Gram-negative endocarditis due to HACEK bacteria (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella and Kingella species) and non-HACEK organisms is an infrequent occurrence but is associated with significant morbidity and mortality. Traditionally, non-HACEK Gram-negative endocarditis has been associated with injection drug use. However, emerging data from more contemporary cohorts suggest changing epidemiology and risk factors for Gram-negative endocarditis, necessitating an updated review of this subject. Moreover, optimal management, including the need for surgical intervention, and strategies for the prevention of Gram-negative endocarditis need to be revisited.

Cardiovascular implantable electronic device (CIED) implantation rate has substantially risen in the foregoing decades. Unfortunately, this upsurge in CIED implantation rate has been accompanied by a disproportionate rise in the rate of CIED infections. Device infection is a major complication of CIED implantation, necessitating removal of an infected device followed by systemic antimicrobial therapy and reimplantation of a new system. In this article, we review the current epidemiology, risk factors, diagnostic strategy and contemporary management of CIED infection. In addition, we address the vexing question of how to best manage patients with Staphylococcus aureus bacteremia, in the setting of an implanted device, but no overt clinical signs of CIED infection. Lastly, we discuss the preventive strategies to minimize risk of CIED infection.

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease ( P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

No abstract

Objective: 1) Outcomes of cardiac arrest in hospitalized patients with tracheostomies. 2) Disposition of patients at the time of hospital discharge. Method: A retrospective electronic chart review was performed of 1102 patients who had cardiac arrest (absence of pulse or non-perfusing rhythm) at a tertiary care academic medical center between Jan 2005-Dec 2009. Data was abstracted and summarized using descriptive statistics. Results: Twenty-six of 1102 (2%) had a tracheostomy at the time of arrest. Median age years = 61 years (range 24-83 years). A total of 18 out of 26 (69%) were male. A total of 18 out of 26 (69%) had return of spontaneous circulation following resuscitation. Fourteen out of 26 (54%) were on mechanical ventilation (MV) at the time of arrest. Twenty-two out of 26 (84%) patients had tracheostomy secondary to prolonged MV. Twelve out of 26 (46%) patients were alive at 3 months and 7 out of 26 (26%) patients were alive at 1 year. Of the 11 patients who survived to discharge, disposition included: 6 out of 11 (54%) home; 3 out of 11 (27%) long-term acute care hospital (LTAC); 2 out of 11 (18%) skilled nursing facility (SNF). Conclusion: The frequency of cardiac arrest in patients with a tracheostomy was 2.4%. Survival at 1 year was 26%. Of those who survived to discharge, 54% of patients went home and 45% were discharged to a LTAC or SNF.