M any clinical and laboratory studies reported in
|
|
- Shannon Bryant
- 6 years ago
- Views:
Transcription
1 Endocarditis after Cardiac Valvular Replacement* ]. E. Okies, M.D.,]. Viroslav, M.D., and T. W. Williams, ]r., M.D. In men and seven women infectious endocarditis developed on their prostheses following valve replacement. ylococcus dermiclis was the most common etiologic agent. Four survivors were treated medically with antibiotics and supportive cardiac drugs. Two required re-replacement of the prosthetic valve in order to remove the source of unremitting infection and mechanical mahunction of the valve. Twelve deaths resulted from persistent infection, systemic embolization, and unresponsive congestive heart failure. Some of the deaths might have been prevented by earher replacement of the prosthetic valve. This should be done early in any patient with persistent sepsis, multiple systemic emboh, or a malfunctioning valve. M any clinical and laboratory studies reported in the past decade suggest that foreign bodies in the cardiovascular system predispose to infection. Bahnson and associates in 95 reported a patient with endocarditis following open heart surgery whose infection responded to removal of an infected silk suture. Elek and Coven noted that the presence of a silk suture increased by a factor of 0,000 the susceptibility to local infection in dogs. Barney and c o l l e a gproduced u e s = ~ infection in all dogs with damaged or prosthetic valves when given bacteria intravenously, while no infections were noted in a group of control animals with normal heart valves given comparable numbers of organisms. Geraci and co-workers 4 were among the first to describe infection on prosthetic valves in human beings and to recommend prophylactic antibiotics to diminish the incidence of infection. In 965 Nelson and associates 5 proved the effectiveness of prophylactic antibiotics in cardiac surgery by lowering a 4. percent incidence of bacterial endocarditis to. From the Cora and Webb Mading Department of Surgery, the Departments of Medicine and Microbiology, Baylor College of Medicine, and the Methodist Hospital, Houston, Texas. Supported by grant RR-0050 from the Clinical Research Centers Branch, National Institutes of Health, Bethesda, Maryland. percent. Amoury and co-workers6 ( 965) and Stein and colleagues ( 966) demonstrated that the incidence of bacterial endocarditis due to ylococcus sp could be lowered to 0 percent if the patients were given specific antistaphylococcic prophylaxis (methicillin, oxacillin, and/ or cloxacillin). Since the great majority of postvalvular replacement endocarditis is caused by staphylococci, the overall incidence has been reduced to less than percent with widespread appropriate use of these antibiotics. SuMMARY OF CASES Since 96, 8 patients who received a single (ten aortic, seven mitral) or double (one aortic and mitral) valve replacement for luetic and rheumatic heart disease have acquired endocarditis on their prostheses. There were men and women ranging in age from 6 to 6 years, Table ). The source of infection was unknown in eight patients. The remainder had these sources of infection: the GU tract ( 5), dental manipulation ( ), surgical wound ( ), gastrointestinal tract ( ) and skin ( ). The organisms were cultured from the blood in all but one case and from the valve at autopsy in one. The organisms recovered were ywcoccus dermidis ( ), ywcoccus aureus ( ), Streptococcus ( ), Klebsiella ( ), Serratia (l ), and Candida albicans (l ). Thirteen patients received prophylactic antibiotics consisting of combinations of penicillin, ampicllin, chloramphenicol, tetracycline, and/ or streptomycin prior to, during, and after valve replacement. Five patients received methicillin- 98
2 ENDOCARDITIS AFTER VALVE REPLACEMENT 99 Table I Case Race Organism Age Sex Valve Prophylaxis Recovered Cultures 66 WF Serratia marcescens 6 WM 4 WM 54 WM WM 8 WF 48 WF 55 WF 5 WM 4 WM 9 WM 60 WM 49 WF 4 WM 0 WF 8 WF WM 55 NM Tetracycline aureus KlebsieUa sp Candida albicans Source of Cause of Group Antibiotic Rx Death Surgery Dental Work Wound Skin ttnknown Gentamicin Vancomycin Colistin Gentamicin ne oxacillin prophylaxis. Upon establishment of a diagnosis of endocarditis the patients were treated with appropriate antibiotics achieving bactericidal levels of :6 dilutions or greater in all but one patient in whom the diagnosis was made at postmortem examination. Clinical diagnosis was based upon the findings of fever and four or more positive blood cultures in all patients and splenomegaly, systemic emboli and hemodynamic abnormalities from valve malfunction in most patients. RESULTS Six of the 8 patients are alive at this time, five more than one year after the course of antibiotic therapy. Medical treatment was the sole form of therapy for four of the six survivors. There were two patients with early infection ( < two weeks) and two with late infections (four months and two years) after surgery. The early infections were caused by dermidis and y Streptococcus while the late were caused by y streptococci (Table ). The other two survivors required replacement of the prosthetic valve because of persistent sepsis and a malfunctioning valve (Table ). Causes of the deaths were analyzed and divided into three major groups: Group!-Patients dying with unremitting infection ( one case ). CHEST, VOL 59, NO., FEBRUARY 9
3 00 OKIES, VIROSLAV AND WILLIAMS Table ---Summary of MedicaUy Cured Parienl lfilh Pro.lhetic Y a l ~ Endocarditi ~ e Onset after Valve Source Serum Race Replace- of MIC/MBC Daily Dose Level Case Age Sex ment Organism pg/ml Antibiotic Rx Duration Peak/Low Remarks 6 8 WF 4 months GU tract -r strep.9/.8 6gm IV :8/6 Renal failure 6weeks present before antibiotic therapy. 49 WF years -r strep 6.5/50 mil U IV :64/6 + 4 weeks.0 gm IM weeks 4 WM weeks GU tract -r strep.8/.56 0gm IV :56/6 Residual aortic 4 weeks insufficiency requiring corrective surgery four monthsl&ter. lo 4 WM weeks 50/00 8 mil U IV Renal failure 5/50 gm IV present before./6.5.5 gm IM antibiotic 6.5/.5 Vancomycin 4gms IV- :/6 therapy. 4 weeks * was used for the first four days. * was used for the next three days. " was used for the next five days. Group II-Patients dying of multiple systemic emboli (four cases). Group III-( a) Patients dying with intractable heart failure without replacement of the prosthetic valve ( three cases ). (b) Patients dying with intractable heart failure with replacement of the prosthetic valve (four cases). All but one patient in Group III had clinical or bacteriologic evidence of infection at the time of death. DISCUSSION When the historic background of the insertion of foreign materials into the heart is reviewed, several interesting facts are noted. First, there is a high incidence of infection surrounding the prosthesis in the absence of prophylactic antibiotics. Barney and co-workers found a 00 percent infection rate in dogs with damaged or prosthetic valves given intravenous bacteria, while no infections could be induced in dogs with normal valves. When bacteria were infused six weeks following valve replacement, no infections were produced. These experiments indicate that the valves can become inoculated during the operative procedure or in the immediate postoperative period. Geraci and associates4 ( 96) reviewed the Mayo Clinic experience with postprosthetic endocarditis and found approximately a 0 percent incidence of staphylococcic infection. In 4 cases of prosthetic valve endocarditis reviewed they noted a mortality of. percent. They were the first to recommend antistaphylococcic prophylaxis in order to prevent this infection. Second, the incidence of infection can be lowered to less than percent when appropriate bactericidal prophylactic antibiotics are used. Nelson and colleagues5 ( 965) in a prospective study of 50 cases of open heart surgery found a 4. percent incidence of endocarditis when no prophylactic antibiotics were used. The incidence was lowered to. percent when prophylactic penicillin and streptomycin were given. The addition of methicillin for one week in the immediate postoperative period lowered the incidence to 0 percent. Amoury and coworkers 6 ( 965) reported cases of prosthetic valve endocarditis (.6 percent incidence in 5 cases), of which were due to dermidis. The mortality in the entire series was 0 percent. In 98 patients who received specific antistaphylococcic prophylaxis, no endocarditis was found during an 8 month follow-up period. Stein and associates ( 966) found an incidence of endocarditis on valvular prostheses of. percent compared to an incidence of less than percent for other open and closed heart operative procedures. When no prophylaxis was given, endocarditis was CHEST, VOL 59, NO., FEBRUARY 9
4 ENDOCARDITIS AFTER VALVE REPLACEMENT Early <0 Days Post Op Cultured in Table ~ r «a n i " m " Earlr and Late ln/ecliom. of Prophylaxis Patients Other Total early infections Late >0 l Days Post Op* Other Total late infections 6 4 Organism SerraJ.ia marcescens Klebsiella sp 'Y Streptococcus dermidis aureus Candida sp dermidis 'Y Streptococcus dermidis 'YStreptococcus *ne of these occurred in less than four months. found in nine of 4 cases (. percent). Various prophylactic antibiotics reduced the incidence to only. percent ( of 4 cases), and methicillin prophylaxis allowed only one infection in 69 cases, for an incidence of 0. percent. Windsor et al 8 ( 968) noted no prosthetic valve endocarditis in 0 patients treated with prophylactic penicillin, streptomycin and methicillin. Of his seven patients who were unable to receive penicillin and methicillin due to drug allergies, ylococcus albus endocarditis developed in one patient. In this series of 8 cases of postoperative prosthetic valve endocarditis, developed early and seven developed late infections. The incidence of staphylococcic infection in the early ( 64 percent) and late ( 0 percent) postoperative period is nearly identical. Five of the patients herein reported received adequate prophylaxis with methicillin-oxacillin. In this small group three developed endocarditis in the early postoperative period from G U tract infections with bacteremia, but none was due to staphylococci. The remaining two patients developed endocarditis late in the postoperative period and were related to urinary tract infection or dental manipulation with bacteremia (Table ). One of these was caused by a methicillin sensitive dermidis (case 5). This emphasizes the importance of proper antibiotic coverage for patients with prosthetic valves undergoing procedures that are likely to cause bacteremia. Third, in some cases of prosthetic valve endocarditis the infection has been cured by excision of the infected prosthesis. Geraci and co-workers9 ( 96) reported one case of Corynebacterium xerosis endocarditis successfully treated with penicillin and valve re-replacement. Walker and associateso 0 ( 969) reported three cases of prosthetic valve endocarditis treated successfully with antibiotics and surgery. One patient died six weeks postoperation of unknown causes. One was alive 0 months and another 5 months following re-replacement of the prosthetic valves and both were doing well. Fourth, there is no evidence of increased incidence of prosthetic valve endocarditis in patients who have received prostheses for the treatment of acute bacterial endocarditis, suggesting that valvular replacement does not increase the chances of persistence or recurrence of the infection in patients treated with adequate antibiotics. Braniff and colleagues ( 96), Okies et al ( 90) as well as other writers have reported series of patients with acute bacterial endocarditis treated by excision and prosthetic valve replacement in the early stages of antibiotic therapy without evidence of prosthetic endocarditis on long-term follow-up. In the majority of patients with infected prostheses some hemodynamic abnormalities ultimately will develop if not treated. This can be due to direct involvement of the annular tissue causing disruption of the suture line of the valve at the annulus with paraprosthetic leakage, or due to mechanical failure of the poppet from an encroaching vegetation. Although sterilization of the valve may be accomplished, the hemodynamic abnormalities persist and can result in intractable heart failure or multiple systemic emboli. Twelve of our 8 patients died with a resulting mortality rate of ffl percent. It was apparent from review of these cases that surgery was not seriously considered in eight patients and was performed only after the patients were moribund in four. We think that some of these patients could have been salvaged if surgical therapy had been undertaken at an earlier stage of their disease process. It is important, therefore, to establish criteria that will allow selection of patients to be reoperated on early in the course of treatment. It is clear that prosthetic valve endocarditis that responds to antibiotic and supportive medical therapy should be treated conservatively so long as no hemodynamic abnormality exists. With signs and symptoms of unremittant infection, systemic embolization, or abnormal hemodynamics, the patient should have surgery promptly in order to remove the source of infection or emboli or to correct the hemodynamic abnormality. Catheterization data has helped to determine the hemodynamic status of some of the patients, but the patient's clinical picture is much more important, since patients with low cardiac output may not show abnormal gradients across CHEST, VOL 59, NO., FEBRUARY 9
5 0 Table 4>--Ciinical Clauifieation of Patienla tdith Pro thetic J' ale Endocardili I Patients who respond to treatment with antibiotics and supportive medical therapv. II Patients who have (a) persistent or recurrent fever and positive blood cultures while receiving adequate antibiotic treatment, (b) systemic-embolization, or (c) mechanical malfunction of the valve or paraprosthetic regurgitation. It is in this group of patients that surgerv should be performed immediately. It is our contention that patients who shift from Group I to Group II should be treated immediately with valvular re-replacement. The decision to remove the infected prosthesis should be made early in this stage of the disease in order to avoid having to perform an emergency procedure. III Moribund patients or patients in whom the annulus has already been destroyed by infection. the affected valves. It was apparent from reviewing our series and from the experience of others, that patients treated for prosthetic valve endocarditis can be separated into three general groups (Table 4). In this series the groupings of patients developing endocarditis in the early and late postoperative periods is as shown in Table 5. All the patients in Group I survived with medical treatment alone. All patients in Group III died with or without surgery. The two patients in Group II survived. Both of these patients were reoperated when they began to deteriorate in spite of adequate medical therapy. The overall mortality for patients with prosthetic valve endocarditis is 0 percent. In the future it should be possible to lower the mortality in Group III by more aggressive early surgical intervention in addition to appropriate antibiotic and medical therapy. Prophylactic antibiotics, particularly methicillin, oxacillin and cloxacillin given prior to and after surgery in appropriate doses will reduce the incidence of prosthetic valve endocarditis to less than percent. It is our policy to administer prophylactic antibiotics to all patients undergoing cardiovascular surgery. ( gm every six hours) is given intramuscularly beginning the night prior to surgery and intravenously ( gm every four hours) Table 5-Cia. ification of the Reported Ca.u a. to Time of On et of Group I Group II Group III Early Late 0 5 OKIES, VIROSLAV AND WILLIAMS following surgery for three to five days until the patient is able to take medications by mouth. Then cloxacillin ( ~ gm every six hours in the fasting state) is given until the sutures are removed and all wounds are well-healed. In patients allergic to penicillin, cephaloridine can be given prior to surgery and cephalothin postoperative in the same dosage and routes as methicillin is used ordinarily. Erythromycin or lincomycin can be used as a substitute for cloxacillin as the oral antibiotic once cephalothin is discontinued. These latter drugs are bacteriostatic and therefore should not be used as the initial prophylactic agents. Prosthetic valve endocarditis is a serious and not uncommon complication in patients undergoing open heart surgery for replacement of diseased valves. Adequate antibiotic prophylaxis will reduce the incidence of endocarditis to < percent. Patients developing prosthetic endocarditis should be treated aggressively medically and surgically in an effort to decrease the 0 percent mortality in this infection. REFERENCES Bahnson HT, Spencer FC, Bennett IL: ylococcal infections of the heart and great vessels, due to silk sutures. Ann Surg 46:99, 95 Elek SD, Coven PE: The virulence of staphylococcus pyogens for man. Brit J Exper Path 8:5, 95 Barney JD, Williams GR, Cayler GG, et al: Influence of intracardiac prosthetic materials on susceptibility to bacterial endocarditis. Circulation 6:684, 96 4 Geraci JE, Dale AJD, McGoon DC: Bacterial endocarditis and endarteritis following cardiac operation. Wis Med J 6:0, 96 5 Nelson RM, Jensen CB, Peterson CA, et al: Effective use of prophylactic antibiotics in open heart surgery. Arch Surg 90:, Amoury RA, Bowman FO, Maim JR: Endocarditis associated with intracardiac prostheses. J Thorac Cardiovasc Surg 5 :6, 966 Stein PD, Harken DE, Dexter L: The nature and prevention of prosthetic valve endocarditis. Amer Heart J :9, Windsor HM, Fagan P, Shennehan MX: Bacterial endocarditis, mitral regurgitation, and intra-atrial thrombosis following mitral valve replacement. Thorax :, Geraci JE, Forth RJ, Ellis FH: Postoperative prosthetic valve bacterial endocarditis due to Corynebacterium xerosis. Mayo Clin Proc 4:6, 96 0 Walter SR, Shumway NE, Merigan TC: Management of infected prostheses. JAMA 08:5, 969 Braniff BA, Shumway NE, Harrison DC: Valve replacement in active bacterial endocarditis. New Eng J Med 6:464, 96 Okies JE, et al: Valvular replacement in bacterial endocarditis. Cardiovas Res Cent Bull 8:6, 90. Reprint requests: Dr. T. Williams, St. Luke's Episcopal Hospital, Houston 05 CHEST, VOL. 59, NO., FEBRUARY 9
Right-Sided Bacterial Endocarditis
New Concepts in the Treatment of the Uncontrollable Infection Agustin Arbulu, M.D., Ali Kafi, M.D., Norman W. Thorns, M.D., and Robert F. Wilson, M.D. ABSTRACT Our experience with 25 patients with right-sided
More informationProsthetic Valvular Endocarditis
Prosthetic Valvular Endocarditis A 12-Year Review By LAuRA SLAUGHTER, M.D., JAMES E. MORRIS, M.D., AND ALBERT STARR, M.D. SUMMARY A retrospective examination was made of a total of 48 patients with infected
More informationTHE USE OF THE PENICILLINASE-RESISTANT
Therapeutic problems THE USE OF THE PENICILLINASE-RESISTANT PENICILLIN IN THE PNEUMONIAS OF CHILDREN MARTHA D. Yow, MARY A. SOUTH AND CHARLES G. HESS From the Department of Pediatrics, Baylor University
More informationProsthetic valve endocarditis: a review of 24 cases
Thorax, 1977, 32, 478-485 Prosthetic valve endocarditis: a review of 24 cases IAN S. PETHERAM AND J. M. H. BOYCE' From Sully Hospital, Sully, South Glamorgan, and St David's Hospital, Cardiff Petheram,
More informationDaniel C. DeSimone, MD Assistant Professor of Medicine
Daniel C. DeSimone, MD Assistant Professor of Medicine Faculty photo will be placed here Desimone.Daniel@mayo.edu 2015 MFMER 3543652-1 Infective Endocarditis Mayo School of Continuous Professional Development
More informationInfective Endocarditis عبد المهيمن أحمد
Infective Endocarditis إعداد : عبد المهيمن أحمد أحمد علي Infective endocarditis Inflammation of the heart valve or endocardium of the heart. The agents are usually bacterial, but other organisms can also
More informationDr Babak Tamizi far MD. Assistant Professor Of Internal Medicine Al-Zahra Hospital Isfahan University Of Medical Sciences
Dr Babak Tamizi far MD. Assistant Professor Of Internal Medicine Al-Zahra Hospital Isfahan University Of Medical Sciences ١ ٢ ٣ A 57-year-old man presents with new-onset fever, shortness of breath, lower
More informationInfective Endocarditis
Frank Lowy Infective Endocarditis 1. Introduction Infective endocarditis (IE) is an infection of the heart valves. A large number of different bacteria are capable of causing this disease. Depending on
More informationVancomycin: Class: Antibiotic.
Vancomycin: Class: Antibiotic. Indications: Treatment of patients with infections caused by staphylococcal species and streptococcal Species. Available dosage form in the hospital: 1G VIAL, 500MG VIAL.
More informationINFECTIVE ENDOCARDITIS AMONGST INTRAVENOUS DRUG ABUSERS SEEN AT THE UNIVERSITY HOSPITAL, KUALA LUMPUR
Med. J. Malaysia Vol. 42 No. 4 December 1987 INFECTIVE ENDOCARDITIS AMONGST INTRAVENOUS DRUG ABUSERS SEEN AT THE UNIVERSITY HOSPITAL, KUALA LUMPUR R. JAYAMALAR MBBS, MRCP. "N. PARASAKTHI MBBS, MSc. "S.D.
More informationEndocardite infectieuse
Endocardite infectieuse 1. Raccourcir le traitement: jusqu où? 2. Proposer un traitement ambulatoire: à partir de quand? Endocardite infectieuse A B 90 P = 0.014 20 P = 0.0005 % infective endocarditis
More informationSepsis and Infective Endocarditis
Sepsis and Infective Endocarditis Michal Holub Department of Infectious Diseases First Faculty of Medicine Charles University in Prague and University Military Hospital Bacteremia and Sepsis bacteremia
More informationInfections Amenable to OPAT. (Nabin Shrestha + Ajay Mathur)
3 Infections Amenable to OPAT (Nabin Shrestha + Ajay Mathur) Decisions regarding outpatient treatment of infections vary with the institution, the prescribing physician, the individual patient s condition
More informationCatheter tip cultures on open-heart surgery patients: associations with site of catheter and age of patients
Catheter tip cultures on open-heart surgery patients: associations with site of catheter and age of patients R FREEMAN, N HJERSING, AND ANITA BURRIDGE From the Department of Microbiology, Freman Hospital,
More informationDisclosures. Native Valve Endocarditis and its Complications. Outline. Outline. Basics. Basics 3/23/2017
Native Valve Endocarditis and its Complications SCVP and Binford Dammin Society of Infectious Disease Pathologists Shared Companion Meeting USCAP 2017 Annual Meeting Disclosures Relevant financial relationships
More informationMULTIVALVULAR INFECTIVE ENDOCARDITIS CLINICAL FEATURES, ECHOCARDIOGRAPHIC DATA AND OUTCOMES
Article Original MULTIVALVULAR INFECTIVE ENDOCARDITIS CLINICAL FEATURES, ECHOCARDIOGRAPHIC DATA AND OUTCOMES L. ABID, B. JERBI, I. TRABELSI, A. ZNAZEN*, S. KRICHÈNE, D. ABID, M. AKROUT, S. MALLEK, F. TRIKI,
More informationa Total Hip Prosthesis by Clostridum perfringens. A Case Report
Haematogenous Infection of a Total Hip Prosthesis by Clostridum perfringens. A Case Report CHAPTER 5 CHAPTER 5 5.1. Introduction In orthopaedic surgery, an infection of a prosthesis is a very serious,
More informationInfective endocarditis (IE) By Assis. Prof. Nader Alaridah MD, PhD
Infective endocarditis (IE) By Assis. Prof. Nader Alaridah MD, PhD Infective endocarditis (IE) is an inflammation of the endocardium.. inner of the heart muscle & the epithelial lining of heart valves.
More informationopen-heart surgery patients
Thorax (1975), 30, 26. Analysis of results of catheter tip cultures in open-heart surgery patients R. FREEMAN and B. KING Department of Microbiology, University of Leeds Freeman, R. and King, B. (1975).
More informationInfective Endocarditis
Infective Endocarditis Infective Endocarditis Historical Perspective.. A concretion larger than a pigeon s egg; contained in the left auricle. Burns, 1809 Osler s Gulstonian lectures provided the 1 st
More informationSurgical Treatment of Prosthetic Valve Endocarditis
Surgical Treatment of Prosthetic Valve Endocarditis William A. Baumgartner, M.D., D. Craig Miller, M.D., Bruce A. Reitz, M.D., Philip E. Oyer, M.D., Stuart W. Jamieson, M.B., B.S., Edward B. Stinson, M.D.,
More informationBacteraemia in patients receiving human cadaveric
J. clin. Path., 1971, 24, 295-299 Bacteraemia in patients receiving human cadaveric renal transplants D. A. LEIGH1 From the Department of Bacteriology, The Wright-Fleming Institute, St Mary's Hospital,
More informationBASIC KNOWLEDGE ABOUT INFECTIVE ENDOCARDITIS FOR CLINICIAN
BASIC KNOWLEDGE ABOUT INFECTIVE ENDOCARDITIS FOR CLINICIAN When should I suspect infective endocarditis? Antibiotic regimen Patient care after completion of treatment Prophylactic Regimens Prosthetic Valve
More informationCoagulase-negative staphylococci causing endocarditis
J. clin. Path., 1973, 26, 517-522 Coagulase-negative staphylococci causing endocarditis after cardiac surgery D. C. E. SPELLER AND R. G. MITCHELL From the Gibson Laboratories, Radcliffe Infirmary, and
More informationCase Studies in Complex Endocarditis
Case Studies in Complex Endocarditis Vera H. Rigolin, MD Professor of Medicine Northwestern University Feinberg School of Medicine Medical Director, Echocardiography Laboratory Northwestern Memorial Hospital
More informationInfective endocarditis
Infective endocarditis Today's lecture is about infective endocarditis, the Dr started the lecture by asking what are the most common causative agents of infective endocarditis? 1-Group A streptococci
More informationOverview. Clinical Scenario. Endocarditis: Treatment & Prevention. Prophylaxis The Concept. Jeremy D. Young, MD, MPH. Division of Infectious Diseases
Endocarditis: Treatment & Prevention Jeremy D. Young, MD, MPH Division of Infectious Diseases Clinical Scenario Patient with MVP scheduled to have wisdom teeth extracted. Has systolic murmur with mid-systolic
More informationTHE SENSITIVITY OF STAPHYLOCOCCI AND OTHER WOUND BACTERIA TO ERYTHROMYCIN, OLEANDOMYCIN, AND SPIRAMYCIN
J. clin. Path. (1959), 12, 163. THE SENSITIVITY OF STAPHYLOCOCCI AND OTHER WOUND BACTERIA TO ERYTHROMYCIN, OLEANDOMYCIN, AND SPIRAMYCIN BY E. J. L. LOWBURY AND L. HURST From the Medical Research Council
More informationClinical Management of the Infected Pacemaker
Clinical Management of the Infected Pacemaker W. B. Firor, M.D., J. F. Lopez, M.D., E. M. Nanson, F.R.C.S., and M. Mori, M.D. T he totally implantable electronic pacemaker has proved to be a remarkable
More informationAntibiotic Treatment of Adults With Infective Endocarditis Due to Streptococci, Enterococci, Staphylococci, and HACEK Microorganisms
Antibiotic Treatment of Adults With Infective Endocarditis Due to Streptococci, Enterococci, Staphylococci, and HACEK Microorganisms Walter R. Wilson, MD; Adolf W. Karchmer, MD; Adnan S. Dajani, MD; Kathryn
More informationResults of Mitral Valve Replacement, with Special Reference to the Functional Tricuspid Insufficiency
Results of Mitral Valve Replacement, with Special Reference to the Functional Tricuspid Insufficiency Ken-ichi ASANO, M.D., Masahiko WASHIO, M.D., and Shoji EGUCHI, M.D. SUMMARY (1) Surgical results of
More informationInfective Endocarditis Empirical therapy Antibiotic Guidelines. Contents
Infective Endocarditis Empirical therapy Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Group Additional author(s): as above Authors Division: Division of Clinical
More informationNatural History of Aortic Valve Endocarditis in Rats
INFECTION AND IMMUNITY, JUlY 192, p. 127-131 19-9567/2/7127-5$2./ Vol. 37, No. 1 Natural History of Aortic Valve Endocarditis in Rats ERIC HtRAIEF, MICHEL P. GLAUSER,* AND LAWRENCE R. FREEDMANt Division
More informationThe Jet Lesion in Aortic Valve Endocarditis
The Jet Lesion in Aortic Valve Endocarditis Lorenzo Gonzalez-Lavin, M.D., and Donald N. Ross, F.R.C.S. ABSTRACT Twenty patients with jet lesions of the mitral valve secondary to aortic valve endocarditis
More informationNATIONAL HEART FOUNDATION HOSPITAL & RESEARCH INSTITUTE
Welcome INFECTIVE ENDOCARDITIS: WHERE WE ARE AT 2005? DR MD HABIBUR RAHMAN FCPS(Medicine) NATIONAL HEART FOUNDATION HOSPITAL & RESEARCH INSTITUTE DEFINITION OF INFECTIVE ENDOCARDITIS Infective endocarditis
More informationOutcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationInfective Endocarditis in King Faisal Specialist Hospital: A Review of 35 Consecutive Adult Patients
Infective Endocarditis in King Faisal Specialist Hospital: A Review of 35 Consecutive Adult Patients Murtada A. Halim, MRCP* M. Oussama Jeroudi, MD Edward N. Mercer, MD, FRCP(C), FACC M. Eid Fawzy, MRCP,
More informationRifampin Resistance. Charlottesville, Virginia i0w organisms in Trypticase soy broth (BBL Microbiology
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 1980, p. 658-662 0066-4804/80/04-0658/05$02.00/0 Vol. 17, No. 14 Treatment of Experimental Staphylococcal Infections: Effect of Rifampin Alone and in Combination
More informationManagement of Catheter Related Bloodstream Infection (CRBSI), including Antibiotic Lock Therapy.
Management of Catheter Related Bloodstream Infection (CRBSI), including Antibiotic Lock Therapy. Written by: Dr K Gajee, Consultant Microbiologist Date: June 2017 Approved by: Drugs & Therapeutics Committee
More informationInfected cardiac-implantable electronic devices: diagnosis, and treatment
Infected cardiac-implantable electronic devices: diagnosis, and treatment The incidence of infection following implantation of cardiac implantable electronic devices (CIEDs) is increasing at a faster rate
More informationHeart on Fire: Infective Endocarditis. Objectives. Disclosure 8/27/2018. Mary McGreal DNP, RN, ANP-c, CCRN
Heart on Fire: Infective Endocarditis Mary McGreal DNP, RN, ANP-c, CCRN Objectives Discuss the incidence of infective endocarditis? Discuss the pathogenesis of infective endocarditis? Discuss clinical
More informationEndocarditis: Medical vs. Surgical Treatment. Nabin K. Shrestha, MD, MPH Infectious Diseases
Endocarditis: Medical vs. Surgical Treatment Nabin K. Shrestha, MD, MPH Infectious Diseases Conflicts of interest Nothing to disclose 2 Complications of infective endocarditis Local complications Heart
More informationVALVULAR HEART DISEASE
VALVULAR HEART DISEASE Stenosis: failure of a valve to open completely, obstructing forward flow. - almost always due to a chronic process (e.g., calcification or valve scarring). Insufficiency : failure
More informationChanges in heart size after homograft replacement of aortic, mitral, or both aortic
British Heart Journal, I972, 34, 503-507. Changes in heart size after homograft replacement of aortic, mitral, or both aortic wand mitral valves M. Baidya, K. Hollinrake, and Magdi H. Yacoub From the Department
More informationMichael Stander, Pharm.D.
Michael Stander, Pharm.D. Endocarditis: Goals Epidemiology Presentation of acute and subacute. Diagnosis: What is Dukes Criteria and how do we approach the diagnosis of endocarditis? Treatment: Understand
More informationI with antibiotics [I, 21. The characteristics of the offending
ORIGINAL ARTICLES Heart Valve Operations in Patients With Active Infective Endocarditis Tirone E. David, MD, Joanne Bos, RN, George T. Christakis, MD, Paulo R. Brofman, MD, David Wong, MD, and Christopher
More informationSurgical Indications of Infective Endocarditis in Children
2016 Annual Spring Scientific Conference of the KSC April 15-16, 2016 Surgical Indications of Infective Endocarditis in Children Cheul Lee, MD Pediatric and Congenital Cardiac Surgery Seoul St. Mary s
More informationTreatment of Infective Endocarditis:
Treatment of Infective Endocarditis: A 1-Year Comparative Analysis JAMES V. RICHARDSON, M.D., ROBERT B. KARP, M.D., JOHN W. KIRKLIN, M.D., AND WILLIAM E. DISMUKES, M.D. SUMMARY The results of surgical
More informationreceived penicillin before admission, an organism was later grown from the bone at operation. The fifth patient (Case
Ann. rheum. Dis. (1972), 31, 40 Septic arthritis A. S. RUSSELL AND B. M. ANSELL M.R.C. Rheuimatism Research Unit, Canadian Red Cross Memorial Hospital, Taplow, Maidenhead, Berks. Joint infection, particularly
More informationSTUDY OF IMPETIGO AND THE RESISTANCE PATTERN OF THE ISOLATES TO VARIOUS ANTIBIOTICS
STUDY OF IMPETIGO AND THE RESISTANCE PATTERN OF THE ISOLATES TO VARIOUS ANTIBIOTICS Abstract Pages with reference to book, From 129 To 132 Aqeel Ahmad, Khursheed Ali Khan ( Department of Microbiology,
More informationINFECTIVE ENDOCARDITIS IN CHILDREN
INFECTIVE ENDOCARDITIS IN CHILDREN Rohayati Taib RIPAS Hospital, Bundar Seri Begawan, Brunei Darussalam Infective Endocarditis (IE) is a microbial infection of the endocardium. It encompasses both bacterial
More informationUrine bench. John Ferguson Sept 2013
Urine bench John Ferguson Sept 2013 Overview Specimen collection- separate presentation Urinalysis: protein, blood, white cells, nitrite Microscopy- crystals and casts- separate presentations quantitative
More informationBacterial endocarditis, mitral regurgitation, and intra-atrial thrombosis following mitral
Thorax (1968), 23, 11. Bacterial endocarditis, mitral regurgitation, and intra-atrial thrombosis following mitral valve replacement HARRY M. WINDSOR, PAUL FAGAN, AND MARK X. SHANAHAN From St. Vincent's
More informationTricuspid Valve Infective Endocarditis In Drug Abusers : Clinical Features and Results of Surgical Treatment
ORIGINAL ARTICLE Tricuspid Valve Infective Endocarditis In Drug Abusers : Clinical Features and Results of Surgical Treatment Medvedev A.P.*, Lashmanov D.I.*, Bhandari Krishna*, Chiginev V.A.*, Pichugin
More informationThe changing landscape of infective endocarditis (IE)in congenital heart disease (CHD)
The changing landscape of infective endocarditis (IE)in congenital heart disease (CHD) Rekwan Sittiwangkul,MD Department of Pediatrics. Chiang Mai University Hospital, 24 th March 2018 Infective endocarditis
More informationExtreme pulmonary hypertension caused by mitral valve disease
British Heart Journal, I975, 37, 74-78. Extreme pulmonary hypertension caused by mitral valve disease Natural history and results of surgery C. Ward and B. W. Hancock From the Cardio-Thoracic Unit, Northern
More informationChallenging clinical situation
Challenging clinical situation A young patient with prosthetic aortic valve endocarditis Gilbert Habib La Timone Hospital Marseille - France October 25 th 2014 Case report History of the disease Clinical
More informationEDUCATIONAL COMMENTARY VANCOMYCIN MONITORING
EDUCATIONAL COMMENTARY VANCOMYCIN MONITORING Commentary provided by: Julie Hall, MHS, MT (ASCP) Assistant Dean, College of Health Professions Assistant Professor, Medical Laboratory Science Grand Valley
More informationvalvular endocarditis. One survey of an institutionalized
Valve Replacement for Left-Sided Endocarditis in Drug Addicts Robert B. Mammana, M.D., Sidney Levitsky, M.D., David Sernaque, M.D., Charles B. Beckman, M.D., and Norman A. Silverman, M.D. ABSTRACT Eighteen
More informationModifiers of the clinical course of infective endocarditis
Modifiers of the clinical course of infective endocarditis Ulrika Snygg-Martin M.D., Ph.D. Infectious Diseases Clinic Sahlgrenska University Hospital Gothenburg, Sweden Infective endocarditis : modifiers
More informationTHE INCREASING IMPORTANCE OF HEALTH CARE-ASSOCIATED INFECTIVE ENDOCARDITIS
THE INCREASING IMPORTANCE OF HEALTH CARE-ASSOCIATED INFECTIVE ENDOCARDITIS Javier López Díaz Instituto de Ciencias del Corazón (ICICOR) Hospital Clínico de Valladolid, Spain No conflict of interest Page
More informationCASE REPORT. Mycotic Aneurysm of Ascending Aorta Due to Sarcina Lutea. G. A. Lopez, M.D., and A. R. C. Dobell, M.D.
CASE REPORT Mycotic Aneurysm of Ascending Aorta Due to Sarcina Lutea G. A. Lopez, M.D., and A. R. C. Dobell, M.D. ABSTRACT A patient developed a mycotic aneurysm of the aortic suture line after aortic
More informationBacteraemia after open-heart surgery
EUNICE LOCKEY, LORENZO GONZALEZ-LAVIN, IRA RAY, and RUTH CHEN National Heart Hospital and Institute of Cardiology, London Thorax (1973), 28, 183. We have analysed the bacteraemias occurring before discharge
More informationby Excision and Homograft Valve
Mycotic Aneurysm of the Aortic Root and Infected Prosthetic Valve Treated by Excision and Homograft Valve Replacement Donald G. Mulder, M.D., and B. Lamar Johnson, Jr., M.D. A mong the most serious complications
More informationTopical antimicrobial agents in wound care. Professor Val Edwards-Jones Manchester Metropolitan University UK
Topical antimicrobial agents in wound care Professor Val Edwards-Jones Manchester Metropolitan University UK Antimicrobial agents Antibacterial agents Antifungal agents Antiviral agents Antiparasitic agents?others
More informationAntibiotic Prophylaxis in Joint Arthroplasty: Do we get it right?
International Journal of Medicine and Medical Sciences ISSN: 2167-0447 Vol. 2 (4), pp. 088-091, April, 2012. Available online at www.internationalscholarsjournals.org International Scholars Journals Full
More informationInfective endocarditis
Infective endocarditis This is caused by microbial infection of a heart valve (native or prosthetic), the lining of a cardiac chamber or blood vessel, or a congenital anomaly (e.g. septal defect). The
More informationEndocarditis, including Prophylaxis
Endocarditis, including Prophylaxis ACOI Board Review 2018 gerald.blackburn@beaumont.org (No Disclosures) Infective Endocarditis Persistant bacteremia (blood cultures drawn >12 hrs apart) w/ organisms
More informationSUBJECTS AND METHODS
Acquired Mitral Stenosis in Children under Fifteen Boonchob PONGPANICH, M.D. and Sahas LIAMSUWAN, M.D. SUMMARY The clinical and hemodynamic studies of acquired MS in 30 children under the age of 15 are
More informationGetting the Point of Injection Safety
Getting the Point of Injection Safety Barbara Montana, MD, MPH, FACP Medical Director Communicable Disease Service Outbreak of Enterococcus faecalis endocarditis associated with an oral surgery practice
More informationOSTEOMYELITIS. If it occurs in adults, then the axial skeleton is the usual site.
OSTEOMYELITIS Introduction Osteomyelitis is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms. Pathophysiology Osteomyelitis may be
More informationNEOSPORIN G.U. Irrigant Sterile (neomycin sulfate polymyxin B sulfate solution for irrigation)
NEOSPORIN G.U. Irrigant Sterile (neomycin sulfate polymyxin B sulfate solution for irrigation) NEOSPORIN G.U.SOLUTION NOT FOR INJECTION DESCRIPTION NEOSPORIN G.U. Irrigant is a concentrated sterile antibiotic
More informationBlood Culture Collection and Interpretation
Blood Culture Collection and Interpretation Catherine Ernst, RN,PBT(ASCP) Blood Cultures Indications for blood culture collection Proper method for blood culture collection Interpreting a blood culture
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Dayer MJ, Jones S, Prendergast B, et al. Incidence
More informationAutologous Pulmonary Valve Replacement of the Diseased Aortic Valve
Autologous Pulmonary Valve Replacement of the Diseased Aortic Valve By L. GONZALEZ-LAvIN, M.D., M. GEENS. M.D., J. SOMERVILLE, M.D., M.R.C.P., ANm D. N. Ross, M.B., CH.B., F.R.C.S. SUMMARY Living tissue
More informationAORTIC GRAFT INFECTION
NURSING CARE Theresa O Keefe NUM Vascular Unit PAH Vascular infections are serious They are associated with high morbidity and mortality The primary cause of surgical wound infections is contamination
More informationReplacement of the mitral valve in the presence of
Mitral Valve Replacement in Patients with Mitral Annulus Abscess Christopher M. Feindel Replacement of the mitral valve in the presence of an abscess of the mitral annulus presents a major challenge to
More informationAciphin Ceftriaxone Sodium
Aciphin Ceftriaxone Sodium Only for the use of Medical Professionals Description Aciphin is a bactericidal, long-acting, broad spectrum, parenteral cephalosporin preparation, active against a wide range
More informationApril 16, 09:00-09:15 중앙대학교 윤신원
April 16, 09:00-09:15 중앙대학교 윤신원 When to perform Echocardiography in IE? Vegetations?(pathologic Whatever the level hallmark) of suspicion Intracardiac abscess? Confirm or R/O at the Earliest opportunity.
More informationSmeloff-Cutter Prosthesis: 1- to 12-Year Follow-up David S. Starr, M.D., Gerald M. Lawrie, M.D., J. F. Howell, M.D., and George C. Morris, Jr., M.D.
Clinical Experience with the Smeloff-Cutter Prosthesis: 1- to 12-Year Follow-up David S. Starr, M.D., Gerald M. Lawrie, M.D., J. F. Howell, M.D., and George C. Morris, Jr., M.D. ABSTRACT To determine the
More informationA study of clinical and etiological profile of infective endocarditis and its correlation with echocardiography in patients of rheumatic heart disease
International Journal of Advances in Medicine Sarkar A et al. Int J Adv Med. 2017 Oct;4(5):1323-1327 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20174177
More informationClinical Experience with a Dacron Velour-Covered Teflon-Disc Mitral- Valve Prosthesis
Clinical Experience with a Dacron Velour-Covered Teflon-Disc Mitral- Valve Prosthesis Arthur C. Beall, Jr., M.D., Robert D. Bloodwell, M.D., Domingo Liotta, M.D., Denton A. Cooley, M.D., and Michael E.
More informationCHIA MEDICAL TEAM RESOURCE PROTOCOLS: Rheumatic Heart Disease
CHIA MEDICAL TEAM RESOURCE PROTOCOLS: Rheumatic Heart Disease It is not very common for children to get an acquired heart disease (meaning that they weren t born with it). In adults, acquired heart disease
More informationBacteremia, Endocarditis, and the Hancock Valve
Bacteremia, Endocarditis, and the Hancock Valve Donald J. Magilligan, Jr., M.D., Edward L. Quinn, M.D., and Julio C. Davila, M.D. ABSTRACT Among 373 patients with porcine xenografts, there were 27 instances
More informationThe Challenge of Managing Staphylococcus aureus Bacteremia
The Challenge of Managing Staphylococcus aureus Bacteremia M A R G A R E T G R A Y B S P F C S H P C L I N I C A L P R A C T I C E M A N A G E R N O R T H / I D P H A R M A C I S T A L B E R T A H E A
More informationESCMID Online Lecture Library. by author
Microbiology for implant related infections Hui Wang M.D, Professor, Director Department of Clinical Laboratory Peking University People s Hospital Beijing, 100044 Email: wanghui@pkuph.edu.cn Outline Epidemiology
More informationDiagnosis and management of bacterial endocarditis in 2003 Blaithnead Murtagh, MD, O.H. Frazier, MD, and George V. Letsou, MD
Diagnosis and management of bacterial endocarditis in 2003 Blaithnead Murtagh, MD, O.H. Frazier, MD, and George V. Letsou, MD The diagnosis of infective endocarditis has been notoriously difficult. Over
More informationGroup B streptococcal infection;. Bacteremia without a focus occurs in 80-85%,. July has been recognised as Group B Strep Awareness Month,.
Group B streptococcal infection;. Bacteremia without a focus occurs in 80-85%,. July has been recognised as Group B Strep Awareness Month,. 12-10-2017 Group B streptococci are uniformly sensitive to penicillin
More informationBacterial Endocarditis
Objectives Bacterial Endocarditis John C. Rotschafer, Pharm. D. Professor College of Pharmacy University of Minnesota Identify which valves are commonly involved with endocarditis Identify common pathogens
More informationNew guidelines for the antibiotic treatment of streptococcal, enterococcal and staphylococcal endocarditis. D. C. Shanson
Journal of Antimicrobial Chemotherapy (1998) 42, 292 296 New guidelines for the antibiotic treatment of streptococcal, enterococcal and staphylococcal endocarditis JAC D. C. Shanson Microbiology Department,
More informationPROSTHETIC VALVE ENDOCARDITIS Dr Bernard Prendergast DM FRCP EUROVALVE CONGRESS MADRID NOVEMBER 2013
PROSTHETIC VALVE ENDOCARDITIS Dr Bernard Prendergast DM FRCP EUROVALVE CONGRESS MADRID NOVEMBER 2013 Prosthetic Valve Endocarditis A Dangerous Disease Affects 1-6% of prosthetic valves Mechanical and biological
More informationmethods will be described in detail elsewhere. It is important to bear in mind that both involve dilution technics and
THE ABSORPTION AND EXCRETION OF PENICILLIN FOLLOWING CONTINUOUS INTRAVENOUS AND SUBCUTANEOUS ADMINISTRATION By LOWELL A. RANTZ AND WILLIAM M. M. KIRBY, WITH THE TECHNICAL ASSISTANCE OF ELIZABETH RANDALL
More informationAntibiotic treatment of streptococcal and enterococcal endocarditis: an overview
European Heart Journal (1995) 16 {Supplement B), 75-79 Antibiotic treatment of streptococcal and enterococcal endocarditis: an overview P. FRANCIOLI Division of Hospital Preventative Medicine and Department
More informationMethicillin-Resistant Staphylococcus aureus (MRSA) S urveillance Report 2008 Background Methods
Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance Report 2008 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services
More informationACCME/Disclosures 4/13/2016 IDPB
ACCME/Disclosures The USCAP requires that anyone in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS which they or their spouse/partner
More informationTreatment of infection
Clinica Ortopedica e Traumatologica Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo Chairman: Prof. F. Benazzo Goals: - Healing of infection - Healing of fracture - Try to keep
More informationBacteriemia and sepsis
Bacteriemia and sepsis Case 1 An 80-year-old man is brought to the emergency room by his son, who noted that his father had become lethargic and has decreased urination over the past 4 days. The patient
More informationDave Laverty MD Orthopedic Trauma Surgeon
Austin Trauma & Critical Care Conference Open Fracture Update 2018 Dave Laverty MD Orthopedic Trauma Surgeon Take Home Points We are stuck in the 90 s Time to antibiotics matters most Gram negative bacteria
More informationDICE Session. The endocarditis team. Bernard Iung Bichat Hospital, Paris Diderot University Paris, France
DICE Session. The endocarditis team Bernard Iung Bichat Hospital, Paris Diderot University Paris, France Faculty disclosure First name - last name I disclose the following financial relationships: Consultant
More informationBacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis
Journal of Antimicrobial Chemotherapy (2003) 52, 820 825 DOI: 10.1093/jac/dkg440 Advance Access publication 30 September 2003 Bacteriological outcome of versus single-agent treatment for staphylococcal
More information