Infective endocarditis in solid organ transplant: a review

Abstract

Purpose of reviewInfective endocarditis remains an uncommon disease with significant morbidity and mortality. In the last two decades, progress has been made describing the unique aspects of infective endocarditis in solid organ transplant (SOT) recipients. Recent findingsIncidence of infective endocarditis in SOT is higher when compared with the general population. End-stage organ dysfunction, diabetes mellitus, older age, and prior intravenous lines have been identified as risk factors predisposing to infective endocarditis in SOT. Staphylococci and enterococci represent the most frequently isolated pathogens, whereas fungi are rarely isolated. Median time from transplantation to diagnosis ranges from 33 to 66 months. Nosocomial acquisition and mural endocarditis are more common in SOT recipients with infective endocarditis. Procurement of organs from patients with infective endocarditis might be well tolerated so long as close monitoring and targeted antibiotics are given. Selected patients might benefit from heart transplantation as definitive or salvage therapy for infective endocarditis. Outcomes of infective endocarditis in SOT recipients compared with the general population might be similar; however, patient survival and graft function are reduced when recipients suffer from infective endocarditis.

Novel Diagnostic Methods for Infective Endocarditis

“…In this prospective study, the technique showed an accuracy of 81.95%, a specificity of 86.92%, a sensitivity of 73.33%, an NPV of 84.96%, and a PPV of 76.39% [87]. 18 F-FDG PET/CT is based on the accumulation of a radioactively labeled glucose analog ( 18 F-FDG) in cells with a large number of metabolically active glucose transporters expressed on their cell surface-activated inflammatory cells (macrophages, leukocytes, and lymphocytes) [88]. Heterogeneous uptake within the heart may be related to infection [89].…”

“…The incidence of IE is also higher in a population of solid organ transplant recipients compared to the general population. Staphylococci and enterococci represent the most frequently isolated pathogens (more common with HAIE [18]).…”

“…Heterogeneous uptake within the heart may be related to infection [89]. In addition, 18 F-FDG PET/CT allows for a quantitative evaluation of extracardiac septic foci, which are complications of IE and represent small criteria for IE diagnosis. However, the diagnostic accuracy of this technique depends on several factors, mainly on proper preparation.…”

Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management

“…The Enterococcus species (11%) and Candida species (6%) represent other common agents. Fungal infections accounted for the most frequent etiologic agent within 30 days of transplantation (60%), while bacterial infections caused the majority of cases (80%) after this period [ 46 , 47 , 48 , 49 ].…”