Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome

Arregle, Florent; Martel, Hélène; Philip, Mary; Gouriet, Frédérique; Casalta, Jean Paul; Ribéri, Alberto; Torras, Olivier; Casalta, Anne-Claire; Camoin-Jau, Laurence; Lavagna, F; Renard, Sébastien; Ambrosi, Pı̈erre; Lépidi, Hubert; Collart, Frédéric; Hubert, Sandrine; Drancourt, Michel; Raoult, Didier; Habib, Gilbert

doi:10.1016/j.acvd.2021.01.004

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…As a limitation, the smaller size of our population could have affected the power of our study, which does not allow significant correlations to be found, even in the presence of differences in rates. The findings from our study highlight the critical prognostic role of septic cerebral emboli in IE patients [ 22 , 23 , 24 , 25 ]; in particular, the association between cerebral embolic phenomena and 6-month mortality may suggest the important role of the late neurological sequelae in determining a negative outcome. In our study, extra-cerebral embolization was present in 29.4% of IE cases, a percentage higher than previous data from the literature, i.e., 17% according to ICE-PCS [ 22 ].…”

Section: Discussionmentioning

confidence: 56%

“…The findings from our study highlight the critical prognostic role of septic cerebral emboli in IE patients [ 22 , 23 , 24 , 25 ]; in particular, the association between cerebral embolic phenomena and 6-month mortality may suggest the important role of the late neurological sequelae in determining a negative outcome. In our study, extra-cerebral embolization was present in 29.4% of IE cases, a percentage higher than previous data from the literature, i.e., 17% according to ICE-PCS [ 22 ]. Nevertheless, neither splenic nor pulmonary or renal embolic phenomena were related to a poor intra-hospital outcome; this means that in our experience extra-cerebral embolic involvement could not represent a prognostic factor, as reported in other studies [ 2 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 56%

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Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Ucciferri

Auricchio

Cutone

et al. 2022

Infectious Disease Reports

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Background: Nowadays, infective endocarditis (IE) is still burdened by a high mortality. In the absence of an adequate prognostic stratification system, it is important to assess new predictors of poor outcomes. The aim of our study is to evaluate which factors were associated with higher mortality in IE patients. Methods: A retrospective cohort study enrolled patients with an IE diagnosis at the Infectious Diseases Clinic of the University ‘G. D’Annunzio’, Chieti, Italy from January 2013 to December 2019. For each patient, demographic, anamnestic and clinical information, embolic phenomena, laboratory and microbiologic data, treatment, and outcomes were collected and analyzed. A correlation analysis was performed. Results: Sixty-eight patients with EI were studied; among them, the mortality was 17.6%, 20.6%, and 23.5%, intra-hospital, at 1 month from discharge and at 6 months from discharge, respectively. Mortality was significantly correlated with age, estimated glomerular filtration rate, and procalcitonin values when considering either basal values (r = 0.266, p = 0.029), or values at 48–72 h from the start of an antibiotic therapy (r = 0.222; p < 0.05), cerebral embolization for 6-month mortality (r = 0.284; p = 0.019), and inadequate antibiotic therapy (r = 0.232, p < 0.05). Conclusions: Procalcitonin values, at EI diagnosis and at 48–72 h after starting antibiotics, are prognostic factors useful for stratifying patient risk, and for setting up a personalized treatment. Of note, cerebral embolization and an inappropriate empirical treatment were associated with a higher mortality in the short- and long-term.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 56%

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Ucciferri

Auricchio

Cutone

et al. 2022

Infectious Disease Reports

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“…In our study, the fact that all patients who underwent a KD had suspicion of endocarditis could have been a recruitment bias since neurologic complications of endocarditis are found in approximately 25% of patients [25,26]. However, we only selected patients without neurologic symptoms or abnormalities on neuroimaging and with apparent normal brain PET on visual interpretation.…”

Section: Discussionmentioning

confidence: 99%

Regional brain glucose metabolism is differentially affected by ketogenic diet: A human semiquantitative positron emission tomography

Horowitz

Doche

Phlip

et al. 2022

Preprint

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Purpose Ketogenic diet (KD) is recommended to avoid intense [18F]FDG myocardial physiologic uptake in PET imaging. Neuroprotective and anti-seizure effects of KD have been suggested, but their mechanisms remain to be elucidated. This [18F]FDG PET study aims to evaluate the effect of KD on glucose brain metabolism. Method Subjects who underwent KD prior to whole-body and brain [18F]FDG PET in our department for suspected endocarditis were retrospectively included. Myocardial glucose suppression (MGS) on whole-body PET was analysed. The main exclusion criteria were brain abnormalities. Thirty-four subjects with MGS were considered the KD population, and 14 subjects without MGS were considered a KD failure. Brain SUVmax of these groups was compared. Second, the KD population (n = 34, mean age: 61.8 ± 17.2 years) was compared to a control group of 27 healthy subjects fasting for at least 6 h (mean age of 62.4 ± 10.9 years). A semiquantitative voxel-based intergroup statistical analysis was conducted using SPM. Results A 20% lower brain SUVmax was found in subjects under KD with MGS in comparison to those without MGS, p = 0.02. Whole-brain voxel-based intergroup analysis revealed that patients under KD had relative hypermetabolism of limbic regions including medial temporal cortices and cerebellum lobes and relative hypometabolism of bilateral posterior regions (occipito-parietal). Conclusion KD globally reduces brain glucose metabolism but with regional differences. These results have a clinical implication, since the realization of a KD could lead to misinterpretation of these regions, and a pathophysiological perspective as it could help understand underlying neurological effects of KD through possible decrease of oxidative stress in posterior regions, and functional compensation in the limbic regions.

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“…In recent years, mNGS is in the exploratory research stage of detecting drug resistance genes, and has clinical application potential and broad application prospects [25]. At the same time, there are also some problems to be solved, such as the inability to determine the source of drug resistance genes, the existence of incomplete gene-phenotype matching, and the qualitative but not quantitative bacterial resistance [26].…”

Section: Discussionmentioning

confidence: 99%

Primary exploring the value of metagenomic next‐generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation

Li²,

Sun³

et al. 2022

Pediatr Surg Int

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To evaluate the value of metagenomic next-generation sequencing (mNGS) in detecting pathogenic bacteria of cholangitis for patients with biliary atresia after Kasai operation. MethodsPatients of biliary atresia with cholangitis after Kasai operation who were admitted to Xi'an Children's Hospital from July 2019 to December 2021 were retrospectively analyzed. Both blood culture and mNGS were carried out in all of these patients. The detection rate of pathogenic bacteria, pathogenic bacteria spectrum, test time, in ammatory indicators and liver function were compared. The correlation between drug resistance gene and drug resistance phenotype was analyzed. All the patients were followed up for 0.5-3 years to evaluate the onset of cholangitis and the survival status of autologous liver. Resultsa total of 30 episodes of cholangitis in 25 patients were included in this study. There were signi cant differences in the detection rate of pathogenic bacteria [23.3 vs.73.3%, P < 0.05] and the test time [120 (114.5-120) vs.16 (16-21) h, P < 0.001] between the blood culture and mNGS. In ammatory indicators (CRP, PCT) and liver function (TB, DB, GGT) were compared before and after anti-infection, and there was signi cant statistical difference with two methods. Four kinds of bacteria were detected by blood cultures, and 10 kinds of bacteria were detected by mNGS. The drug-resistant phenotypes and drugresistant genotypes of 3 Klebsiella pneumoniae strains were compared, h Cholangitis occurred 3 times in 1 case (4%) and twice in 3 cases (12%). Autologous liver survived in 17 cases (68%). ConclusionCompared with traditional blood culture, mNGS is more e cient, convenient and accurate in the detection of pathogens. It provides a new method for the accurate detection of pathogenic bacteria of cholangitis with biliary atresia after Kasai operation.

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Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome

Cited by 19 publications

References 26 publications

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Regional brain glucose metabolism is differentially affected by ketogenic diet: A human semiquantitative positron emission tomography

Primary exploring the value of metagenomic next‐generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation

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