Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72.
About: This article is published in Medicine.The article was published on 1977-07-01. It has received 413 citations till now. The article focuses on the topics: Infective endocarditis & Endocarditis.
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TL;DR: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection, and Mortality remains relatively high.
Abstract: (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.131.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.643.09) were associated with an increased risk of inhospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. Conclusions: In the early 21st century, IE is more often an acute disease, characterized by a high rate ofS aureus infection. Mortality remains relatively high.
1,816 citations
TL;DR: The third iteration of the Infective Endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic fever, endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young was presented in this article.
Abstract: Background—Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results—This work represents the third iteration of an infective endocarditis “treatment” document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions—The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)
1,568 citations
TL;DR: Patients in this study had an advanced mean age, high incidence of underlying valvular disease, short mean duration of symptoms, and 15% mortality, the lowest reported for a large series.
Abstract: Strict case definitions were applied to 123 clinically diagnosed cases of infective endocarditis. Cases were categorized as definite (19), probable (44), or possible (41) endocarditis or were rejected (19). Compared to other published studies, our patients had an advanced mean age (57), high incidence of underlying valvular disease (66%), short mean duration of symptoms (27 days), and 15% mortality, the lowest reported for a large series. Most cases were caused by viridans streptococci, Staphylococcus aureus, or enterococci; Enterobacteriacae were absent, and negative cultures infrequent (5%). Subgroups included nosocomial endocarditis (13%), usually with underlying valvular disease and invasive procedures; prosthesis endocarditis (12%); and cases requiring cardiac surgery (18%). Deaths were caused by heart failure, neurologic events, or superinfection. Strict definitions are useful in managing suspect cases, and are essential in comparing clinical studies. Early recognition and treatment should be the focus of efforts to reduce mortality from endocarditis.
719 citations
TL;DR: The variability in the clinical presentation of IE requires a diagnostic strategy that will be both sensitive for disease detection and specific for its exclusion across all the forms of the disease, and the current literature is reviewed.
Abstract: Infective endocarditis (IE) carries a high risk of morbidity and mortality. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome. Therapy of IE caused by the more commonly encountered organisms, including streptococci, enterococci, staphylococci, and the HACEK organisms ( Hemophilus parainfluenzae, Hemophilus aphrophilus, Actinobacillus [Hemophilus] actinomycetemcomitans, Cardiobacterium hominis, Eikenella species , and Kingella species), has been addressed previously by this committee.1 Likewise, the antimicrobial prevention of endocarditis has also been previously addressed.2 In this article, we review and update the current literature with respect to diagnostic challenges and strategies, difficult therapeutic situations, and management choices in patients with IE. This article focuses predominantly on adults with IE. A separate article, currently in preparation, will address the issues of IE in childhood.
### Clinical Criteria
The diagnosis of IE is straightforward in those patients with classic oslerian manifestations: bacteremia or fungemia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In other patients, however, the classic peripheral stigmata may be few or absent.3 This may occur during acute courses of IE, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to Staphylococcus aureus infection of right-sided heart valves, or in patients with IE caused by microorganisms such as HACEK. Acute IE evolves too quickly for the development of immunologic vascular phenomena, which are more characteristic of subacute IE. In addition, acute right-sided IE valve lesions do not create the peripheral emboli and immunologic vascular phenomena that can result from left-sided valvular involvement.3
The variability in the clinical presentation of IE requires a diagnostic strategy that will be both sensitive for disease detection and specific for its exclusion across all the forms of the disease. In 1981, von Reyn et al4 proposed a scheme for strict case definitions of IE …
648 citations
Cites background from "Infective endocarditis: a review of..."
...Risk of Embolization Systemic embolization occurs in 22% to 50% of cases of IE.(25,80,89,90)Emboli often involve major arterial beds, including lungs, coronary arteries, spleen, bowel, and extremities....
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TL;DR: Elderly males and diabetics were found to be particularly susceptible to the disease and prompt, aggressive therapy should result in minimal complications, residual neurologic deficits, and low mortality.
Abstract: Nine cases of pyogenic vertebral osteomyelitis from the present series and 309 cases from the literature were reviewed Elderly males and diabetics were found to be particularly susceptible to the disease Neck or back pain was present in 92% of the patients and lasted for longer than three months in > 50% Atypical symptoms, such as chest or abdominal pain, were seen in 15% The erythrocyte sedimentation rate was elevated consistently, but only about 50?%o of patients had fever or leukocytosis The urinary tract was the most common source of infection (285%) The lumbar region was the most commonly involved site (48%) Narrowing of disk spaces with vertebral end-plate involvement on X ray was seen in 74%o of the cases Staphylococcus aureus was the causative organism in 55%7 of cases Parenteral antibiotic therapy for four weeks or longer resulted in a good response, but shorter courses of therapy resulted in higher rates of failure The erythrocyte sedimentation rate fell to one-half to two-thirds of pretherapy levels by the completion of successful therapy Bed rest was an adequate mode of immobilization in most cases The death rate was lower than 5%, and the rate of residual neurologic deficits was lower than 7% Permanent neurologic damage was significantly more frequent in diabetic patients Early diagnosis and prompt, aggressive therapy should result in minimal complications, residual neurologic deficits, and low mortality
395 citations
Cites background from "Infective endocarditis: a review of..."
...In two large series of patients with infective endocarditis (total, 225 patients) [76-78], no case of vertebral osteomyelitis was reported....
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...Although back pain is a common presenting complaint of patients with infective endocarditis [76, 78], the occurrence of vertebral osteomyelitis in this particular setting appears to be curiously infrequent....
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