Infective endocarditis in patients with liver cirrhosis: a systematic review

Ιωάννου, Πέτρος; Savva, Eirini; Kofteridis, Diamantis P.

doi:10.1080/1120009x.2021.1878332

Cited by 6 publications

(6 citation statements)

References 93 publications

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“…A systematic review reported that aminoglycosides, vancomycin, and cephalosporins were the antimicrobials most frequently used for treatment of IE in cirrhosis. 13 A previous study reported no difference in duration of treatment for IE in cirrhosis (mean 40 ± 28 days) versus no cirrhosis (mean 42 ± 22 days). 14 However, it should be noted that previous studies demonstrated an approximately six-fold increased risk of death from IE in cirrhosis compared to non-cirrhotic control patients.…”

Section: Discussionmentioning

confidence: 85%

“…To date, there is no specific treatment recommendation regarding the preferred antibiotic or duration for IE treatment in cirrhosis, particularly in LT candidates. A systematic review reported that aminoglycosides, vancomycin, and cephalosporins were the antimicrobials most frequently used for treatment of IE in cirrhosis 13 . A previous study reported no difference in duration of treatment for IE in cirrhosis (mean 40 ± 28 days) versus no cirrhosis (mean 42 ± 22 days) 14 .…”

Section: Discussionmentioning

confidence: 98%

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Watch out for the Saurkraut: Weissella confusa endocarditis in a liver transplant candidate

Wijarnpreecha

Fontana

2022

Clinical Liver Disease

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Watch out for the Saurkraut: Weissella confusa endocarditis in a liver transplant candidate

Wijarnpreecha

Fontana

2022

Clinical Liver Disease

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“…The median age of patients with liver transplantation and IE was lower than the age in other cohorts with patients with IE, where mean age is around 70 years [ 55 , 56 , 57 ]. However, the age is similar to that of patients with end-stage liver disease, as well as in patients with IE and kidney transplantation [ 58 , 59 ]. This is also in line with the literature, as in a recent study patients with solid organ transplantation and IE had a lower age compared with patients with IE but without solid organ transplantation [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…This, however, is in contrast with the findings of a recent study showing that patients with solid organ transplantation may be more likely to have IE of staphylococcal etiology [ 4 ]. Furthermore, the microbiology of patients with IE and liver transplantation also differs from the microbiology of patients with IE and liver cirrhosis, where the most commonly identified pathogens are Staphylococcus aureus and Streptococcus spp., with Enterococcus being the third most commonly identified pathogen [ 58 ], implying that the status of transplantation may be associated with increased occurrence of IE by Enterococcus spp. On the other hand, patients with liver transplantation may have recurrent hospitalizations, prolonged stays in the hospital or the intensive care unit, multiple indwelling vascular catheters, need for hemodialysis, and multiple courses of antimicrobial treatment for infections such as bacteremia, cholangitis, spontaneous bacterial peritonitis, that impact their risk of infection and colonization with nosocomial and multi-drug resistant organisms.…”

Section: Discussionmentioning

confidence: 99%

Endocarditis in Liver Transplant Recipients: A Systematic Review

Ιωάννου

Alexakis

Kofteridis

2021

JCM

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Infective Endocarditis (IE) is associated with significant mortality. Interestingly, IE in patients with liver transplantation has not been adequately described. The aim of this review was to systematically review all published cases of IE in liver transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed, Scopus and Cochrane Library (through 2nd January 2021) for studies providing epidemiological, clinical, microbiological, treatment data and outcomes of IE in liver transplant recipients was conducted. A total of 39 studies, containing data for 62 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 69.4%, fungi in 25.8%, and gram-negative microorganisms in 9.7% of cases, while in 9.3% IE was culture-negative. The aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Aminoglycosides, vancomycin and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in half of the cases. Clinical cure was noted in 57.4%, while overall mortality was 43.5%. To conclude, this systematic review thoroughly describes IE in liver transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.

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“…Rifampicin is not used in isolation, due to the risk of rapid resistance development, but may be a useful adjective antimicrobial agent in gram-positive biofilmforming infections, due to its action on non-dividing microbial cells found in biofilms [49][50][51][52]. IE in cirrhotic patients most commonly affects the aortic valve [53]. Given that this condition is characterized by a high risk of treatment failure and ensuing mortality, we decided to add rifampicin to the regimen, for its synergistic action against Gram-positive microbial biofilm, with careful monitoring of the patient's liver function [53,54].…”

Section: Antimicrobial Susceptibility and Therapeutic Repercussionsmentioning

confidence: 99%

Pediococcus pentosaceus Endocarditis in a Patient With Recent Transcatheter Aortic Valve Implantation and Liver Cirrhosis: A Case Report and Review of the Literature

Mantzios,

Spyropoulou,

Hatzianastasiou

et al. 2024

Cureus

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Transcatheter aortic valve implantation (TAVI) is increasingly being used in the management of severe aortic stenosis, mainly in older and/or medically compromised patients, due to its minimally invasive nature. As in any valve replacement procedure, endocarditis is a recognized complication, more so in TAVI patients, in whom comorbidities are highly prevalent. We report the case of a 70-year-old male with a history of liver cirrhosis and a recent TAVI, who presented with recurrent fever and sustained Pediococcus pentosaceus bacteremia. The diagnosis of endocarditis was delayed, as the microorganism was initially discarded as a contaminant, given that Pediococci are rarely described as human pathogens. However, in cirrhotic patients, microbiota may cause intermittent bacteremia and thereby affect prosthetic valves. Transthoracic echocardiography was not helpful in validating the diagnosis, as is often the case in TAVI patients. Transesophageal echocardiography was deemed perilous, due to esophageal varices complicating the underlying cirrhosis. Therefore, endocarditis diagnosis was based on sustained bacteremia and Duke's criteria, including the presence of high fever, a predisposing cardiac lesion, splenic infarction, and the exclusion of an alternative diagnosis. Moreover, cirrhosis enhanced the side effects of treatment and led to the need for regimen changes and prolonged hospitalization. Given the precariousness of the situation, confirmation of treatment success by 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan was sought. This is the first reported case of Pediococcus TAVI endocarditis in a cirrhotic patient, highlighting the unique challenges in the diagnosis and management of TAVI endocarditis in patients with co-existing conditions.

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Infective endocarditis in patients with liver cirrhosis: a systematic review

Cited by 6 publications

References 93 publications

Watch out for the Saurkraut: Weissella confusa endocarditis in a liver transplant candidate

Watch out for the Saurkraut: Weissella confusa endocarditis in a liver transplant candidate

Endocarditis in Liver Transplant Recipients: A Systematic Review

Pediococcus pentosaceus Endocarditis in a Patient With Recent Transcatheter Aortic Valve Implantation and Liver Cirrhosis: A Case Report and Review of the Literature

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