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At least 19 recordsLinked to original sources
PubMed1979

[Therapy of bacterial endocarditis].

The successful treatment of bacterial endocarditis requires a close cooperation to a clinical microbiological laboratory. This performs blood cultures, estimation of sensitivity to the different antibiotics, if anyhow possible also quantitatively, and supervision of therapy by serum bactericidal tests. Synergistic combinations by adding one of the aminoglycosides bring the best chances for therapeutic success. Special advices are given in dependence of the numerous causative bacterial agents. Rare ones are sufficiently taken into consideration. If blood cultures remain negative, empiricial chemotherapy is recommended. Surgical treatment by operative replacement of the infected heart valves and insertion of prosthetic ones is indicated in uncontrolled infection, in severe heart failure caused by valve perforation, and in recurrent embolism. Early interventions have a much better prognosis. Special problems are connected to bacterial endocarditis in prosthetic valves. Bacterial endocarditis in drug addicts is of relatively good prognosis in spite of the frequent complications. Patients with suspicious or evident bacterial endocarditis should be transferred to centers owing sufficient diagnostic and therapeutic experiences.

Administration, Oral↗
PubMed1979

[The hemolytic syndrome in subacute bacterial endocarditis].

Long lasting subacute bacterial endocarditis often presents with marked anemia. Infective mechanisms and hemolysis are considered as most important pathophysiological mechanisms. Pronounced hemolytic anemia, thrombocytopenia and edema observed in two cases are possible misleading symptoms in the diagnosis of subacute bacterial endocarditis.

Anemia, Hemolytic, Autoimmune↗
PubMed1978

Vancomycin therapy of bacterial endocarditis.

Fifteen patients with bacterial endocarditis were treated with vancomycin between 1967 and 1976. The indications for vancomycin therapy were penicillin-cephalosporin allergy in six patients, antibiotic resistant bacteria in six, initial therapy in one and culture-negative endocarditis in two. The causative microorganisms were Staph. epidermidis (four patients), Staph. aureus (two patients), diphtheroids (four patients), viridans streptococci (two patients) and enterococci (one patient). Minimum inhibitory concentrations of vancomycin for these organisms ranged from 0.8 to 3.1 micrograms/ml. The patients received vancomycin for two to 10 weeks (mean five weeks). Cure was achieved in 13 patients, including six with prosthetic valve endocarditis (PVE). Two patients had a relapse of PVE and cultures of blood or heart valve were positive within two months of vancomycin therapy. Vancomycin serum levels did not exceed 50 micrograms/ml, and no serious drug toxicity was encountered in any patient. Three patients had minimal audiogram changes beyond the social hearing range. One patient had mild phlebitis and a rash, and one patient had a transient leukopenia. Vancomycin is an effective nontoxic antibiotic in patients with endocarditis when penicillin or cephalosporin therapy is not appropriate.

Adult↗
PubMed1977

Musculoskeletal manifestations of bacterial endocarditis.

In a retrospective analysis of bacterial endocarditis, 84 of 192 cases (44%) were found to have musculoskeletal manifestations of one or more types. Common manifestations were arthralgias (32 cases), arthritis (26 cases), low back pain (24 cases), diffuse myalgia (16 cases), and myalgias localized to the thigh or calf (11 cases). The joint manifestations typically were monarticular or oligoarticular, and the myalgias were commonly unilateral. No association was found between the pattern of rheumatic symptoms and other clinical manifestations, laboratory tests, or causative bacterial organisms. In 52 patients (27%), musculoskeletal complaints were the first or among the first symptoms of bacterial endocarditis. The frequency and character of these manifestations and their tendency to occur early in the course of the disease indicate that they are an important feature of endocarditis which, if not recognized, may cause a delay in the diagnosis by mimicking a rheumatic disease.

Adolescent↗
PubMed1977

[Anatomic and bacteriological study of surgically extracted valves in patients with bacterial endocarditis].

We studied 64 cases of bacterial endocarditis which required heart surgery for hemodynamic defects and/or failure of the antibiotic therapy. We performed a bacteriologic and histologic investigation of the removed valves. The organisms were evidenced through culture and specific stainings. According to the different organisms we evaluated the best duration of antibiotic therapy to achieved sterilization, and suggest a helpful medical and surgical treatment for the bacterial endocarditis.

Anti-Bacterial Agents↗
PubMed1979

Bacterial endocarditis due to penicillin-resistant Streptococcus viridans.

Bacterial endocarditis remains a formidable diagnostic and therapeutic problem for clinicians. Streptococcus viridans still accounts for 45 to 50 per cent of all cases and between 5 to 10 per cent of all clinical isolates of Streptococcus viridans from patients with bacterial endocarditis may be relatively resistant to penicillin. The case of a 9-year-old child with Tetralogy of Fallot and a Waterston shunt who subsequently developed bacterial endocarditis due to penicillin-resistant Streptococcus viridans following failure of oral penicillin dental prophylaxis is presented. In the face of penicillin resistance, additional considerations for workup, including microbiological assays for antimicrobial synergism become necessary in the selection of a therapeutic regimen.

Child↗
PubMedDate not supplied

Treatment of bacterial endocarditis with vancomycin.

Five patients with bacterial endocarditis who were allergic to penicillin were treated successfully with vancomycin. The causative microorganisms were Streptococcus bovis, S faecalis, S agalactiae, S intermedius, and Staphylococcus aureus. Except for the strain of S faecalis, vancomycin was bactericidal against these organisms at easily achievable serum concentrations. To insure a bactericidal serum titer of 1:8 or greater, streptomycin was added in the therapy of the case caused by S faecalis. There was no toxicity from vancomycin therapy in our patients except for mild phlebitis at the infusion site. Vancomycin appears to be an effective alternative to penicillin in individuals with endocarditis due to susceptible organisms. Vancomycin in combination with an aminoglycoside may be appropriate therapy for enterococcal endocarditis.

Adult↗
PubMed1975

Bacterial endocarditis in idiopathic hypertrophic subaortic stenosis.

Bacterial endocarditis complicating idiopathic hypertrophic subaortic stenosis (IHSS) is uncommon but endocarditis may be the first clinical manifestation of IHSS. In this report of such a case, the aortic and the mitral valves were the sites of the bacterial infection. Many chordae tendineae to the mitral valve were ruptured from the extension of the infectious process. The endothelial lesions, which served as the seat for the bacterial infection on the anterior mitral leaflet, likely resulted from its abutting action against the septal prominence. Damage to the aortic valve leaflet may have resulted from abnormal valve motion caused by IHSS and created an environment conducive to endocarditis. This patient developed aortic insufficiency during the course of bacterial endocarditis, suggesting that the occasional association of aortic insufficiency in patients with IHSS may be secondary to healed endocarditis of the aortic valve.

Adult↗
PubMed1977

Musculoskeletal manifestations of bacterial endocarditis.

The records of 180 patients out of 247 with bacterial endocarditis were examined. 50 patients had rheumatic manifestations. In 10 there was arthritis of 2-12 weeks' duration before diagnosis; 19 had myalgia/arthralgia; 17 had back or neck pain; 14 had demonstrable arthritis; and 2 tenosynovitis of the foot. Of the 14 patients with arthritis, 8 had monarticular arthritis and 6 polyarticular. All but one patient had a raised erythrocyte sedimentation rate, and in one patient rheumatoid factor was positive. The rheumatic features responded when the endocarditis was treated. Some of the symptoms undoubtedly resulted from the infection and fever of the endocarditis, and emboli may have caused the transient aches but there was no evidence that they caused the synovitis in the patients with arthritis. The rheumatic manifestations of bacterial endocarditis can mimic other rheumatic diseases and disguise the underlying disease.

Adolescent↗
PubMed1977

[Bacterial endocarditis: clinical and bacteriological aspects and prognostic factors].

The microbiological, clinical and therapeutic aspects of all (71) cases of bacterial endocarditis admitted to the Hôpital cantonal, Geneva, between August 1970 and October 1974 were reviewed: there was a definite trend towards higher prevalence of acute cases compared to subacute cases. The pathogenic role of S. epidermidis, mostly in cases of prosthetic valve endocarditis, could be demonstrated in several cases. When defined initially by microbiological criteria only, acute endocarditis were characterized by rapid evolution, destruction of the valvular structures (especially aortic valve), and by further evolution under adequate antibiotic therapy: thus, 10/25 patients with acute endocarditis died, whereas the mortality rate in the subacute cases was only 10/46. Many cases in our series showed one or more often frequent embolic phenomena: 70% of the cured cases and 80% of the patients with a fatal outcome. An unfavorable evolution could be correlated with neurologic involvement, cardiac rhythm or conduction disturbances, and/or heart failure; indeed, heart failure due to various mechanisms was the single most frequent cause of death and is presently the main therapeutic problem. Thus, acute infection leading to destruction of the aortic valve and to heart failure still carries a bad prognosis, even if emergency valve replacement is attempted. Finally, 22/30 patients who developed a bacterial endocarditis after oral or urological procedures knew about a heart murmur, but did not receive antibiotic prophylaxis. This clearly shows that emphasis should be put on the elaboration and diffusion of adequate prophylactic regimens.

Adult↗
PubMed1977

[Auriculo-ventricular perforation in bacterial endocarditis. Surgical treatment].

The authors report a case of bacterial endocarditis during which the precise nature of the heart lesions were only discovered at operation. There left ventricle and right atrium. The characteristics of the systolic murmur and the findings on phonocardiography together with left ventricular angiography had suggested mitral incompetence. There were no conduction disorders in this patient which might have helped in preoperative diagnosis. In connection with this case, the authors recall the characteristics of aneuryms of the membranous septum and congenital or acquired communications between the left venticle and the right atrium.

Aortic Valve Stenosis↗
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↗