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Results for “ENDOCARDITIS, BACTERIAL”

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PubMed1992

Increased risk of bacterial endocarditis in inflammatory bowel disease.

PURPOSE: The purpose of this retrospective as well as prospective case-control study was to analyze a possible overrepresentation of inflammatory bowel diseases among patients with native valve endocarditis as well as the factors that predispose patients with inflammatory bowel disease to infective endocarditis. PATIENTS AND METHODS: Among 213 consecutive patients treated for proven native valve endocarditis, six (2.8%) had inflammatory bowel diseases (three with ulcerative colitis and three with Crohn's disease). Three patients with inflammatory bowel disease were from the retrospective group, and three were from the prospective group. The prevalence of inflammatory bowel diseases has been determined to be 0.0641% in the Düsseldorf area. RESULTS: On the basis of these data, a 44-fold overrepresentation of inflammatory bowel diseases among the 213 patients with endocarditis was calculated with a statistical significance of p much less than 0.001. CONCLUSIONS: Inflammatory bowel disease may be considered an independent risk factor for bacterial endocarditis. Reasons may be more frequent bacteremias as a result of the higher incidence of diagnostic and therapeutic interventions, as well as increased permeability of the damaged mucosa for bacteria and the therapeutic immunosuppression in patients with active inflammatory bowel disease. Prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.

Adolescent↗

PubMed1984

Hospital personnel with penicillin-resistant Streptococcus viridans. A case for special consideration in the prevention of bacterial endocarditis.

Penicillin is the drug of choice for the prevention of bacterial endocarditis (BE) resulting from dental treatment. The susceptibility of Streptococcus viridans to this antimicrobial agent was studied. A representative sample of hospital personnel (N = 76) was compared to a control group of seventy-six subjects who were not associated with the hospital. Twenty-four of the hospital personnel worked in wards that consume 0.13 to 1.64 (mean +/- SD = 0.88 +/- 0.64) gm penicillin per day per position (low consumption group = LCG) and fifty-two worked in wards that consume 2.27 to 3.67 (mean +/- SD = 3.04 +/- 0.55) gm penicillin per day per position (high consumption group = HCG). Antibiograms of oral isolates showed that, while 48.08% of the subjects from the HCG revealed penicillin-resistant S. viridans only 8.33% of the subjects from the LCG and 7.89% of the control group presented such results. The data presented suggest that there are subjects who may unknowingly carry penicillin-resistant S. viridans as part of their oral flora. It is therefore recommended that the preferable antibiotic used for the prevention of BE should be determined by an antibiogram.

Carrier State↗

PubMed1980

Surgical management of left ventricular-aortic discontinuity complicating bacterial endocarditis.

Successful hemodynamic repair of left ventricular-aortic discontinuity complicating bacterial endocarditis in 2 patients was achieved using a composite valve-woven Dacron tube graft. The prosthetic valve was sutured without tension into the remaining aortic annulus, ventricular muscle, and base of the aortic leaflet of the mitral valve. Use of the composite graft allows adequate debridement of the abscess, restores ventricular-aortic continuity, excludes the abscess wall from systemic pressure, and does not require saphenous vein coronary bypass. Total exclusion of the aortic root, as described, is a lifesaving alternative repair in the care of desperately ill patients with this condition.

Abscess↗

PubMed1981

[Bacterial endocarditis in congenital heart defects (author's transl)].

Seven patients with bacterial endocarditis have been treated at the Department of Pediatric Cardiology University Göttingen from September 1975 to July 1978. All of them had congenital heart defects considered as a predisposing condition and confirmed by previous cardiac catheterization, three patients were cyanotic. Unlike the spectrum of micro-organisms prevalent hitherto Pseudomonas aeruginosa was isolated in three cases. In one of these patients antibiotic drug therapy was unsuccessful and only surgical management with closure of the rest-VSD and excision of the endocardiac lesions was finally helpful. Another patient died and Pseudomonas aeruginosa endocarditis was disclosed by post mortem examination only. The onset of symptoms in four patients was less than six months after cardiac surgery. In two cases aortic valve prosthesis became necessary. No relapse during the further follow up period was observed.

Adolescent↗

PubMed1995

Right-sided bacterial endocarditis due to Flavobacterium odoratum in a patient on chronic hemodialysis.

Bacterial endocarditis, particularly involving the left side, has been shown to occur in patients in regular hemodialysis. We report a case of right-sided endocarditis characterized by a very torpid evolution. Although the diagnosis was suspected early in the course, confirmation was obtained 2 months after the onset. Flavobacterium odoratum was identified in the fourth month of evolution and only after multiple blood cultures had been obtained. We believe the very low infectivity of F. odoratum and its very slow growth in culture media prevented an early diagnosis.

Endocarditis, Bacterial↗

PubMed1982

[Bacterial endocarditis due to Corynebacterium diphtheriae (author's transl)].

A case of bacterial endocarditis with unusual features in a 5 year-old boy is reported. There was no underlying heart disease or provocating factor. The organism was a non toxigenic Corynebacterium diphtheriae which was difficult to classify. It appeared to be close to the JK group of Corynebacterium described by the Center for Disease Control and considered as possibly responsible for severe infections. However, it was sensitive to penicillin. The course of the disease was complicated by the destruction of coronary valves and by splenic infarctus. Replacement of the aortic valve with a prosthesis was necessary. The boy was finally cured but the outcome remains uncertain.

Child, Preschool↗

PubMed1996

[Acute myocardial infarction in bacterial endocarditis].

The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.

Aortic Valve↗

PubMed1975

[Prognosis and treatment of bacterial endocarditis. Review of 70 cases].

The long term results of medical and surgical treatments have been reviewed in 70 cases examined during the last 8 years. In 24 of them, bacterial endocarditis developed after valvular replacement. Antibiotic treatment was administered during at least 6 weeks. Determinations of the minimum inhibitory concentration of the antibiotic and of the bactericidal power of the serum were considered as the most important laboratory controls. In the post-operative cases with prosthetic valves, numerous pathogenic organisms were found, including gram (minus) bacilli and monilia, which may partly account for the high mortality in this group. Despite surgical reinterventions, 20 of the 24 patients died. For the gram (+) cocci, prognosis is however statistically worse (at the 99% confidence limit) when prosthetic valves are present. Out of the 46 patients without prosthetic valves, 31 (68%) had a favourable bacteriological and haemodynamic evolution; in this group, gram (minus) bacilli and monilia were never found to be the pathogenic organisms. For streptococci infections, recovery was obtained in 73% of the cases (24 out of 33). Percentages of long term recovery are very similar in mitral (67%) and aortic (69%) valvular involvment, but the frequency of surgical indication was very different in either group. In cases of aortic valvular disease, valvular replacement was indicated for bacteriological or haemodynamic reasons in 19 of the 20 patients who recovered. Amongst the 9 patients who died, 6 were not operated upon. Valvular replacement is by far less frequently necessary in cases of bacterial endocarditis on the mitral valve : one prosthetic valve amongst 8 patients who recovered. Finally, the authors discuss the place of surgery in the treatment of bacterial endocarditis. According to their experience, recent improvement in the prognosis of the disease seems to depend more on the surgical approach of the problem than on the discovery of new antibiotics.

Anti-Bacterial Agents↗

PubMed1998

Aneurysmal pouch on left coronary cusp accompanied by bacterial endocarditis.

A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.

Aortic Valve↗

PubMedDate not supplied

Cefoxitin therapy for bacterial endocarditis.

Of 22 patients who were suspected of having bacterial endocarditis and who were treated with cefoxitin intravenously (8-12 g per day), 12 were evaluated for responses to therapy. Ten patients had infections due to a single pathogen, and two had polymicrobial infections. Staphylococci were isolated from eight patients, and streptococci from four; both of these pathogens were susceptible to 2-16 micrograms of cefoxitin/ml. Staphylococcus aureus and four strains of anaerobic bacteria, including Bacteroides fragilis (minimal inhibitory concentration, 32 micrograms/ml), were isolated from one patient. The average level of cefoxitin in serum was 32.8 micrograms/ml (range, 14.5-64 micrograms/ml) at 1 hr after an intravenous dose of 2 g; after 5 hr the average level in serum was 8.5 micrograms/ml (range, 2-20 micrograms/ml). The mean (+/- SD) level of cefoxitin in myocardial tissues from eight rabbits at 1 hr following a 250-mg/kg dose of the antibiotic was 4 +/- 0.5 micrograms/g. On the average, patients were treated for 29 days (range, 14-40 days), and they became afebrile in 6.2 days (range, three to 20 days). Both clinical and microbiologic responses to cefoxitin therapy were excellent in 10 patients with monobacterial infections. Both patients with polymicrobial infections were not cured. One, who was infected with a mixed flora of anaerobes, died; the other was cured after surgical valvectomy. These results suggest that cefoxitin is effective in the treatment of endocarditis due to a single susceptible organism but that this antibiotic should be used with caution in patients whose endocarditis is caused by a mixed population of bacterial pathogens.

Adult↗

PubMed1994

Bacterial endocarditis and septic arthritis presenting as polymyalgia rheumatica.

We describe a case of enterococcus endocarditis in a 74-year-old woman with hypercholesterolemia, porcine aortic valve, and osteoarthritis. She presented with the abrupt onset of severe back pain, proximal myalgia, and left knee synovitis, associated with an anemia and marked elevation of ESR. She was misdiagnosed as having polymyalgia rheumatica until both the synovial fluid and blood cultures grew enterococcus. Her musculoskeletal symptoms totally resolved with antibiotic treatment. Septic arthritis is a rare manifestation of bacterial endocarditis. However, one-third of all cases of bacterial endocarditis have musculoskeletal symptoms. These include backache, arthritis of the peripheral joints, and diffuse myalgia and arthralgia. Unexplained rheumatic complaints should alert us to the possibility of bacterial endocarditis.

Aged↗

PubMed1967