Recurrent Prosthetic Valve Endocarditis Caused by Staphylococcus aureus Colonizing Skin Lesions in Severe Atopic Dermatitis (original) (raw)
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Staphylococcus aureus Prosthetic Valve Endocarditis: Optimal Management and Risk Factors for Death
Clinical Infectious Diseases, 1998
The mortality rate associated with Staphylococcus aureus prosthetic valve endocarditis (PVE) remains high. To identify clinical events associated with an increased risk of death among patients with S. aureus PVE and to evaluate the role of valve replacement surgery in reducing mortality, we conducted a retrospective cohort study of patients who met strict criteria for definite S. aureus PVE. The primary endpoint for the study was survival at 3 months from the date of diagnosis. S. aureus PVE was diagnosed in 33 patients. Of these, 14 (42%) died within 90 days of the diagnosis. Cardiac complications were detected in 22 (67%), and central nervous system (CNS) complications were detected in 11 (33%). A stepwise logistic regression multivariate model demonstrated that cardiac complications, but not CNS complications, were associated with increased mortality and that performing valve replacement surgery during antibiotic therapy was associated with decreased mortality. These associations were confirmed by using a Cox proportional hazards model with timedependent covariates to control for survival bias. Performing valve replacement surgery during antimicrobial therapy will reduce the mortality among patients with S. aureus PVE, even those without evidence of cardiac complications.
Case of prosthetic valve endocarditis with osteomyelitis associated with disregarded skin infection
Background: Prosthetic valve endocarditis (PVE) is a serious condition associated with high mortality rate. The causes of PVE vary from surgical procedure to superficial skin infection. Sometimes it is difficult to identify latent infections in the body and recognize them as the true causes of PVE. We describe here a case of PVE complicated by osteomyelitis that was hematogenously disseminated from a disregarded infected skin tumor on the head. Methods: A 73-year-old man who underwent aortic valve replacement developed prosthetic valve endocarditis complicated by osteomyelitis that was disseminated from an infected skin tumor on the head. During the follow-up after the first operation, neither a small skin mass on the head nor lower back pain had been considered manifestations of infection. With progressive pain and fever, however, the patient was referred back to our hospital for further examination; vegetation and paravalvular leakage around the aortic valve and lumbar osteomyelitis was detected. Results: A Staphylococcus aureus blood culture confirmed the diagnosis of prosthetic valve endocarditis associated with osteomyelitis, originating from the infected skin tumor. Re-operation was performed. The affected aortic valve was excised through a transverse aortotomy, revealing a deep annular abscess and partial valvular dehiscence. After the abscess was debrided completely, the damaged annulus was reconstructed with an autologous pericardium. For the valve implantation, pledgeted 2-0 mattress sutures were threaded through the aortic root from the outside, considering the potential fragility of the annulus. With multidisciplinary treatment, re-aortic valve replacement by cardiac surgeons, removal of the skin tumor by dermatologists, and intensive antibiotic therapy for osteomyelitis by orthopedists, the patient recovered. Conclusion: Valve replacement patients are vulnerable to external infective agents, hence awareness should be directed towards the potential threats. Keywords: Endocarditis, prosthesis, infection, co-morbidity, reoperation
Recurrent Staphylococcus warnerii prosthetic valve endocarditis: A case report and review
Annals of Clinical Microbiology and Antimicrobials, 2011
To our knowledge, there have been only six S. warneri endocarditis cases reported in the English-language literature (Medline: 1966 to April 2011). We report a case of recurrent S. warneri endocarditis in a patient with prosthetic valve and silicon mammoplasty and we also review the relevant literature.
Medical Versus Surgical Management of Staphylococcus aureus Prosthetic Valve Endocarditis
American Journal of Medicine, 2006
The study's purpose was to identify prognostic factors associated with mortality in Staphylococcus aureus prosthetic valve endocarditis and to determine whether these factors influenced decisions to treat medically versus surgically. We also analyzed whether there was a subset of patients who were cured with medical therapy alone. SUBJECTS AND METHODS: A retrospective review of patients with S aureus prosthetic valve endocarditis was performed. Demographic and clinical data were collected from existing medical records. Severity of illness was classified using American Society of Anesthesiologists (ASA) score. Impact of treatment on in-hospital mortality was assessed using multiple logistic regression analysis. RESULTS: Fifty-five patients met the Duke criteria for definite S aureus prosthetic valve endocarditis. Twenty-three patients were treated medically, and 32 patients had surgical intervention. Overall mortality was 36% (28% in the surgical group and 48% in the medical group). ASA score IV (P Ͻ .001) and older age (P ϭ .014) were significant risk factors of mortality. Patients with ASA score IV (P ϭ .037) and multiple prosthetic valves (P ϭ .013) were less likely to undergo surgery. Medically treated patients were older compared with those in the surgical group (median age 66 vs 55 years, P ϭ .04). All 4 patients aged less than 50 years in the medically treated group survived. CONCLUSION: Mortality was generally higher in the medically treated patients with S aureus prosthetic valve endocarditis. Multivariable analysis showed that ASA class IV and bioprosthetic valves were independent predictors of mortality. A subset of medically treated patients characterized by age less than 50 years, ASA score III, and without cardiac, central nervous system, or systemic complications were cured without surgical intervention.
Cureus, 2022
We report a case of ST-elevation myocardial infarction (STEMI) due to septic emboli secondary to Staphylococcus capitis endocarditis in a 32-year-old male patient with a past medical history of infectious endocarditis requiring mechanical aortic, mitral and tricuspid valve replacement presented with sharp chest pain and shortness of breath. Electrocardiogram demonstrated an acute inferior STEMI. Coronary angiography revealed occlusion of the terminal left anterior descending (LAD) artery associated with a large apical wrap-around segment exhibiting TIMI 0 flow. Primary angioplasty was not performed given the distal location of the embolus. Clinical suspicion for septic or thrombotic coronary artery embolism was high given the patient's history of mechanical valve prosthesis and in the setting of sub-therapeutic INR. Transesophageal echocardiography revealed a new mobile echodensity on the mitral prosthesis consistent with vegetation. S. capitis was isolated from blood cultures, confirming the diagnosis of endocarditis. S. capitis is a rare cause of prosthetic valve endocarditis and should remain in the differential of septic coronary artery embolism among patients with features of infectious endocarditis.
The American Journal of Medicine, 1991
This report describes seven patients from three university hospitals whose native valve infective endocarditis was caused by Staphylococcus epidermidis. The literature on endocarditis caused by S. epidermidis is also reviewed and the clinical features of patients with native valve endocarditis due to this organism are compared with those of patients from a general series of infective endocarditis cases. Compared with infective endocarditis caused by other organisms, S. epidermidis endocarditis tends to occur more frequently in male patients. Patients with S. epidermidis endocarditis exhibit fewer embolic complications and skin manifestations. The frequency of congestive heart failure is lower in this group. The relative indolent course and apparent rarity of native valve S. epidermidis endocarditis necessitate a high index of suspicion for early diagnosis.
Clinical Infectious Diseases, 2005
Background. Staphylococcus aureus native valve infective endocarditis (SA-NVIE) is not completely understood. The objective of this investigation was to describe the characteristics of a large, international cohort of patients with SA-NVIE. Methods. The International Collaboration on Endocarditis Merged Database (ICE-MD) is a combination of 7 existing electronic databases from 5 countries that contains data on 2212 cases of definite infective endocarditis (IE). Results. Of patients with native valve IE, 566 patients (34%) had IE due to S. aureus, and 1074 patients had IE due to pathogens other than S. aureus (non-SA-NVIE). Patients with S. aureus IE were more likely to die (20% vs. 12%;), to experience an embolic event (60% vs. 31%;), or to have a central nervous system P ! .001 P ! .001 event (20% vs. 13%;) and were less likely to undergo surgery (26% vs. 39%;) than were patients P ! .001 P ! .001 with non-SA-NVIE. Multivariate analysis of prognostic factors of mortality identified age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), periannular abscess (OR, 2.4; 95% CI, 1.1-5.6), heart failure (OR, 3.9; 95% CI, 2.3-6.7), and absence of surgical therapy (OR, 2.3; 95% CI, 1.3-4.2) as variables that were independently associated with mortality in patients with SA-NVIE. After adjusting for patient-, pathogen-, and treatment-specific characteristics by multivariate analysis, geographical region was also found to be associated with mortality in patients with SA-NVIE (). P ! .001 Conclusions. S. aureus is an important and common cause of IE. The outcome of SA-NVIE is worse than that of non-SA-NVIE. Several clinical parameters are independently associated with mortality for patients with SA-NVIE. The clinical characteristics and outcome of SA-NVIE vary significantly by geographic region, although the reasons for such regional variations in outcomes of SA-NVIE are unknown and are probably multifactorial. A large, prospective, multinational cohort study of patients with IE is now under way to further investigate these observations. Staphylococcus aureus infective endocarditis (SAIE) is a complication of S. aureus bacteremia in 4 clinically distinct groups: injection drug users, hospitalized patients with nosocomial infections, prosthetic valve recipients,