Early surgery determines prognosis in patients with infective endocarditis: outcome in patients managed by an Endocarditis Team—a prospective cohort study

Pecoraro, Alfonso; Herbst, Philip; Janson, Jacques; Wagenaar, Riegardt; Ismail, Zane; Taljaard, Jantjie; Prozesky, Hans; Pienaar, Colette; Doubell, Anton

doi:10.21037/cdt-21-590

Cited by 4 publications

(5 citation statements)

References 39 publications

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“…This cluster of cases was notable for the aggressive nature of the infection and high mortality. A recent prospective cohort of 72 IE cases in the Western Cape described an in-hospital mortality rate of 18% 22 in contrast to the 80% mortality rate observed in our cohort. Only one individual survived, likely because of early identification and prompt surgical intervention (within 24 h of diagnosis).…”

Section: Discussioncontrasting

confidence: 99%

“…The high rate of complications and relentless progression of disease despite appropriate, directed antibiotic therapy highlights the importance of surgical management of IE. 22 Although the pathogenesis of non-toxigenic C. diphtheriae infection remains obscure, it seems likely that other virulence factors replace toxin production in these strains. Differences in protein secretion related to synthesis of pili and cellular adherence and invasion may contribute to virulence in some strains.…”

Section: Discussionmentioning

confidence: 99%

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Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases

Lovelock,

du Plessis,

van der Westhuizen

et al. 2024

Southern African Journal of Infectious Diseases

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Background: Classical toxin-mediated respiratory diphtheria has become less common because of widespread effective vaccination globally but invasive disease as a result of non-toxigenic strains of Corynebacterium diphtheriae is not prevented by vaccination and may result in severe disease, including infective endocarditis (IE).Objectives: To describe the outbreak and subsequent investigation of a cluster of five cases of non-toxigenic C. diphtheriae endocarditis.Method: A retrospective observational case series of five cases of non-toxigenic C. diphtheriae endocarditis identified in the rural West Coast district of the Western Cape province of South Africa between May 2021 and June 2021.Results: Non-toxigenic C. diphtheriae IE had an aggressive clinical course with high mortality in this cohort. Only one of five patients survived to hospital discharge. The surviving patient received a prompt diagnosis with early surgical intervention but still had a complicated clinical course. Notably, only one case had a pre-existing risk factor for IE, namely a prosthetic valve. Whole genome sequencing of clinical isolates confirmed that all isolates were of the same novel sequence type of non-toxigenic C. diphtheriae but despite a thorough investigation no epidemiological link was ever found between the cases.Conclusion: Non-toxigenic strains of C. diphtheriae are less well known but may be highly virulent and cause severe invasive disease.Contribution: This is the largest cluster of non-toxigenic C. diphtheriae IE ever described in South Africa and expands the body of literature on this unusual but possibly emerging infection.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases

Lovelock,

du Plessis,

van der Westhuizen

et al. 2024

Southern African Journal of Infectious Diseases

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“…Surgical management of endocarditis remains to be challenging and is related with significant morbidity and mortality. [ 11 , 12 ] Univariable and multivariable analyses also showed that prolonged ICU stay is statistically significantly related to acute renal injury, prolonged intubation time, in-hospital mortality, and 1-year mortality (Table 6 ). Determining the risk factors of prolonged ICU stay has clinical significance for the management of IE.…”

Section: Discussionmentioning

confidence: 97%

“…During fluid administration, cardiac function needs to be closely monitored either with cardiac output monitoring or echocardiography. [ 11 , 14 ]…”

Section: Discussionmentioning

confidence: 99%

Risk factors of prolonged intensive care unit stay following cardiac surgery for infective endocarditis

Huang,

Wen,

et al. 2023

Medicine

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Introduction: Prolonged intensive care unit (ICU) stay is common in serious patients undergoing cardiac surgery. Prolonged ICU stay is associated with increased mortality and worse prognosis. This study was conducted to determine the risk factors for prolonged ICU stay after cardiac surgery for infective endocarditis (IE) and we try to decrease the operative risk of mortality and morbidity of cardiac surgery for IE. Methods: The retrospective study of patients with IE undergoing cardiac surgery between January 2006 and November 2022 at our hospital was performed. Results: 896 patients undergoing cardiac surgery were divided into group of ICU stay ≤ 3d (n = 416) and group p of ICU stay > 3d (n = 480). There were 48 operative deaths (5.4%). Univariable and multivariable analyses showed that factors are associated with prolonged ICU stay following cardiac surgery for IE, including male (P < .001), age (P < .001), weight (P = .009), vegetation length (P < .001), paravalvular leak (P < .001), aortic cross-clamp time (P < .001), cardiopulmonary bypass (CPB) time (P < .001), mechanical ventilation time (P < .001), hospitalized time postoperative (P = .032), creatinine of serum before surgery (P < .001), creatinine of serum 24h after surgery (P = .005), creatinine of serum 48h after surgery (P < .001), fluid balance on operation day (P < .001), postoperative acute kidney injury (P < .001), left ventricular end diastolic dimension (LVEDD) preoperative (P < .001), LVEDD postoperative (P < .001), chest drainage (P = .032), frozen plasma (P = .016), preoperative aortic insufficiency (P < .001), and packed red cells (P < .001). Conclusions: In our study, shortness of ICU stay and optimization of pre-, peri-, and postoperative factors that can shorten ICU stay, therefore, contribute to a better postoperative outcome and leads to lower rates of mortality and morbidity.

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“…The ideal timing for surgery in patients with IE is still uncertain. Nevertheless, early surgical intervention has been linked to a lower risk of mortality ( 6 , 7 ). In patients with IE, prompt surgical treatment can decrease the risk of bacterial emboli and thromboembolic events, as well as related complications ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Postoperative follow-up of 221 patients with infective endocarditis from Gaoligong mountain area of Yunnan in China: a retrospective, single-center, observational cohort study

Li,

Jia

et al. 2024

J Thorac Dis

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Background Despite improvements in management, infective endocarditis (IE) is still associated with high mortality and morbidity. The outcome of patients with IE remains unclear in high-altitude areas of China. To characterize the epidemiological features and surgical outcomes, a retrospective analysis was conducted to 221 patients diagnosed with IE from a single center. In addition, to assess the prognosis of patients, a multivariate logistic regression model was performed to analyze the affecting risk factors. Methods A retrospective analysis was conducted on the clinical data of 221 patients with IE who underwent surgical treatment at the Department of Cardiac Surgery of Yan’an Hospital Affiliated to Kunming Medical University from January 2013 to December 2019. The analysis evaluated patient demographics, pathogenic bacterial composition, echocardiography results, and surgical treatment outcomes. After a 1-year follow-up period, the mortality rate was statistically analyzed. The patients were divided into two groups based on their survival status: those who survived and those who did not. Relevant factors were compared between the two groups, and a multivariate logistic regression model was used to analyze the risk factors that affect the prognosis of patients with IE. Results Out of the 221 patients diagnosed with IE, 164 were male and 57 were female, with an average age of 39.25±14.36 years. The most common underlying heart diseases were bicuspid aortic valve disease (24.9%), congenital heart disease (19.5%), rupture of aortic sinus aneurysm (5.0%) and rheumatic valvular disease (2.3%). The blood culture had a positive rate of 48.42% (107/221), with Streptococcus viridans (29.9%) and Streptococcus haematoides (13.1%) being the main specifically pathogenic bacteria identified. Transthoracic echocardiography produced positive results in 89.6% (198/221) of cases. The findings included vegetation formation (100%), valve perforation or tear (21.7%), and perivalvular abscess formation (5.6%). Out of the patients, 174 underwent elective surgery, 47 received emergency surgery, and 11 died within 1 year after surgery, resulting in a mortality rate of 5.0%. However, the death group had longer operation time, cardiopulmonary bypass (CPB) time and higher EuroSCORE II compared to the non-death group (P<0.05). Logistic regression analysis identified preoperative hematocrit decrease, prolonged operation time and CPB time, high New York Heart Association (NYHA) cardiac function grade, and liver diseases as risk factors for 1-year mortality in patients with IE (OR =1.003, 0.000, 1.006, 1.026, 1.624 and 4.746). Conclusions IE primarily affects young and middle-aged men with rheumatic heart valvular disease as the main underlying heart disease and Streptococcus viridans as the main pathogen. Surgical intervention significantly r...

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Early surgery determines prognosis in patients with infective endocarditis: outcome in patients managed by an Endocarditis Team—a prospective cohort study

Cited by 4 publications

References 39 publications

Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases

Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases

Risk factors of prolonged intensive care unit stay following cardiac surgery for infective endocarditis

Postoperative follow-up of 221 patients with infective endocarditis from Gaoligong mountain area of Yunnan in China: a retrospective, single-center, observational cohort study

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