Infective endocarditis

Transcription

1 Infective endocarditis Infective endocarditis is universally fatal if unrevealed and untreated. Heart failure due to aquired valvular incompetence or abscesses, frequent embolic phenomena from vegetations to several organs including the brain are responsible for death and permanent sequelae after cured infections. Problems of special concern are prosthetic valve endocarditis - difficult to diagnose and often in need of combined surgical and medical treatment. Research programs covering different aspects of infective endocarditis have been performed at our institution since 1980 s covering epidemiology in an urban area, different aspects of antibiotic therapy, surgical interventions, cerebral embolism, culture negative cases, prosthetic heart valve infections. Our institution is since 1995 in charge of a national registry of all cases of infective endocarditis treated at swedish depts of infectious diseases, has produced national guidelines for diagnosis and treatment, and participate in the steering committee of International Collaboration on endocarditis (ICE). ICE performs a world-wide (63 sites) scientific collaboration involving different aspects of infective endocarditis. Main scientific projects at our institution are: I Cerebral complications in infective endocarditis Cerebral embolization with influenze of protective and risk factors with focus on antiplatelet and anticoagulant therapy are main subjects of study. A collaboration with Rigshospitalet and Gentofte hospital in Copenhagen has been established. Studies with magnetic resonance imaging and brain damage markers showed a higher than expected cerebral embolization rate. Incidence of cerebral embolization/hemorrhage/infection is investigated by cerebral MRT,cerebrospinal fluid neurochemical damage markers and cultures. Risk factors and indications for acute heart surgery are evaluated. Does anti-platelet therapy decrease embolization rate? Does coumadin therapy increase risk of cerebral bleeding? Researchers Dr Ulrika Snygg-Martin, MD, PhD, specialist in infectious diseases, Sahlgrenska University Hospital defended her thesis in June 2009 on Cerebral complications in infective endocarditis (Institute of Biomedicine, Sahlgrenska Academy). Lars Olaison was main supervisor.

2 Dr NE Bruun, MD, PhD and Dr RV Rasmussen, PhD-student, Dept of Cardiology, Gentofte University Hospital, Copenhagen and Dr C Hassager, MD, PhD, Dept of Cardiology, Rigshospitalet University Hospital, Copenhagen Publications Snygg-Martin U, Gustafsson L, Rosengren L, Alsiö A, Ackerholm P, Andersson R, Olaison L. Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis Jul 1;47(1): PubMed PMID: Rasmussen RV, Snygg-Martin U, Olaison L, Buchholtz K, Larsen CT, Hassager C, Bruun NE. Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe? Cardiology. 2009;114(4): Epub 2009 Aug 19. PubMed PMID: Rasmussen RV, Snygg-Martin U, Olaison L, Andersson R, Buchholtz K, Larsen CT, Hansen TF, Køber L, Hassager C, Bruun NE. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis. Scand J Infect Dis. 2009;41(6-7): PubMed PMID: Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L The influence of warfarin treatment on cerebrovascular complications in left-sided infective endocarditis Submitted 2009 Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L The relationship between cerebrovascular complications and established use of antiplatelet therapy: A cohort study of the effects in left-sided infective endocarditis Submitted 2009

3 Ulrika Snygg-Martin Cerebral complications in infective endocarditis Thesis at the Institute of Biomedicine, Sahlgrenska Academy. June II Prosthetic valve endocarditis Diagnosis of this disease and it s common complication abscess formation is difficult even for experienced readers of transesofageal echocardiography. A new tool is ECG-gated cardiac computed tomography. A prospective study of all patients with aortic prosthetic valve endocarditis from Västra Götaland region started Study of all patients for risk factors that supports or contraindicates acute valvular surgery. Study of aortic allografts as prosthesis substitute. Long-term follow-up study of all patients from 1995 and forward with emphasis on survival, relapse, late valvular infections, need of prosthesis exchange. Study of different antibiotic treatment regimens. Researchers Mattias Ericsson, MD, training for specialist degree in infectious diseases, PhD-student with focus on prosthetic valve endocarditis. Lars Olaison main supervisor Gunnar Svensson, MD, PhD, Dept of Cardiothoracic surgery, supervisor for prosthetic valve surgery, Sahlgrenska University Hospital Agneta Flinck, MD, PhD, Dept of Radiology, Sahlgrenska University Hospital Carl Lamm, MD, Dept of Radiology, Sahlgrenska University Hospital Erika Fagman, MD, Dept of Radiology, Sahlgrenska University Hospital Odd Bech-Hansen, MD, PhD, Dept of Clinical Physiology, Sahlgrenska University Hospital Publications: Fagman E, Bech-Hansen O, Lamm C, Olaison L, Flinck A, Svensson G ECG-gated cardiac computed tomography: A new imaging modality in the diagnosis of aortic prothetic valve endocarditis Submitted 2010 III Cardiac device infections.

4 Evaluation of a new strategy with extraction and reimplantation of devices. Study of different treatments regimens for local infections. Explore levels of bacterial growth and biofilm on electro-extracted electrodes due to local infections. Researchers: Charles Kennergren, MD, PhD, Dept of Cardiothoracic surgery, Sahlgrenska University Hospital, supervisor for pacemaker devices surgery, head of national centre for laser assisted pacemaker cable extractions. Publications: Kennergren C. Cardiac implantable electronic device treatment: taking care of complications. Europace Nov;11(11): PubMed PMID: Kennergren C, Bjurman C, Wiklund R, Gäbel J. A single-centre experience of over one thousand lead extractions. Europace May;11(5): Epub 2009 Mar 27. PubMed PMID: ; Kennergren C, Bucknall CA, Butter C, Charles R, Fuhrer J, Grosfeld M, Tavernier R, Morgado TB, Mortensen P, Paul V, Richter P, Schwartz T, Wellens F; PLESSE investigators group. Laser-assisted lead extraction: the European experience. Europace Aug;9(8): Epub 2007 Jun 27. PubMed PMID: Rundström H, Kennergren C, Andersson R, Alestig K, Hogevik H. Pacemaker endocarditis during 18 years in Göteborg. Scand J Infect Dis. 2004;36(9): PubMed PMID: IV Biochemical markers for inflammation in cardiac stress in infective endocarditis

5 Analysis of prognostic markers for cardiac stress in infective endocarditis. Serial consecutive serum samples during treatment and follow-up of patients at Dept of Infectious diseases, Sahlgrenska University Hospital are analyzed including NT pro BNP and different cytokines. Different patient groups are studied dead during treatment, nonsurgery/survived, surgery/survived, posttreatment heart congestion, posttreatment need of valvular surgery. Researchers: Michael Fu, MD, PhD, Wallenberg Laboratory, Dept of Cardiology, Sahlgrenska University Hospital Christian Bjurman, MD, PhD-student. Michael Fu is main supervisor. V National and international studies Large patient materials are needed for relevant studies of subgroups divided by leftsided native valve-, prosthetic valve- and rightsided valve endocarditis and also by different microbial etiologies. Göteborg has a leading position in cooperation with Duke University, Durham, NC, USA. National studies have given evidence that shortened aminoglycoside therapy with less nefrotoxic adverse effects can be given in the difficult-to-treat enterococcal endocarditis group. These guidelines are now implemented in Sweden and also included by American Heart Association (AHA) as a promising alternative. Guidelines concerning indications for acute valvular surgery serve as national guidelines and has been published in international journals. Several aspects of antimicrobial therapy, surgical therapy, patient risk categories are studies. Researchers: Rune Andersson, MD, PhD, specialist in infectious diseases, internal medicin, Research and Development Center, Skaraborg Hospital Maria Werner, MD, PhD, specialist in infectious diseases, Dept of Infectious diseases, Borås Hospital. Defended her thesis in Dec 2006 on Blood culture negative endocarditis (Institute of Biomedicine, Sahlgrenska Academy). Harriet Hogevik was main supervisor. Harriet Hogevik, MD, PhD, specialist in infectious diseases, Uddevalla Hospital Ralph Corey, MD, PhD, specialist in infectious diseases, Duke University Medical Center, Durham, NC, USA Bruno Hoen, MD, PhD, specialist in infectious diseases, Dept of Infectious diseases, Hopital Saint-Jacques, Besancon, France

6 José Miro, MD, PhD, specialist in infectious diseases, Hospital Clinic-Institut d Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain Publications: Lalani T, Cabell CH, Benjamin DK, Lasca O, Naber C, Fowler VG Jr, Corey GR, Chu VH, Fenely M, Pachirat O, Tan RS, Watkin R, Ionac A, Moreno A, Mestres CA, Casabé J, Chipigina N, Eisen DP, Spelman D, Delahaye F, Peterson G, Olaison L, Wang A; for the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators. Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis. Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment-Selection Bias. Circulation Feb 16. [Epub ahead of print] PubMed PMID: Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med Mar 9;169(5): PubMed PMID: Werner M, Andersson R, Olaison L, Hogevik H; Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis. A 10-year survey of blood culture negative endocarditis in Sweden: aminoglycoside therapy is important for survival. Scand J Infect Dis. 2008;40(4): PubMed PMID: Westling K, Aufwerber E, Ekdahl C, Friman G, Gårdlund B, Julander I, Olaison L, Olesund C, Rundström H, Snygg-Martin U, Thalme A, Werner M, Hogevik H. Swedish guidelines for diagnosis and treatment of infective endocarditis. Scand J Infect Dis. 2007;39(11-12): Review. PubMed PMID:

7 Wang A, Athan E, Pappas PA, Fowler VG Jr, Olaison L, Paré C, Almirante B, Muñoz P, Rizzi M, Naber C, Logar M, Tattevin P, Iarussi DL, Selton-Suty C, Jones SB, Casabé J, Morris A, Corey GR, Cabell CH; International Collaboration on Endocarditis-Prospective Cohort Study Investigators. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA Mar 28;297(12): PubMed PMID: Kourany WM, Miro JM, Moreno A, Corey GR, Pappas PA, Abrutyn E, Hoen B, Habib G, Fowler VG Jr, Sexton DJ, Olaison L, Cabell CH, ICE MD Investigators. Influence of diabetes mellitus on the clinical manifestations and prognosis of infective endocarditis: a report from the International Collaboration on Endocarditis-Merged Database. Scand J Infect Dis. 2006;38(8): PubMed PMID: Maria Werner Blood culture negative endocarditis Thesis at the Institute of Biomedicine, Sahlgrenska Academy. Dec 19, 2006 Cabell CH, Abrutyn E, Fowler VG Jr, Hoen B, Miro JM, Corey GR, Olaison L, Pappas P, Anstrom KJ, Stafford JA, Eykyn S, Habib G, Mestres CA, Wang A; International Collaboration on Endocarditis Merged Database (ICE-MD) Study Group Investigators. Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database. Am Heart J Nov;150(5): PubMed PMID: Wang A, Pappas P, Anstrom KJ, Abrutyn E, Fowler VG Jr, Hoen B, Miro JM, Corey GR, Olaison L, Stafford JA, Mestres CA, Cabell CH; International Collaboration on Endocarditis Investigators. The use and effect of surgical therapy for prostheticvalve infective endocarditis: a propensity analysis of a multicenter, international cohort. Am Heart J Nov;150(5): PubMed PMID:

8 Anderson DJ, Olaison L, McDonald JR, Miro JM, Hoen B, Selton-Suty C, Doco-Lecompte T, Abrutyn E, Habib G, Eykyn S, Pappas PA, Fowler VG, Sexton DJ, Almela M, Corey GR, Cabell CH. Enterococcal prosthetic valve infective endocarditis: report of 45 episodes from the International Collaboration on Endocarditis-merged database. Eur J Clin Microbiol Infect Dis Oct;24(10): PubMed PMID: Anguera I, Miro JM, Cabell CH, Abrutyn E, Fowler VG Jr, Hoen B, Olaison L, Pappas PA, de Lazzari E, Eykyn S, Habib G, Pare C, Wang A, Corey R; ICE-MD investigators. Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the International Collaboration on Endocarditis Merged Database. Am J Cardiol Oct 1;96(7): PubMed PMID: Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, Olaison L, Eykyn S, Hoen B, Abrutyn E, Raoult D, Bayer A, Fowler VG Jr; International Collaboration on Endocarditis Merged Database Study Group. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis Aug 15;41(4): Epub 2005 Jul 6. Erratum in: Clin Infect Dis Oct1;41(7): PubMed PMID: McDonald JR, Olaison L, Anderson DJ, Hoen B, Miro JM, Eykyn S, Abrutyn E, Fowler VG Jr, Habib G, Selton-Suty C, Pappas PA, Cabell CH, Corey GR, Marco F, Sexton DJ. Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database. Am J Med Jul;118(7): PubMed PMID: Chirouze C, Cabell CH, Fowler VG Jr, Khayat N, Olaison L, Miro JM, Habib G, Abrutyn E, Eykyn S, Corey GR, Selton-Suty C, Hoen B; International Collaboration on Endocarditis Study Group. Prognostic factors in 61 cases of Staphylococcus aureus prosthetic valve infective endocarditis from the International Collaboration on Endocarditis merged database.

9 Clin Infect Dis May 1;38(9): Epub 2004 Apr 14. PubMed PMID: Olaison L, Pettersson G. Current best practices and guidelines. Indications for surgical intervention in infective endocarditis. Cardiol Clin May;21(2):235-51, vii. Review. PubMed PMID: Werner M, Andersson R, Olaison L, Hogevik H. A clinical study of culture-negative endocarditis. Medicine (Baltimore) Jul;82(4): PubMed PMID: Olaison L, Schadewitz K; Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis. Enterococcal endocarditis in Sweden, : can shorter therapy with aminoglycosides be used? Clin Infect Dis Jan 15;34(2): Epub 2001 Dec 7. PubMed PMID: Gothenburg Feb Lars Olaison MD, PhD, associate professor Dept of infectious diseases Institute of biomedicine Sahlgrenska University Hospital Gothenburg, Sweden Tel: Cell phone: lars.olaison@infect.gu.se