{"content"=>"Case Report: A rare case of prosthetic valve infective endocarditis caused by .", "i"=>{"content"=>"Aerococcus urinae"}} (original) (raw)
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Prosthetic valve endocarditis caused by Aerococcus Urinae
IDCases, 2020
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Native and Prosthetic Aortic Valve Endocarditis
Aortic Valve, 2011
The epidemiological profile of IE has changed substantially over the last few years. In industrialized countries, the typical pattern of IE is now an elderly patient with a degenerative heart valve disease or with a prosthetic valve or an intracardiac device such as a pacemaker or defibrillator leads. Major changes have occurred in the mode of acquisition of IE and in its microbiological profile (Thuny et al, 2010). Significant geographical variations have been shown. The highest increase in the rate of staphylococcal IE has been reported in the USA, where chronic hemodialysis, diabetes mellitus, and intravascular devices are the three major factors associated with the development of Staphylococcus aureus (S. aureus) endocarditis. In other countries, the main predisposing factor for S. aureus IE may be intravenous drug abuse (Habib et al, 2009). 1.4 Incidence The incidence of IE ranges from one country to another within 3-10 episodes/100,000 person-years. This may reflect methodological differences between surveys rather than true variation. Of note, in these surveys, the incidence of IE was very low in young patients but increased dramatically with age-the peak incidence was 14.5 episodes/100,000 personyears in patients between 70 and 80 years old. In all epidemiological studies of IE, the male:female ratio is 2:1, although why there is a higher proportion of men is poorly understood. Furthermore, female patients may have a worse prognosis and undergo valve surgery less frequently than their male counterparts (Habib et al, 2009). Patients with prosthetic aortic valves are reported to have an incidence of PVE of 0.3 to 1.2 episodes per 100 patients/year, and approximately 1.4% of patients undergoing aortic valve replacement develop PVE during the first postoperative year. 1.5 Types of infective endocarditis IE should be regarded as a set of clinical situations that are sometimes very different from each other. In an attempt to avoid overlap, the following four categories of IE must be separated according to the site of infection and the presence or absence of intracardiac foreign material: left-sided native valve IE, left-sided prosthetic valve IE, right-sided IE, and device-related IE (the latter includes IE developing on pacemaker or defibrillator leads with or without associated valve involvement). With regard to acquisition, the following situations can be identified: community-acquired IE, healthcare-associated IE (nosocomial and non-nosocomial), and IE in intravenous drug abusers (IVDAs) (Habib et al, 2009). 1.6 Microbiology The microbiology of IE of the aortic valve depends on whether the valve is native or prosthetic, and whether the infection is hospital-or community-acquired. According to microbiological findings, the following categories are proposed: 1. IE with positive blood cultures. This is the most important category, representing 85% of all IE. Causative microorganisms are most often staphylococci, streptococci, and enterococci (Murdoch et al, 2009). a. IE due to streptococci and enterococci. Oral (formerly viridans) streptococci form a mixed group of microorganisms, which includes species such as S. sanguis, S. mitis, S. salivarius, S. mutans, and Gemella www.intechopen.com Native and Prosthetic Aortic Valve Endocarditis 95 morbillorum. Microorganisms of this group are almost always susceptible to penicillin. Members of the S. milleri or S. anginosus group (S. anginosus, S. intermedius, and S. constellatus) must be distinguished since they tend to form abscesses and cause hematogenously disseminated infections, that often require a longer duration of antibiotic treatment. Likewise, nutritionally variant "defective" streptococci, recently reclassified into other species (Abiotrophia and Granulicatella), should also be distinguished since they are often tolerant to penicillin [minimal bactericidal concentration (MBC) much higher than the minimal inhibitory concentration (MIC)]. Group D streptococci form the Streptococcus bovis/ Streptococcus equinus complex, including commensal species of the human intestinal tract, and were until recently gathered under the name of Streptococcus bovis. They, like oral streptococci, are usually sensitive to penicillin. Among enterococci, E. faecalis, E. faecium, and, to a lesser extent, E. durans, are the three species that cause IE. b. Staphylococcal IE. Traditionally, native valve staphylococcal IE is due to S. aureus, which is most often susceptible to oxacillin, at least in community-acquired IE. In contrast, staphylococcal prosthetic valve IE is more frequently due to coagulase-negative staphylococci (CNS) with oxacillin resistance. However, in a recent study of 1779 cases of IE collected prospectively in 16 countries, S. aureus was the most frequent cause, not only of IE, but also of prosthetic valve IE (Fowler et al, 2005). Conversely, CNS can also cause native valve IE (Chu et al, 2004, 2008) especially S. lugdunensis, which frequently has an aggressive clinical course. 2. IE with negative blood cultures because of prior antibiotic treatment. This situation arises in patients who received antibiotics for unexplained fever before any blood cultures were done and in whom the diagnosis of IE was not considered; usually the diagnosis is eventually considered in the face of relapsing febrile episodes following antibiotic discontinuation. Blood cultures may remain negative for many days after antibiotic cesation, and causative organisms are most often oral streptococci or CNS. 3. IE frequently associated with negative blood cultures. They are usually due to fastidious organisms such as nutritionally variant streptococci, fastidious Gram-negative bacilli of the HACEK group (H. parainfluenzae, H. aphrophilus, H. paraphrophilus, H. influenzae, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae, and K. denitrificans), Brucella, and fungi. 4. IE associated with constantly negative blood cultures. They are caused by intracellular bacteria such as Coxiella burnetii, Bartonella, Chlamydia, and, as recently demonstrated, Tropheryma whipplei, the agent of Whipple's disease (Richardson et al, 2003). Overall, these account for up to 5% of all IE. Diagnosis in such cases relies on serological testing, cell culture, or gene amplification (Habib et al, 2009).
A Case of Pacemaker Endocarditis Caused by Aerococcus urinae
Case Reports in Infectious Diseases
Background. Aerococcus urinae has lately been acknowledged as a cause of infective endocarditis (IE) especially in older males with underlying urinary tract disorders. In this population, cardiac implanted electronical devices (CIED) are not uncommon, but despite the capacity of A. urinae to form biofilm in vitro, no cases of aerococcal CIED infections have been reported to date. Case Presentation. An 84-year-old male with pacemaker was admitted with dysuria one month after a transurethral procedure for urinary bladder cancer. A. urinae was isolated from urine and blood. Transesophageal echocardiography (TEE) was without signs of vegetation on valves or pacing cables. The patient was treated with a twelve-day course of β-lactam antibiotics. Forty days after the initial admission, the patient was readmitted due to malaise, general pain of the joints, chills, and renewed blood cultures grew A. urinae. TEE demonstrated a 10 × 5 mm vegetation on either the tricuspid valve or one of the ...
Cardiovascular Research, 2022
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci, and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent, and frequently, false-negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal, and viral pathogens in blood and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
Management of Prosthetic Valve Infective Endocarditis
The American Journal of Cardiology, 2008
years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus. In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.
INFECTIOUS ENDOCARDITIS IN VALVE PROSTHESES: AN UPDATED REVIEW OF CLINICAL ASPECTS (Atena Editora)
INFECTIOUS ENDOCARDITIS IN VALVE PROSTHESES: AN UPDATED REVIEW OF CLINICAL ASPECTS (Atena Editora), 2023
Introduction: The management carried out in patients with IE is very important for the outcome and prognosis. For this, a thorough history and physical examination are essential. Laboratory tests and echocardiography will contribute to better clinical reasoning and subsequently to appropriate treatment. Objective: Understand which group has a higher prevalence of presenting IE and what is the best treatment after a correct diagnosis. Methodology: This is a bibliographic review related to infectious endocarditis in valve prostheses. 10 articles were selected from the SciELO, PubMed and SOCESP Magazine (Society of Cardiology of the State of São Paulo). The following inclusion criteria were defined: articles in Portuguese and English, published between 2018 and 2023 and which addressed the themes proposed for this research, review-type studies, meta-analysis and observational studies. Results: Descriptions regarding the symptoms of IE are described as fever, heart murmurs, petechiae, anemia and embolic phenomena. It is important to highlight that IE is more common in elderly people aged between 50 and 60 years. Conclusion: It is concluded that elderly people with valve prostheses, vascular catheters, pacemakers and cardioverter defibrillators are more susceptible to infectious endocarditis.
BMJ, 1983
During 1965 to 1982, 32 episodes of infective endocarditis on prosthetic valves in 30 patients were treated at this hospital. In early endocarditis (presenting within four months of operation) staphylococci were the organisms most commonly responsible. Early endocarditis appears to be declining in incidence and is largely preventable; sternal sepsis was the main predisposing factor, requiring urgent and effective treatment. Streptococci were the most common organisms in late onset disease, but as with natural valve endocarditis a wide range of organisms was responsible. All but one of the patients with early onset disease were treated conservatively, but mortality was high; prompt surgical replacement of infected prostheses is probably indicated in such patients. Medical management was effective in most patients with late onset disease, and for them early surgical intervention may not be justified.