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PubMed1999

Bacterial endocarditis in neonatal intensive care.

OBJECTIVES: To ascertain the incidence of bacterial endocarditis in a level III neonatal nursery. To document the clinical features, assess survival, and evaluate the role of central venous catheters in neonates with bacterial endocarditis. METHODOLOGY: Index cases were identified by retrospective review of the echocardiographic records of infants admitted to the neonatal nursery from 1983 to 1995. Data obtained by review of the clinical records of these infants, and case-matched controls. RESULTS: From January 1983 to December 1995, 12,249 infants were admitted to the Special Care Nursery. Eight infants with endocarditis were identified, an incidence of 0.07%. Presenting symptoms and signs were often vague and nonspecific. Gestation less than 32 weeks, birthweight less than 1500 g, thrombocytopenia and neutropenia or neutrophilia were common features. Infants with endocarditis had a significantly higher Clinical Risk Index for Babies score than those without endocarditis. The tricuspid valve was involved in seven infants, six of whom had a percutaneous central venous catheter in situ before diagnosis. Mitral valve involvement occurred in two infants, neither of whom had central lines inserted. However, compared to infants without endocarditis, the placement of a central venous line was not of statistical significance. Seven of the eight infants survived following prolonged antibiotic therapy. CONCLUSIONS: Bacterial endocarditis is a rare but serious condition which is usually not fatal. In the premature newborn infant, presenting signs and symptoms are often nonspecific. Endocarditis should therefore be considered in the unwell very low birthweight infant.

Catheterization, Central Venous↗

PubMed1988

Treatment of bacterial endocarditis in a horse.

Using echocardiography, mitral valve bacterial endocarditis was diagnosed in a yearling Thoroughbred filly with a history of periodic fever and intermittent hind limb lameness. Streptococcus sp were isolated from blood, and the filly was treated with penicillin, resulting in a bacteriologic cure. Severe mitral regurgitation developed secondary to scarring of the valve, which resulted in the filly's death. A poor prognosis usually is indicated in horses with bacterial endocarditis, as bacteriologic cures are infrequent and severe valvular insufficiency often develops.

Animals↗

PubMed1975

[Proceedings: Chemotherapy of bacterial endocarditis].

The present concepts of antibiotic therapy in bacterial endocarditis are reviewed. Recommendations for the treatment of the most frequent pathogens -- streptococci of the viridans group, enterococci, staphylococci -- and for unknown organisms are presented. Antimicrobial therapy directed against gramnegative organisms, especially of the pseudomonas group, and against anaerobic bacteria is briefly discussed. The presence of renal impairment calls for adjustment of dosage; relevant nomograms are published in the literature. Probenecid may be added to the antibiotic therapy to increase serum levels of penicillins and some cephalosporins, though a major drawback is its side effects. Clinical experience teaches that every recrudescence of bacterial endocarditis adds permanent damage to an already impaired valve. Hence it is of utmost importance that the aim of antimicrobial therapy should be a 100% cure.

Cephalosporins↗

PubMed1972

Surgical aspects of bacterial endocarditis.

Forty patients with a previous history of bacterial endocarditis were treated surgically between December 1967 and August 1971. Of 28 patients who had elective valve replacements there were four hospital deaths and one late death. Seven patients underwent emergency operation for intractable heart failure before completion of antibiotic treatment, six survived operation and there was one late death. Six patients had operations for infection on pre-existing valve substitutes, of whom three were treated as emergencies. There were two hospital and no late deaths. 78% of all patients were alive and well four years to nine months after operation.These results confirm that in addition to elective valve replacement surgery has an important role both in the treatment of intractable heart failure during the infective stage of bacterial endocarditis and in the eradication of infection on cardiac prostheses.

Adolescent↗

PubMed1976

Bacterial endocarditis at Blegdamshospitalet in Copenhagen 1944-1973.

The clinical pattern of 34 cases ob subacute bacterial endocarditis (SBE) and 46 cases of acute bacterial endocarditis (ABE) is outlined. In the SBE group the mortality was 9% and the incidence of major complications during the treatment period was 15% for cerebrovascular accidents, 9% for other systemic or pulmonary emboli and 9% for congestive heart failure indicating valvular damage. In 31 bacteriologically proven cases growth was obtained in 68% of all blood cultures, and in 94% of the cases at least one positive culture was among the first 5 ones drawn. In the ABE group the overall mortality was 72% and mortality for cases occurring after 1960 was 58%. Major factors contributing to death were valvular incompetence, uncontrolled infection and embolisation. In order to reduce major complications and resulting disability in SBE it is suggested that treatment be started on clinical suspicion as soon as 5 blood cultures have been drawn over a period of 48 hours. Attempts to reduce mortality in ABE may include cardiac surgery in the acute phase.

Acute Disease↗

PubMed1980

Culture-negative septic arthritis and bacterial endocarditis. Diagnosis by synovial biopsy.

The capacity of bacterial endocarditis to mimic other systemic illnesses is well known. This report describes a patient with blood culture-negative bacterial endocarditis who presented with features suggestive of rheumatoid arthritis. Despite sterile synovial fluid, synovial biopsy culture resulted in identification of the causative organism and led to specific antibiotic therapy and cure. This is the first report of such a case.

Anti-Bacterial Agents↗

PubMed1964

BACTERIAL ENDOCARDITIS DUE TO AN ACTINOBACILLUS.

A case of subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans followed dental extraction under penicillin cover. Isolation of the organism was only achieved by incubating blood cultures in a CO(2)-enriched atmosphere. The patient was successfully treated with streptomycin.

Actinobacillus↗

PubMed1982

Association between serum inhibitory and bactericidal concentrations and therapeutic outcome in bacterial endocarditis.

Several recent reviews on the therapy of bacterial endocarditis have recommended that a serum inhibitory and/or bactericidal concentration (SIC/SBC) of 1:8 or more be achieved to ensure successful therapeutic outcome. We conducted a methodologic and statistical analysis of the available literature on endocarditis to determine the association between SIC/SBC titers of 1:8 or more and therapeutic outcome. We reviewed 17 studies published between 1948 and 1980 in which both SIC/SBC and therapeutic outcome were available. Factors that affect outcome, such as age, duration of symptoms, organism, and valve status, varied widely among the 226 patients. The methods used to measure SIC/SBC differed with respect to the time of obtaining the blood specimen relative to the antibiotic dose, size of the bacterial inoculum, type of broth, and definition of the bactericidal end-point. None of the 17 studies showed a significant association between SIC/SBC titers of 1:8 or more and survival or bacteriologic cure. Fifteen of the 17 also failed to demonstrate a significant association between SIC/SBC titers of 1:8 or more and medical cure. However, each of the studies that failed to demonstrate an association between SIC/SBC titers of 1:8 or more and improved therapeutic outcome had an insufficient sample size to confidently exclude a false-negative result. Analysis of the published data reveals insufficient evidence to demonstrate that SIC and SBC titers are of prognostic value in the therapy of patients with bacterial endocarditis.

Anti-Bacterial Agents↗

PubMed1987

Neonatal bacterial endocarditis of the pulmonary valve: report of two cases.

Bacterial endocarditis in the neonate is rare and fatal in the majority of reported cases. This article reports two neonates who survived bacterial endocarditis. One patient was infected with group B beta-hemolytic streptococcus (GBBS) while the second grew Streptococcus saluvarius from the blood.

Ampicillin↗

PubMed1982

Valve replacement for bacterial endocarditis.

During the 10-year period 1970-79, 88 patients underwent valve replacement for complications of bacterial endocarditis. The mean age of the patients was 42 (15-60) years. There were 64 men and 22 women. Thirty-three patients had a history of rheumatic fever. In 11 cases the murmur was heard already in childhood. In 44 cases (50%) no heart disease was diagnosed before the onset of symptoms of bacterial endocarditis. Strepto- and staphylococci were the most common organisms found in culture. In 12 cases a dental and in 12 a respiratory tract infection preceded the endocarditis. In 51 cases, however, the origin of the infection remained unestablished. Intractable heart failure and embolizations were most common indications for operation. Only 9 patients underwent operation in the acute phase. Aortic valve replacement (AVR) was performed in 58 cases, mitral valve replacement (MVR) in 19, both AVR and MVR in 6, AVR and aneurysm of sinus Valsalva repair in 3 cases, AVR and repair of VSD in one and AVR combined with myocardial revascularization and replacement of the ascending aorta for aneurysm in one case. The early mortality was 9 patients (10%) and late mortality 9 patients. During follow-up times of up to 10 years, 7 patients experienced embolic complications. They recovered uneventfully. One valve prosthesis was replaced because of thrombosis and another due to paraprosthetic leak. Two patients had a late recurrent bacterial endocarditis 5 and 8 years postoperatively. They were treated conservatively and recovered. It was concluded that after valve replacement for bacterial endocarditis, the risk of recurrent infection is relatively low and that results approaching those for elective valve replacement can be achieved.

Adolescent↗

PubMed1973

Fibrinogen catabolism study of three patients with bacterial endocarditis and renal disease.

Three patients with bacterial endocarditis who developed renal failure have been studied by means of a radiofibrinogen catabolism study. Two were studied at the time of bacteraemia and one during the subsequent "immunological phase" of circulating immune complexes. Accelerated fibrinogen catabolism was found in all cases. Intravascular coagulation may be an important factor in the pathogenesis of proliferative glomerulonephritis in such cases.

Acute Kidney Injury↗

PubMed1982

Failure of erythromycin in preventing bacterial endocarditis.

Use of oral erythromycin to prevent bacterial endocarditis has been accepted in the treatment of penicillin-allergic patients who required oral or sinusal surgery. A case of Streptococcus sanguis endocarditis, however, developed in a patient following intravenous erythromycin administration during surgery on the maxillary sinus. The organism isolated proved resistant to erythromycin. This isolation of an erythromycin-resistant organism, together with previous reports of the drug's failure in preventing endocarditis in animal models, and recognition of the bacteriostatic action of erythromycin, argue for caution in our current practice of using erythromycin as a single drug therapy to prevent endocarditis in the patient who is allergic to penicillin.

Adult↗

PubMed1978

Neurologic complications of bacterial endocarditis.

(1) Neurologic complications remain a significant problem in bacterial endocarditis. Of 218 patients with endocarditis, 84 (39%) had a neurologic complication and 58% of these 84 patients died. In contrast, the mortality rate was only 20% among those endocarditis patients without neurologic complications. (2) Of the neurologic complications, cerebral embolism is the most frequent and important. An embolic stroke occurred in 37 (17%) of our patients, with 30 of these patients dying. Emboli are important not only in terms of the direct morbidity and mortality they cause via cerebral infarction, but also because of their role in the causation of mycotic aneurysms, brain abscesses, and abnormal CSF formulae. (3) Cerebral emboli are particularly common in patients with mitral valve infection, and in patients with infection due to virulent organisms, particularly S. aureus and enteric gram-negative bacilli. (4) Mycotic aneurysms occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Management of angiographically demonstrated mycotic aneurysms is dependent upon the presence or absence of hemorrhage, the anatomic location of the aneurysm, and the clinical course of the patient. Healing of mycotic aneurysms can occur during the course of effective antimicrobial therapy, thus obviating the need for neurosurgical intervention in all such patients. (5) Macroscopic brain abscess is a rare complication of bacterial endocarditis. Miliary microscopic abscesses are more common than larger abscesses, particularly in patients with acute disease and miliary infection in other organs of the body. (6) Focal seizures occur most commonly in endocarditis patients with acute embolic disease; generalized seizures are of diverse etiologies, with metabolic factors being most important. Penicillin neurotoxicity should be considered in patients with impaired renal function who are receiving high dose penicillin. (7) With the exception of hemorrhagic complications, lumbar puncture results tend to reflect the nature of the infecting organism rather than the nature of the neurologic complication. Endocarditis due to virulent organisms such as S. aureus is usually associated with a purulent CSF formula while nonvirulent organisms, such as viridans streptococci, susually have aseptic or normal CSF formulae.

Adolescent↗

PubMed1978

Bacterial endocarditis of the mitral valve associated with annual calcification.

Bacterial endocarditis, caused mainly by Staphylococcus aureus, was found at autopsy in five patients who had a calcified posterior mitral valve annulus. Clincopathologic correlation indicates that the infection should be suspected in elderly patients with a calcified mitral annulus, the murmur of mitral insufficiency, fever, anemia, polymorphonuclear leukocytosis and a positive blood culture, regardless of evidence of peripheral embolism or of another disease that could cause the last four features. Pertinent pathologic findings are a calcified mitral valve annulus, vegetations of bacterial endocarditis towards the base of the posterior leaflet associated with leaflet perforation and an annulus abscess, and no other valvular disease. The infection may develop on the atrial aspect of a leaflet ulcerated by the calcium mass or may begin on its ventricular aspect, subsequently perforating the leaflet and infecting its atrial surface.

Aged↗

PubMedDate not supplied

Musculoskeletal manifestations of bacterial endocarditis.

The musculoskeletal (MS) involvement of 91 patients with bacterial endocarditis (BE) is reported. Twenty-three patients (25.2%) exhibited MS symptoms; 74% had arthralgias often associated with arthritis and low back pain (LBP), 48% had myalgias, and 43.4% had LBP. The articular symptoms usually were polyarticular and symmetric, affecting both the large and small joints. Two of 12 patients had a positive test for rheumatoid factor activity, and 2 of 5 had a positive FANA test. Patients with MS symptoms did not differ from those with no such symptoms by their mean age, by their underlying heart disease, or by the nature of their cardiac lesions. They were characterized by female preponderance and increased prevalence of streptococcal infections. In view of our data and the relevant literature, it seems that MS symptoms are common in patients with BE. They often antedate the diagnosis of BE by several weeks and can mimic other rheumatic diseases. Therefore, unexplained rheumatic symptoms should always alert the physician to the possibility of bacterial endocarditis.

Adult↗

PubMed2006

Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections.

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Adult↗

PubMed1981

Severe backache as a presenting sign of bacterial endocarditis.

We report on two patients whose presenting sign of bacterial endocarditis was a sudden and severe backache. According to the literature, 25-44% of patients with bacterial endocarditis have musculoskeletal symptoms and in about 27% these symptoms are the first sign of the disease. The most probable pathogenetic mechanism of these symptoms is arterial microembolization consisting of bacteria and immune complexes.

Aged↗

PubMedDate not supplied

Bacterial endocarditis in children: clinical and laboratory findings, and the role of echocardiography in its diagnosis and management.

We report clinical and laboratory findings of 15 children with bacterial endocarditis, admitted to the Department of Child Health, University of Indonesia/Cipto Mangunkusumo Hospital from February, 1987 to June, 1989. There were 8 boys and 7 girls with bacterial endocarditis, ranging in age from 10 weeks to 16 years. The diagnosis was suspected because of prolonged fever, with or without other manifestations, i.e. congestive heart failure, refractory anemia, or paroxysmal atrial tachycardia. The underlying heart disease was congenital in 12 cases and rheumatic heart disease in 3 cases. The clinical, electrocardiographic, and radiologic manifestations were generally predominated by the pre-existing heart disease. No 'characteristic' findings of bacterial endocarditis, i.e. Osler's nodes, Janeway lesions or splinter haemorrhages were detected. Positive bacterial culture was obtained in 12 cases; the most frequent bacteria isolated was Pseudomonas aeruginosa (4 cases). Streptococcus viridans was isolated in 2 cases only. Vegetation was visualized echocardiographically in 12 cases; 9 with clear cut evidence of large vegetation, and in the other 3 the vegetation was equivocal. On follow-up they disappeared gradually with clinical improvement. Large vegetation might need 2 full months to disappear echocardiographically. It is concluded that bacterial endocarditis is not a rare complication of structural heart disease in our hospital, with a high mortality rate. The availability of good resolution echocardiography has been very helpful in establishing the diagnosis as well as in following-up patients with bacterial endocarditis.

Adolescent↗