Posts filed under ‘Infecciones cardio-vasculares’

Criteria for Identifying Patients With Staphylococcus aureus Bacteremia Who Are at Low Risk of Endocarditis: A Systematic Review

Open Forum Infectious Diseases Fall 2017 V.4 N.4

George S Heriot; Katie Cronin; Steven Y C Tong; Allen C Cheng; Danny Liew

Esta revisión sistemática examina los métodos y resultados de estudios recientes que informan criterios clínicos capaces de identificar a pacientes con bacteriemia por Staph aureus que tienen un riesgo muy bajo de endocarditis (EI).

Se realizaron búsquedas en PubMed, EMBASE y la base de datos CENTRAL de la Colaboración Cochrane para artículos publicados después de marzo de 1994 utilizando una combinación de MeSH y términos de búsqueda de texto libre para S. aureus y bacteriemia y EI.

Los estudios se incluyeron si presentaban una combinación de criterios clínicos y microbiológicos con una razón de verosimilitud negativa de ≤ 0,20 para EI.

Encontramos 8 estudios que empleaban diversos criterios y estándares de referencia cuyos criterios se asociaron con razones de probabilidad negativas entre 0.00 y 0.19 (que corresponden al 0% -5% de riesgo de EI con una prevalencia de fondo del 20%).

El beneficio de la ecocardiografía para los pacientes que cumplen estos criterios es incierto.






April 1, 2018 at 3:13 pm

Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review

International Journal of Infectious Diseases February 2018 V.67 P.3–6

Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli


  • Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
  • A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
  • At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
  • PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
  • This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.


To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.


Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.


One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.


Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.



February 18, 2018 at 4:03 pm

Emerging group C and group G streptococcal endocarditis: A Canadian perspective

International Journal of Infectious Diseases December 2017 V.65 N. P.128–132

Sylvain A. Lother, Davinder S. Jassal, Philippe Lagacé-Wiens, Yoav Keynan


The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE.


Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria.


Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%.


IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.



February 9, 2018 at 1:25 pm

Long-term acute care hospitals.

Clinical Infectious Diseases August 1, 2009  V.49 N.3 P.438-43.     

Munoz-Price LS1.

Author information



Long-term acute care hospitals (LTACHs) are health care facilities that admit complex patients with acute care needs (eg, mechanical ventilator weaning, administration of intravenous antibiotics, and complex wound care) for a mean duration of stay of 25 days. LTACHs are different than nursing homes and were initially created in the 1990s in an effort to decrease Medicare costs by facilitating prompt discharge from intensive care units of patients with difficulty weaning mechanical ventilation; however, current admission diagnoses are quite broad. Patients admitted to these facilities have multiple comorbidities and are at risk for colonization with multidrug-resistant organisms. LTACH patients have been shown to have high rates of hospital-acquired infections, including central vascular catheter-associated bloodstream infection and ventilator-associated pneumonia. In addition, LTACHs have been implicated in various regional outbreaks of multidrug-resistant organisms. This review summarizes the limited amount of scientific literature on LTACHs while highlighting their infection control problems, as well as the role LTACHs play on regional outbreaks.



January 30, 2018 at 4:08 pm

Quantifying infective endocarditis risk in patients with predisposing cardiac conditions.

Eur Heart J. 2017 Nov 17.

Thornhill MH1,2, Jones S3,4, Prendergast B5, Baddour LM6, Chambers JB5, Lockhart PB2, Dayer MJ7.

Author information

1 Unit of Oral and Maxillofacial Medicine, Pathology and Surgery, University of Sheffield School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TA, UK.

2 Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.

3 Department of Population Health, NYU School of Medicine, NYU Translational Research Building, 227 East 30th Street, New York, NY 10016, USA.

4 Department of Clinical and Experimental Medicine, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK.

5 Department of Cardiology, St Thomas’ Hospital, Westminster bridge Road, London SE1 7EH, UK.

6 Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

7 Department of Cardiology, Taunton and Somerset NHS Trust, Musgrove Park, Taunton, Somerset TA1 5DA, UK.



There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions.


English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions-even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices.


These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

abstract (CLIC en PDF)


January 25, 2018 at 8:32 am

Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: Nationwide population based cohort and a case crossover study

BMJ September 7, 2017 V.358 

Sarah Tubiana, epidemiologist12, Pierre-Olivier Blotière, statistician2, Bruno Hoen, professor3, Philippe Lesclous, professor4, Sarah Millot, associate professor5, Jérémie Rudant, epidemiologist2 , Alain Weill, epidemiologist2, Joel Coste, professor2, François Alla, professor2, Xavier Duval, professor1

1INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; INSERM CIC-1425, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France

2Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France

3Service de Maladies Infectieuses et Tropicales et Inserm-CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre, Guadeloupe, France

4INSERM, U 1229, RMeS, Nantes, France, UFR d’Odontologie, Université de Nantes, Nantes, France, CHU Hôtel Dieu, Nantes, France

5Department of Odontology, CHRU Université de Montpellier, France; UMR 1149 INSERM, CRI. Université Paris Diderot, France



To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves.


Nationwide population based cohort and a case crossover study.


French national health insurance administrative data linked with the national hospital discharge database.


All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014.

Main outcome measures

Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods.


The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% v 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03).


Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves.



January 6, 2018 at 12:11 pm

Infección por Coxiella burnetti (Fiebre Q)

Enf Infecciosas & Microbiologia Clínica 2010 V.28 Supl.1 P.29-32

Maria Teresa Fraile Fariñas (a) y Carlos Muóz Collado (b)

a Servicio de Microbiología, Hospital General de Valencia, Valencia, España

bDepartamento de Microbiología y Ecología, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España

La fiebre Q todavía es una enfermedad poco conocida, a pesar de que se describió hace más de 60 años. Aunque tampoco se conoce la prevalencia exacta, probablemente el número de casos de fiebre Q está subestimado.

La presentación clínica es muy variada e incluye formas graves con un mal pronóstico.

Frecuentemente, los casos agudos se presentan como una infección asintomática, un síndrome gripal, una neumonía o una hepatitis.

Probablemente, los factores del huésped juegan un papel importante en el desarrollo de la enfermedad crónica, que se puede presentar como una endocarditis con hemocultivo negativo.

El diagnóstico de fiebre Q debe considerarse en los casos de fiebre de origen desconocido, especialmente si el sujeto ha estado en contacto con mamíferos probablemente contaminados.

Los mejores métodos de diagnóstico microbiológico son los que permiten la detección directa de la bacteria (cultivo celular y reacción en cadena de la polimerasa, PCR), si bien estos procedimientos deben realizarse en laboratorios con un nivel de bioseguridad adecuado y con personal especializado.

Para el diagnóstico indirecto el método de referencia es la inmunofluorescencia indirecta (IFI), que es muy sensible y específica.

En los casos de fiebre Q aguda el diagnóstico deberían confirmarlo unos títulos de anticuerpos (IgG y/o IgM), obtenidos por inmunofluorescencia, superiores al punto de corte calculado para cada área geográfica, o bien por seroconversión.


October 30, 2017 at 8:14 am

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