Browsing by Subject "Infective endocarditis"

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    A contemporary picture of enterococcal endocarditis
    (Elsevier, 2020-02-03) Pericàs, Juan M.; Llopis, Jaume; Muñoz, Patricia; Gálvez-Acebal, Juan; Kestler, Martha; Valerio, Maricela; Hernández-Meneses, Marta; Goenaga, Miguel Á.; Cobo-Belaustegui, Manuel; Montejo, Miguel; Ojeda-Burgos, Guillermo; Sousa-Regueiro, M. Dolores; Alarcón, Arístides de; Ramos-Martínez, Antonio; Miró, José M.; García-Vázquez, Elisa; GAMES Investigators; Medicina
    BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p ¼ 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p ¼ 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs.45.9%; p ¼ 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p ¼ 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
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    Bartonella Endocarditis in Spain: Case Reports of 21 Cases
    (Multidisciplinary Digital Publishing Institute (MDPI), 2022-05-10) García-Álvarez, Lara; García-García, Concepción; Muñoz, Patricia; Fariñas-Álvarez, María del Carmen; Gutiérrez Cuadra, Manuel; Fernández-Hidalgo, Nuria; García-Vázquez, Elisa; Moral-Escudero, Encarnación; Alonso-Socas, María del Mar; García-Rosado, Dácil; Hidalgo-Tenorio, Carmen; Domínguez, Fernando; Goikoetxea-Agirre, Josune; Gainzarain, Juan Carlos; Rodríguez-Esteban, María Ángeles; Bosch-Guerra, Xerach; Oteo, José A.; Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES); Medicina
    Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment.
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    Clinical features and outcomes of streptococcus anginosus group Infective endocarditis: A multicenter matched cohort study
    (Oxford University Press, 2021-03-25) Escrihuela-Vidal, Francesc; López-Cortés, Luis Eduardo; Escolà-Vergé, Laura; Alarcón González, Arístides de; Cuervo, Guillermo; Sánchez-Porto, Antonio; Fernández-Hidalgo, Nuria; Luque, Rafael; Montejo, Miguel; Miró, José M.; Goenaga, Miguel Ángel; Muñoz, Patricia; Valerio, Maricela; Ripa, Marco; Sousa-Regueiro, Dolores; Gurguí, Mercé; Fariñas-Álvarez, María Carmen; Mateu, Lourdes; García-Vázquez, Elisa; Gálvez-Acebal, Juan; Carratalà, Jordi; Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES); Barcelona Endocarditis Study Team (BEST); Medicina
    Background. Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods. We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results. Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/ SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P = .116); valve disorder, including perforation (22.2% vs 18.1%, P = .584), pseudoaneurysm (16.7% vs 8.3%, P = .108), or prosthesis dehiscence (1.4% vs 6.3%, P = .170); paravalvular complications, including abscess (25% vs 18.8%, P = .264) and intracardiac fistula (5.6% vs 3.5%, P = .485); heart failure (34.7% vs 38.9%, P = .655); or embolic events (41.7% vs 32.6%, P = .248). Indications for surgery (70.8% vs 70.8%; P = 1) and mortality (13.9% vs 16.7%; P = .741) were similar between groups. Conclusions. SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.
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    Endocarditis caused by anaerobic bacteria
    (Elsevier, 2017-04-05) Kestler, M.; Muñoz, P.; Marín, M.; Goenaga, M.A.; Idígoras Viedma, P.; Alarcón, A. de; Lepe, J.A.; Sousa Regueiro, D.; Bravo-Ferrer, J.M.; Pajarón, M.; Costas, C.; García-López, M.V.; Hidalgo-Tenorio, C.; Moreno, M.; Bouza, E.; García-Vázquez, Elisa; Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES); Medicina
    Background Infective endocarditis (IE) caused by anaerobic bacteria is a rare and poorly characterized disease. Most data reported in the literature are from case reports [1–3]. Therefore, we assessed the situation of anaerobic IE (AIE) in Spain using the database of the Spanish Collaboration on Endocarditis (GAMES). Methods We performed a prospective study from 2008 to 2016 in 26 Spanish centers. We included 2491 consecutive cases of definite IE (Duke criteria). Results Anaerobic bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years (IQR, 56–73), and 19 (86.4%) patients were men. Most patients (14 [63.6%]) had prosthetic valve IE and all episodes were left-sided: aortic valves, 12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic. Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality was 18.2% during admission and 5.5% after 1 year of follow-up. When patients with AIE were compared with the rest of the cohort, we found that although those with AIE had a similar age and Charlson comorbidity index, they were more likely to have community-acquired IE (86.4% vs. 60.9%, p = 0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have had lower mortality rates during admission (18.2% vs. 27.3%). Conclusion IE due to anaerobic bacteria is an uncommon disease that affects mainly prosthetic valves and frequently requires surgery. Otherwise, there are no major differences between AIE and IE caused by other microorganisms.
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    Infective endocarditis treated in a secondary hospital: epidemiological, clinical, microbiological characteristics and prognosis, with special reference to patients transferred to a third level hospital
    (Sociedad Española de Quimioterapia, 2021-11-30) Peláez Ballesta, Ana Isabel; García-Vázquez, Elisa; Gómez Gómez, Joaquín; Medicina
    ABSTRACT: Introduction. To analyse the clinical and epidemiological characteristics and mortality-related factors of patients admitted to a secondary hospital with Infective Endocarditis (IE). Methods. Observational study of a cohort of patients who have been diagnosed with IE in a secondary hospital and evaluated in accordance with a pre-established protocol. Results. A total of 101 cases were evaluated (years 2000-2017), with an average age of 64 years and a male-to-female ratio of 2:1. 76% of the cases had an age-adjusted Charlson comorbidity index of >6, with 21% having had a dental procedure and 36% with a history of heart valve disease. The most common microorganism was methicillin-susceptible S. aureus (36%), with bacterial focus of unknown origin in 54%. The diagnostic delay time was 12 days in patients who were transferred, compared to 8 days in patients who were not transferred (p=0.07); the median surgery indication delay time was 5 days (IQR 13.5). The in-hospital mortality rate was 34.6% and the prognostic factors independently associated with mortality were: cerebrovascular events (OR 98.7%, 95% CI, 70.9–164.4); heart failure (OR 27.3, 95% CI, 10.2–149.1); and unsuitable antibiotic treatment (OR 7.2, 95% CI, 1.5–10.5). The mortality rate of the patients who were transferred and who therefore underwent surgery was 20% (5/25). Conclusions. The onset of cerebrovascular events, heart failure and unsuitable antibiotic treatment are independently and significantly associated with in-hospital mortality. The mortality rate was higher than the published average (35%); the diagnostic delay was greater in patients for whom surgery was indicated.
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    Multivalvular endocarditis: A rare condition with poor prognosis
    (Multidisciplinary Digital Publishing Institute (MDPI), 2022-08-13) Álvarez-Zaballos, Sara; González-Ramallo, Victor; Quintana, Eduard; Muñoz, Patricia; Villa-Martínez, Sofía de la; Fariñas, M. Carmen; Arnáiz-de las Revillas, Francisco; Alarcón, Arístides de; Rodríguez-Esteban, M. Ángeles; Miró, José M.; Goenaga, Miguel Ángel; Goikoetxea-Agirre, Josune; García-Vázquez, Elisa; Boix-Palop, Lucía; Martínez-Sellés, Manuel; GAMES investigators; Medicina
    Background. Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE). Methods. We used a retrospective analysis of the Spanish IE Registry (2008–2020). Results. From 4064 definite cases of valvular IE, 577 (14.2%) had MIE. In patients with MIE, the most common locations were mitral (552, 95.7%) and aortic (550, 95.3%), with mitral-aortic involvement present in 507 patients (87.9%). The most common etiologies were S. viridans (192, 33.3%) and S. aureus (113, 19.6%). MIE involved only native valves in 450 patients (78.0%). Compared with patients with SIE, patients with MIE had a similar age (69 vs. 67 years, respectively, p = 0.27) and similar baseline characteristics, but were more frequently men (67.1% vs. 72.9%, p = 0.005) and had a higher incidence of intracardiac complications (36.2% vs. 50.4%, p < 0.001), heart failure (42.7% vs. 52.9%, p < 0.001), surgical indication (67.7 vs. 85.1%, p < 0.001), surgery (46.3% vs. 56.3%), and in-hospital mortality (26.9% vs. 34.3%, p < 0.001). MIE was an independent predictor of in-hospital mortality (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1–1.7, p = 0.004) but did not have an independent association with 1-year mortality (OR 1.1, 95% CI 0.9–1.4, p = 0.43). Conclusions. About one-seventh of the valvular IE patients had MIE, mainly due to mitral-aortic involvement. MIE is associated with a poor in-hospital prognosis. An early diagnosis and treatment of IE might avoid its spread to a second valve
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    Outpatient parenteral antibiotic treatment for infective endocarditis: A prospective cohort study from the GAMES cohort
    (Oxford University Press, 2019-06-14) Pericàs, Juan M.; Llopis, Jaume; González-Ramallo, Víctor; Goenaga, Miguel Á.; Muñoz, Patricia; García-Leoni, M. Eugenia; Fariñas, M. Carmen; Pajarón, Marcos; Ambrosioni, Juan; Luque, Rafael; Goikoetxea, Josune; Oteo, José A.; Carrizo, Enara; Bodro, Marta; Reguera-Iglesias, José M.; Navas, Enrique; Hidalgo-Tenorio, Carmen; Miró, José M; García-Vázquez, Elisa; Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES); Medicina
    Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods. Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed. Results. A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04–1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09–.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22–.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions. OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.