Estudio games de endocarditis infecciosa en España

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 30/11/2015. Tesis formato europeo (compendio de artículos)INTRODUCTION. Infective Endocarditis History Review. The very term "endocarditis", referring to an individual tissue and an inflammatory process, goes back to early-nineteenth-century with clinicians such as Broussais and Bouillaud, [1]. However, it was very difficult during that period to define endocarditis in a simple, unequivocal manner[2]. Thus, the term "endocarditis" continued to be used for a disease which underwent endless development throughout the nineteenth century. William Bart Osler (1849-1919) is the eponym linked to infective endocarditis in general (Osler's disease) and one of its peripheral manifestations (Osler's nodes). He established that blood elements such as fibrin and platelets deposited on the damaged endocardium - substrate of nonbacterial thrombotic endocardiopathy - and constituted the nucleus of vegetation, devaluing the concept that it depended on secretions from the endocardium [6]. Stimulated by Osler's presentations, Lord Thomas Jeeves Horder (1871-1955)5, emphasized the pre-existence of valvulopathy and congenital cardiopathy, the importance of the oral and intestinal points of entry, the occurrence of mycotic aneurysm, the presence of splenomegaly and the identification of streptococcal etiology in more than 60% of the cases confirmed through necropsies [7]...INTRODUCCIÓN. Revisión Histórica de la Endocarditis Infecciosa. El término "endocarditis", se refiere a un tejido individual y a un proceso inflamatorio, que retrocede a la primera parte del siglo diecinueve, con médicos como Broussais y Bouillaud, antes de que surgiera la teoría de los gérmenes y el nacimiento de la bacteriología [1]. Sin embargo, fue muy difícil durante este período definir la endocarditis de forma simple e inequívoca. No siempre existió una clara relación entre las ideas y los argumentos eran confusos, tortuosos, circulares y no concluyentes. En su discusión sobre la sífilis, Ludwik Fleck, señaló que la enfermedad es un fenómeno cambiante que constantemente integra nueva información y conceptos [2]. Por lo tanto, el término "endocarditis" continúo siendo utilizado para definir una enfermedad que atravesó un largo proceso de desarrollo durante el siglo diecinueve. Simultáneamente, también existieron modificaciones en los vínculos etiológicos entre las anomalías anatómicas, los síntomas clínicos y las observaciones durante la autopsia. La patología de la enfermedad fue regularmente reformulada y su definición cambió de periodo a periodo y de país en país. La teoría de los gérmenes y el uso del microscopio cambio la visión y el concepto de la enfermedad a finales de siglo. El hecho de ser posible "ver" diminutas granulaciones hasta entonces invisibles no eran suficientes para transformar estas granulaciones en una herramienta analítica. La percepción de que la enfermedad es un todo relativamente coherente con los síntomas etiológicos, llevaron sin embargo a la realización de experimentos en el laboratorio [3]. Hugo Ribbert (1855-1920) realizó experimentos sobre la inducción de endocarditis infecciosa, inyectando Staphlylococcus aureus cultivado en patatas, en conejos e indentifico colonias bacterianas sobre la superficie de las válvulas cardíacas, especialmente en la chordae tendineae de la válvula mitral. En el mismo año, WK Wyssokowitsch (1854-1912), obtuvo la colonización de bacterias en la válvula aortica, inyectadas en el torrente sanguíneo de conejos a través de la arteria carótida. Gracias al conjunto de experimentos realizados en esa época, se obtuvieron dos conclusiones: a) la anterioridad de una endocardiopatía trombótica no bacteriana; b) la colonización del sustrato por bacterias circulantes. El siglo diecinueve termina con la asociación entre la lesión valvular, el punto de entrada y la circulación de microorganismos, la fiebre y las manifestaciones extra-cardíacas como la síntesis del diagnóstico de la endocarditis infecciosa [1, 4]...Depto. de MedicinaFac. de MedicinaTRUEunpu

Estudio games de endocarditis infecciosa en España

INTRODUCTION. Infective Endocarditis History Review. The very term "endocarditis", referring to an individual tissue and an inflammatory process, goes back to early-nineteenth-century with clinicians such as Broussais and Bouillaud, [1]. However, it was very difficult during that period to define endocarditis in a simple, unequivocal manner[2]. Thus, the term "endocarditis" continued to be used for a disease which underwent endless development throughout the nineteenth century. William Bart Osler (1849-1919) is the eponym linked to infective endocarditis in general (Osler's disease) and one of its peripheral manifestations (Osler's nodes). He established that blood elements such as fibrin and platelets deposited on the damaged endocardium - substrate of nonbacterial thrombotic endocardiopathy - and constituted the nucleus of vegetation, devaluing the concept that it depended on secretions from the endocardium [6]. Stimulated by Osler's presentations, Lord Thomas Jeeves Horder (1871-1955)5, emphasized the pre-existence of valvulopathy and congenital cardiopathy, the importance of the oral and intestinal points of entry, the occurrence of mycotic aneurysm, the presence of splenomegaly and the identification of streptococcal etiology in more than 60% of the cases confirmed through necropsies [7]..

A contemporary picture of enterococcal endocarditis

BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE. Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. KEYWORDS: enterococci; epidemiology; heart failure; infective endocarditis; prosthetic valves; relapse

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

A Contemporary Picture of Enterococcal Endocarditis

GAMES Investigators.[Background] Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking.[Objectives] The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort.[Methods] This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses.[Results] Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse.[Conclusions] Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective