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APPENDIX 1......e121

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REFERENCES......e124

It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

3D
: three-dimensional
AIDS
: acquired immune deficiency syndrome
b.i.d.
: bis in die (twice daily)
BCNIE
: blood culture-negative infective endocarditis
CDRIE
: cardiac device-related infective endocarditis
CHD
: congenital heart disease
CIED
: cardiac implantable electronic device

/pdf/2015-esc-guidelines-for-the-management-of-infective-2z2r1c1flx.pdf

2015 ESC Guidelines for the management of infective endocarditis

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.

/pdf/clinical-practice-guidelines-by-the-infectious-diseases-3wgg73ktjz.pdf

Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Infectious Diseases Society of America.

In the 1980s, after a steady decline during preceding decades, there was a resurgence in the rate of tuberculosis in the United States that coincided with the acquired immunodeficiency syndrome epidemic. Disease patterns since have changed, with a higher incidence of disseminated and extrapulmonary disease now found. Extrapulmonary sites of infection commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. The diagnosis of extrapulmonary tuberculosis can be elusive, necessitating a high index of suspicion. Physicians should obtain a thorough history focusing on risk behaviors for human immunodeficiency virus (HIV) infection and tuberculosis. Antituberculous therapy can minimize morbidity and mortality but may need to be initiated empirically. A negative smear for acid-fast bacillus, a lack of granulomas on histopathology, and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis. Novel diagnostic modalities such as adenosine deaminase levels and polymerase chain reaction can be useful in certain forms of extrapulmonary tuberculosis. In general, the same regimens are used to treat pulmonary and extrapulmonary tuberculosis, and responses to antituberculous therapy are similar in patients with HIV infection and in those without. Treatment duration may need to be extended for central nervous system and skeletal tuberculosis, depending on drug resistance, and in patients who have a delayed or incomplete response. Adjunctive corticosteroids may be beneficial in patients with tuberculous meningitis, tuberculous pericarditis, or miliary tuberculosis with refractory hypoxemia.

Extrapulmonary tuberculosis: an overview.

ContextComplicated left-sided native valve endocarditis causes significant
morbidity and mortality in adults. Lack of valid data regarding estimation
of prognosis makes management of this condition difficult.ObjectiveTo derive and externally validate a prognostic classification system
for adults with complicated left-sided native valve endocarditis.Design, Setting, and PatientsRetrospective observational cohort study conducted from January 1990
to January 2000 at 7 Connecticut hospitals among 513 patients older than 16
years who experienced complicated left-sided native valve endocarditis and
who were divided into derivation (n = 259) and validation (n = 254) cohorts.Main Outcome MeasureAll-cause mortality at 6 months after baseline.ResultsIn the derivation and validation cohorts, the 6-month mortality rates
were 25% and 26%, respectively. Five baseline features were independently
associated with 6-month mortality (comorbidity [P =
.03], abnormal mental status [P = .02], moderate
to severe congestive heart failure [P = .01], bacterial
etiology other than viridans streptococci [P<.001
except Staphylococcus aureus, P = .004], and medical
therapy without valve surgery [P = .002]) and were
used to create a prognostic classification system. In the derivation cohort,
patients were classified into 4 groups with increasing risk for 6-month mortality:
5%, 15%, 31%, and 59% (P<.001). In the validation
cohort, a similar risk among the 4 groups was observed: 7%, 19%, 32%, and
69% (P<.001).ConclusionsAdults with complicated left-sided native valve endocarditis can be
accurately risk stratified using baseline features into 4 groups of prognostic
severity. This prognostic classification system might be useful for facilitating
management decisions.

https://jamanetwork.com/journals/jama/articlepdf/196393/joc21831.pdf

Complicated left-sided native valve endocarditis in Adults: Risk classification for mortality

ContextComplicated, left-sided native valve endocarditis causes significant
morbidity and mortality in adults. The presumed benefits of valve surgery
remain unproven due to lack of randomized controlled trials.ObjectiveTo determine whether valve surgery is associated with reduced mortality
in adults with complicated, left-sided native valve endocarditis.Design and SettingRetrospective, observational cohort study conducted from January 1990
to January 2000 at 7 Connecticut hospitals. Propensity analyses were used
to control for bias in treatment assignment and prognostic imbalances.PatientsOf the 513 adults with complicated, left-sided native valve endocarditis,
230 (45%) underwent valve surgery and 283 (55%) received medical therapy alone.Main Outcome MeasureAll-cause mortality at 6 months after baseline.ResultsIn the 6-month period after baseline, 131 patients (26%) died. In unadjusted
analyses, valve surgery was associated with reduced mortality (16% vs 33%;
hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.29-0.63; P<.001). After adjustment for baseline variables associated with
mortality (including hospital site, comorbidity, congestive heart failure,
microbial etiology, immunocompromised state, abnormal mental status, and refractory
infection), valve surgery remained associated with reduced mortality (adjusted
HR, 0.35; 95% CI, 0.23-0.54; P<.02). In further
analyses of 218 patients matched by propensity scores, valve surgery remained
associated with reduced mortality (15% vs 28%; HR, 0.45; 95% CI, 0.23-0.86; P = .01). After additional adjustment for variables that
contribute to heterogeneity and confounding within the propensity-matched
group, surgical therapy remained significantly associated with a lower mortality
(HR, 0.40; 95% CI, 0.18-0.91; P = .03). In this propensity-matched
group, patients with moderate to severe congestive heart failure showed the
greatest reduction in mortality with valve surgery (14% vs 51%; HR, 0.22;
95% CI, 0.09-0.53; P = .001).ConclusionsValve surgery for patients with complicated, left-sided native valve
endocarditis was independently associated with reduced 6-month mortality after
adjustment for both baseline variables associated with the propensity to undergo
valve surgery and baseline variables associated with mortality. The reduced
mortality was particularly evident among patients with moderate to severe
congestive heart failure.

/pdf/impact-of-valve-surgery-on-6-month-mortality-in-adults-with-3hfnp2kau5.pdf

Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis.

Impact of Valve Surgery on 6-Month Mortality in Adults With Complicated, Left-Sided Native Valve Endocarditis

Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions.

Methods. We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria.

Results. We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included gram-positive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%.

Conclusion. Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.

Holenarasipur R. Vikram

Papers

Extrapulmonary tuberculosis: an overview.

Complicated left-sided native valve endocarditis in Adults: Risk classification for mortality

Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis.

Impact of Valve Surgery on 6-Month Mortality in Adults With Complicated, Left-Sided Native Valve Endocarditis

Clinical Manifestations and Management of Left Ventricular Assist Device–Associated Infections