Gram-negative infective endocarditis: a retrospective analysis of 10 years data on clinical spectrum, risk factor and outcome

Abstract

Infective endocarditis (IE) is a significant cause of morbidity and mortality. Underlying congenital heart disease and acquired valvular disease significantly increases the IE risk, which is still prevalent in developing countries. Gram-negative organism related IE prevalence appears to be rising with limited data on their presentation and outcomes. This study hopes to shed further light on this subject. This retrospective cross-sectional study occurred in a tertiary care center in South India. A retrospective cross-sectional study performed in a single tertiary care center in South India. All patients with IE from 2006 to 2016 were included in this study. The details of clinical presentation, laboratory investigations, clinical course, microbiology, and outcomes were obtained. Patients fulfilling the modified Duke's criteria and a culture-proven diagnosis of gram-negative IE were eligible for inclusion. A total of 27 patients were enrolled from Jan 2006 to Dec 2016, among whom 78% were male. Prior structural heart disease was common in our cohort (41%) with renal (55%) and embolic (51%) complications being the most common systemic complications. A comparison of mortality with survivors found that congenital and acquired structural heart disease had a higher risk of mortality. Non-fermenting GNB accounted for 52% of the cohort, with Pseudomonas accounting for 19%. E. coli was the most common bacilli isolated, constituting 37% of the cohort. Assessment of risk factors for adverse outcomes found that renal dysfunction and intravascular device were significant with multivariate-logarithmic analysis showing renal dysfunction as an independent risk factor. In-hospital mortality in this series was 30%. In conclusion, gram-negative IE was more prevalent among males. Underlying structural heart disease was the most common risk factor associated with the disease. Renal dysfunction and embolic complications were the most common complications in this cohort. E. coli and NFGNB accounted for 70% of the offending organisms. In-hospital mortality was similar to patients with IE secondary to common organisms. The presence of renal dysfunction was an independent risk factor for an adverse outcome.

A cardiovascular magnetic resonance imaging-based pilot study to assess coronary microvascular disease in COVID-19 patients

“…Concurrent to his clinical improvement, a substantial increase in global MPR was observed at least in this single patient—further supporting the relationship between CMR-based assessment of CMD and clinical symptoms of exertional dyspnoea. Obviously, more comprehensive imaging data—including strain data—will be helpful to improve our understanding of the underlying pathophysiology and the relationship of specific imaging parameters to clinical outcome 22 .…”

Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature

“…In the past 50 years, the incidence of Gram-negative endocarditis has been increasing[ 55 , 56 ]. In addition to the traditional risk factors of structural heart disease (congenital or acquired)[ 57 , 58 ], most cases of Gram-negative endocarditis are mainly caused by medical related events[ 59 ]. Patients with indwelling catheters, invasive lines, and intracardiac devices are at higher risk[ 60 , 61 ].…”

“…Embolic symptoms can be divided into the presence or absence of central nervous system involvement, including neurological complications such as stroke or transient ischemic attack, and other complications such as metastatic infection, mesenteric ischemia, and peripheral terminal artery occlusion[ 41 , 62 ]. A large prospective study found that the incidence of new murmurs was 48%-60%, and 30%-40% of patients lost weight[ 17 , 59 ]. Studies have reported that about 11%-33% of patients have splenomegaly[ 59 , 63 ].…”

“…A large prospective study found that the incidence of new murmurs was 48%-60%, and 30%-40% of patients lost weight[ 17 , 59 ]. Studies have reported that about 11%-33% of patients have splenomegaly[ 59 , 63 ].…”

Aortic root fistula complicating Austrian syndrome

“…6,7 Risk factors for developing embolic infarcts are older age, prior embolic events, multiple valvular endocarditis, larger vegetation's and virulent organisms like Staphylococcus aureus, and Candida. 8,9 Reports of embolic events in Streptococcus pneumonia are uncommon and mostly in presence of the Austrian syndrome. These embolic infarcts are often multiple, bilateral, and tend to be distributed in the territory of middle cerebral artery territory similar to our patient.…”