Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

Abstract

Background The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated correlations between bacterial infections and IE manifestations diagnosed by ECHO. Methods In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher’s exact test was used for comparisons between categorical variables, and student’s t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. Results The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Correlations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S. aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). Conclusions Correlations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

Conversion of intravenous to oral antibiotic therapy in an adult intensive care unit

“…The cardiac clinical ICU showed a high consumption of oxacillin, which may be associated with the clinical picture of endocarditis and bacteremia caused by Staphylococcus aureus, one of the most prevalent pathogens found in this study. [24][25] It was observed that, in the cardiac surgical ICU, cefazolin was the most widely used antibiotic; the use of cefazolin in cardiac surgery is well documented in the literature, and may have contributed to the consumption found. [26][27] It is worth highlighting the consumption of the latest generation antimicrobial, ceftazidime/avibactam, indicated for the treatment of enterobacteria with multidrug-resistant KPC carbapenemases.…”

Patients with infective endocarditis and history of injection drug use –a register-based study of a 10-year period

“…This contributes to the relatively high prevalence of patients with IDU among patients admitted to the hospital with IE, which was presented in a previous study [10]. According to guidelines, most of the patients with IE at the hospital are discussed within an endocarditis team, comprising specialists in infectious diseases, cardiology, clinical physiology and thoracic surgery [11].…”

Hampton’s Hump: A Notable Radiographic Finding in a Patient with Infectious Endocarditis

“…A clinical diagnosis of IE can be assisted utilizing the Duke Criteria, which determine the likelihood of IE based on clinical presentation and findings which are weighted by odds ratio; patients can be clinically diagnosed by meeting 2 major criteria, 5 minor criteria, or a combination of 1 major and 3 minor criteria-these criteria will be addressed in greater detail below. The best imaging modality for point-of-care diagnosis of IE is a transesophageal echocardiogram (TEE), though transthoracic echocardiography (TTE) may also identify advanced or severe disease [5]. Though imaging alone does not establish a definitive diagnosis of IE, it is important for clinicians to understand the high weight placed on echocardiographic findings (which fulfill one major Duke Criterion) and to be familiar with the imaging findings that should warrant further consideration of IE.…”