflex disappeared, and creatine kinase levels were increased 500 times higher than normal. The patient was primarily diagnosed with hypokalemic periodic paralysis, myositis, Guillain-Barre syndrome, and upper respiratory infection. Subsequently, the patient was treated with the following： cefuroxime for infection, potassium supplements, breviscapin for promoting blood circulation through the removal of stasis, and ATP/CO-A for myocardial nutrition. Antiviral drugs were not administered. However, laboratory samples were continuously monitored. Creatine kinase levels decreased to normal, and muscle pain was obviously relieved following antibiotics treatment. The results led to a final diagnosis of infective myositis. RESULTS： Four days after treatment （April 29th）, muscular tenderness and throat congestion were obviously improved （＋/-）. The neurological examination showed the patient was conscious, cooperated with treatment, and had normal intellect. No abnormalities of the cranial nerve were observed upon examination. Proximal and distal muscle strength and muscular tensions of the four limbs were all normal. Reflexes of the right biceps brachii muscle and its tendon were decreased, and knee tendon and Achilles tendon reflex were not induced. A Babinski reflex was not detected. The neurological examination presented no abnormalities, and the related creatine kinases were within normal range by re-examination at 2 weeks, and l and 3 months after discharge. CONCLUSION： A diagnosis of infective myositis should be considered for patients with clear prodromes of infection, that include symptoms of periodic paralysis and elevated creatine kinase levels. Treatment with sufficient antibiotics can obtain good results.展开更多
Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, tra...Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.展开更多
Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve impla...Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.展开更多
BACKGROUND Infective endocarditis(IE) is a rare disease with a high mortality rate.Leclercia adecarboxylata(L.adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae,and it can rarely be a pathogen w...BACKGROUND Infective endocarditis(IE) is a rare disease with a high mortality rate.Leclercia adecarboxylata(L.adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae,and it can rarely be a pathogen which often affects immunodeficient patients.There are about three cases of immunocompetent patients with monomicrobial L.adecarboxylata infection.There are only three reported cases of IE caused by L.adecarboxylata in the world.The mitral valve is often affected in IE,and the prognosis for IE with mitral valve lesions is often poor.CASE SUMMARY A 51-year-old man was found to have moderate to severe mitral stenosis on echocardiography.He came to our Cardiothoracic Surgery Department for surgical management.A diastolic murmur was heard on auscultation of the heart in the mitral region.On the second day of hospitalisation,he presented with slurred speech,reduced muscle strength in the left limb,and acute cerebral infarction on cranial computed tomography.Surgical treatment was decided to postpone.On the ninth day of admission,the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit,where echocardiogram revealed an anterior mitral valve leaflet vegetation.After empirical anti-infective treatment with vancomycin(1g q12h),an emergency valve replacement was performed.Bacterial culture identified L.adecarboxylata.Antiinfective treatment with piperacillin-tazobactam(4.5g q8h) was added for 4 wk.Follow-up echocardiography showed normal bioprosthetic valve function after mitral valve replacement.CONCLUSION We report the first case of L.adecarboxylata IE in China,and clinicians should pay attention to this pathogen.展开更多
Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such...Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such patients.Literature data are few, and optimal treatment methods, indications for surgery, and types of operative techniquesare still under debate. We present an adult patient with a rare combination of the ventricular septal defect (VSD)and PV IE who underwent surgical treatment. Neocuspidization with autologous pericardium was utilized for thereconstruction of his PV. We discuss details of this novel surgical technique.展开更多
文摘Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])
文摘Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.
文摘Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.
文摘Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 416 consecutive patients diagnosed with IE and sepsis at Guangdong Provincial People's Hospital were enrolled.The patients were divided into three groups according to the tertiles of NT-pro-BNP level of the first blood collection within 24 hours after admission:<2000 pg/mL(n=138),2000-7167 pg/mL(n=140),and>7167 pg/mL(n=138).Univariate and multivariate regression analysis were used to explore the predictive value of NT-pro-BNP for short-term mortality,and the best cut-off value was determined by receiver operating characteristic(ROC)curve.Results In-hospital and 6-month death occurred in 65 and 94 patients,respectively.Higher in-hospital mortality was found in patients with higher serum NT-pro-BNP levels(9.4%vs.13.6%vs.23.9%,P=0.003).ROC curve analysis identified an optimal NT-pro-BNP cutoff level of 1357 pg/mL[area under curve(AUC):0.652,95%CI:0.588-0.717,P<0.001].Multivariate regression analysis showed that both log-transformed NT-pro-BNP(in-hospital mortality:OR:1.987,95%CI:1.045-3.778,P=0.036;6-month mortality:HR:1.714,95%CI:1.072-2.7400,P=0.025)and NT-pro-BNP>1357 pg/mL(in-hospital mortality:OR:8.059,95%CI:1.813-35.818,P=0.006;6-month mortality:HR:5.193,95%CI:1.806-14.938,P=0.002)were both independent risk factors for in-hospital and 6-month mortality.Conclusions Serum NT-pro-BNP could serve as an independent predictor of in-hospital and 6-month mortality in patients with IE complicated with sepsis.
文摘BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with NVIE;and(2)the impact of DM on NVIE outcomes.METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample,of which 22284(28%)had DM.We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test.We compared baseline comorbidities,microorganisms,and in-patients procedures between those with vs without DM.Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality,stroke,acute heart failure,cardiogenic shock,septic shock,and atrioventricular block.RESULTS Crude rates of DM increased from in 22%in 2004 to 30%in 2014.There were significant differences in demographics,comorbidities and NVIE risk factors between the two groups.Staphylococcus aureus was the most common organism identified with higher rates in patients with DM(33.1%vs 35.6%;P<0.0001).After propensity matching,in-hospital mortality(11.1%vs 11.9%;P<0.0001),stroke(2.3%vs 3.0%;P<0.0001),acute heart failure(4.6%vs 6.5%;P=0.001),cardiogenic shock(1.5%vs 1.9%;P<0.0001),septic shock(7.2%vs 9.6%;P<0.0001),and atrioventricular block(1.5%vs 2.4%;P<0.0001),were significantly higher in patients with DM.Independent predictors of mortality in NVIE patients with DM include hemodialysis,congestive heart failure,atrial fibrillation,staphylococcus aureus,and older age.CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes.Further studies are crucial to identify the clinical,and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.
文摘AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
基金Supported by the grant from the National Natural Science Foundation of China (30700373)
文摘Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.
文摘AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas(ACF)secondary to iatrogenic or infectious disorders.METHODS From a Pub Med search using the term"aortocameral fistula",30 suitable papers for the current review were retrieved.Reviews,case series and case reports published in English were considered.Abstracts and reports from scientific meetings were not included.A total of 38 reviewed subjects were collected and analyzed.In addition,another case-an adult male who presented with ACF between commissures of the right and noncoronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV-is added,the world literature is briefly reviewed.RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed,analyzed and stratified into either congenital(47%)or acquired(53%)according to their etiology.Of all subjects,11%were asymptomatic and 89%were symptomatic with dyspnea(21×)as the most common presentation.Diagnosis was established by a multidiagnostic approach in 23(60%),single method in 14(37%)(echocardiography in 12 and catheterization in 2),and at autopsy in 2(3%)of the subjects.Treatment options included percutaneous transcatheter closure in 12(30%)with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24(63%).CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV.The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.
文摘Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model.Results By 2030,the incidence of IE will increase uncontrollably on a global scale,with developed countries having the largest number of cases and developing countries experiencing the fastest growth.The affected population will be predominantly males,but the gender gap will narrow.The elderly in high-income countries will bear the greatest burden,with a gradual shift to middle-income countries.The incidence of IE in countries with middle/high-middle social-demographic indicators(SDI) will surpass that of high SDI countries.In China,the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030,respectively.IEassociated deaths and heart failure will continue to impose a significant burden on society,the burden on women will increase and surpass that on men,and the elderly in high-SDI countries will bear the heaviest burden.High systolic blood pressure has become the primary risk factor for IE-related death.Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade.The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled.Gender,age,regional,and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.
文摘Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-yearold male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.
基金Supported by Science and Technology Planning Project of Guangdong Province,No.A2016057.
文摘BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis patients and to identify potential risk factors for disturbed sleep quality after surgery.METHODS The Pittsburgh Sleep Quality Index(PSQI)and the Epworth Sleepiness Scale were used to assess patient sleep quality.Logistic regression was used to explore the potential risk factors.RESULTS The study population(n=139)had an average age of 43.40±14.56 years,and 67.6%were men(n=94).Disturbed sleep quality was observed in 86 patients(61.9%)during hospitalization and remained in 46 patients(33.1%)at 6 mo after surgery.However,both PSQI and Epworth Sleepiness Scale scores showed significant improvements at 6 mo(P<0.001 and P=0.001,respectively).Multivariable logistic regression analysis showed that the potential risk factors were age(odds ratio=1.125,95%confidence interval:1.068-1.186)and PSQI assessed during hospitalization(odds ratio=1.759,95%confidence interval:1.436-2.155).The same analysis in patients with PSQI≥8 during hospitalization suggested that not using sleep medication(odds ratio=15.893,95%confidence interval:2.385-105.889)may be another risk factor.CONCLUSION The incidence of disturbed sleep after infective endocarditis surgery is high.However,the situation improves significantly over time.Age and early postoperative high PSQI score are risk factors for disturbed sleep quality at 6 mo after surgery.
基金Qinghai provincial commission of health and family planning appropriate technology promotion project(2018-wjtg-03).
文摘Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.
文摘BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.
文摘Infective endocarditis （IE） occurs at a rate of approximately 1-7/100 000 people per year, and has a high morbidity and mortality despite advances in antibiotic and surgical treatments.
文摘Legionella pneumophila infection can cause Legionnaires’disease,a severe form of pneumonia.Extrapulmonary manifestations of Legionella infections include myocarditis,pericarditis,and endocarditis.We present a rare case of pneumonia caused by Legionella pneumophila with a possible etiologic link to a recently recovered culture-negative infective endocarditis.
文摘BACKGROUND： Infective myositis is rare. The retrospective report of clinical data and symptoms from one patient with infective myositis will hopefully provide more information for clinicians in the diagnosis of this disease. METHODS： A male patient, 65 years old, was admitted with ＂fever and muscle pain since four days ago, accompanied by inertia of all limbs for one day＂, to the First Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine on April 25th, 2005. Following admission, a history of diseases was record, and detailed physical and neurological examinations were performed. During the examination, symmetrical myasthenia appeared, tendon reflex disappeared, and creatine kinase levels were increased 500 times higher than normal. The patient was primarily diagnosed with hypokalemic periodic paralysis, myositis, Guillain-Barre syndrome, and upper respiratory infection. Subsequently, the patient was treated with the following： cefuroxime for infection, potassium supplements, breviscapin for promoting blood circulation through the removal of stasis, and ATP/CO-A for myocardial nutrition. Antiviral drugs were not administered. However, laboratory samples were continuously monitored. Creatine kinase levels decreased to normal, and muscle pain was obviously relieved following antibiotics treatment. The results led to a final diagnosis of infective myositis. RESULTS： Four days after treatment （April 29th）, muscular tenderness and throat congestion were obviously improved （＋/-）. The neurological examination showed the patient was conscious, cooperated with treatment, and had normal intellect. No abnormalities of the cranial nerve were observed upon examination. Proximal and distal muscle strength and muscular tensions of the four limbs were all normal. Reflexes of the right biceps brachii muscle and its tendon were decreased, and knee tendon and Achilles tendon reflex were not induced. A Babinski reflex was not detected. The neurological examination presented no abnormalities, and the related creatine kinases were within normal range by re-examination at 2 weeks, and l and 3 months after discharge. CONCLUSION： A diagnosis of infective myositis should be considered for patients with clear prodromes of infection, that include symptoms of periodic paralysis and elevated creatine kinase levels. Treatment with sufficient antibiotics can obtain good results.
文摘Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.
文摘Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.
文摘BACKGROUND Infective endocarditis(IE) is a rare disease with a high mortality rate.Leclercia adecarboxylata(L.adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae,and it can rarely be a pathogen which often affects immunodeficient patients.There are about three cases of immunocompetent patients with monomicrobial L.adecarboxylata infection.There are only three reported cases of IE caused by L.adecarboxylata in the world.The mitral valve is often affected in IE,and the prognosis for IE with mitral valve lesions is often poor.CASE SUMMARY A 51-year-old man was found to have moderate to severe mitral stenosis on echocardiography.He came to our Cardiothoracic Surgery Department for surgical management.A diastolic murmur was heard on auscultation of the heart in the mitral region.On the second day of hospitalisation,he presented with slurred speech,reduced muscle strength in the left limb,and acute cerebral infarction on cranial computed tomography.Surgical treatment was decided to postpone.On the ninth day of admission,the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit,where echocardiogram revealed an anterior mitral valve leaflet vegetation.After empirical anti-infective treatment with vancomycin(1g q12h),an emergency valve replacement was performed.Bacterial culture identified L.adecarboxylata.Antiinfective treatment with piperacillin-tazobactam(4.5g q8h) was added for 4 wk.Follow-up echocardiography showed normal bioprosthetic valve function after mitral valve replacement.CONCLUSION We report the first case of L.adecarboxylata IE in China,and clinicians should pay attention to this pathogen.
文摘Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such patients.Literature data are few, and optimal treatment methods, indications for surgery, and types of operative techniquesare still under debate. We present an adult patient with a rare combination of the ventricular septal defect (VSD)and PV IE who underwent surgical treatment. Neocuspidization with autologous pericardium was utilized for thereconstruction of his PV. We discuss details of this novel surgical technique.
