Temporal trends of infective endocarditis in North America from 2000 to 2017 – a systematic review

Objectives To examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Patients and Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews™, Ovid Embase™, Ovid Medline™, Scopus™, and Web of Science™ were searched for studies published between January 1, 2000 and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8,588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for two studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7-14.4%, while the percentage of patients who underwent surgery ranged from 6.4-16.0%. Conclusion Overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations have been highlighted for use in subsequent systematic reviews of IE

Infective endocarditis due to Propionibacterium species

AbstractPropionibacterium species rarely cause infective endocarditis. When identified in blood cultures, they may be inappropriately disregarded as skin flora contaminants. The purpose of this study was to characterize the clinical presentation and management of endocarditis due to Propionibacterium species. All cases of endocarditis due to Propionibacterium species that were treated at the Mayo Clinic, Rochester, USA were retrospectively reviewed, and the English language medical literature was searched for all previously published reports. Seventy cases, which included eight from the Mayo Clinic, were identified (clinical details were available for only 58 cases). The median age of patients was 52 years, and 90% were males. In 79% of the cases, the infection involved prosthetic material (39 prosthetic valves, one left ventricular Teflon patch, one mitral valve ring, one pulmonary artery prosthetic graft, three pacemakers, and one defibrillator). Blood cultures were positive in 62% of cases. All 22 cases with negative blood cultures were microbiologically confirmed by either positive valve tissue cultures (n = 21) or molecular methods (n = 1). Endocarditis was complicated by abscess formation in 36% of cases. The majority (81%) of patients underwent surgery, either for valve replacement and debridement of a cardiac abscess, or removal of an infected device. Crude in-hospital mortality was 16%. The median duration of postoperative antibiotic treatment was 42 days. Patients were commonly treated with a penicillin derivative alone or in combination with gentamicin. On the basis of the above data, it is recommended that infective endocarditis should be strongly suspected when Propionibacterium species are isolated from multiple blood cultures, particularly in the presence of a cardiovascular device

Escalating incidence of infective endocarditis in Europe in the 21st century

Aim: To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe. Methods: A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence. Results: Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%. Conclusion: Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase. Trial registeration number: CRD42020191196

Efeito da adição de enzimas em dietas de frangos de corte à base de milho e farelo de soja sobre a digestibilidade ileal de nutrientes Effect of enzymes supplementation in corn soybean meal broiler diets on ileal digestibility of nutrients

Dois experimentos, utilizando pintos de corte Avian Farm, no período de 8 a 18 dias de idade, foram realizados para se avaliar o efeito de enzimas microbianas sobre os coeficientes de digestibilidade (CD) ileal aparente da matéria seca (MS), da proteína bruta (PB), da energia bruta (EB), do fósforo (P) e do cálcio (Ca) de dietas à base de milho e farelo de soja com diferentes níveis de Ca e P disponível (Pd). Óxido crômico (0,5%) foi adicionado às dietas a fim de se estimar o fator de indigestibilidade. Todas as aves foram abatidas aos 19 dias, para a coleta da digesta. O primeiro experimento foi realizado em arranjo fatorial 2 x 2, com seis repetições contendo 10 aves. As dietas foram formuladas contendo dois níveis de Ca e Pd normal (1%Ca/0,45%Pd) e baixo (0,70%Ca/0,32%Pd) x dois níveis de enzima fitase (0 e 1 kg/t de ração). O segundo experimento foi realizado em arranjo fatorial 2 x 3, sendo dois níveis de Ca e Pd normal (1%Ca/0,45%Pd) e baixo (0,70%Ca/0,32Pd%) e três combinações de enzimas: complexo multienzimático (CM) com fitase (Fit): 0 kg/t para o controle, 2 kg/t (CM) e 2 kg/t mais 1 kg/t de fitase (CM+Fit), com seis repetições, contendo 10 aves cada. No experimento 1, a adição de fitase melhorou a digestibilidade ileal da MS (5,2%), PB (2,4%) e EB (3,8%). Interação significativa foi observada na digestibilidade do Ca e P, sendo que adição da fitase melhorou a digestibilidade do Ca e P em ambos níveis de Ca e P. No segundo experimento, a adição do CM melhorou o CD da PB, P e Ca em 3; 4,7; e 7,8%, respectivamente. A associação do CM+fitase mostrou efeito aditivo no aproveitamento do Ca e P. Interação foi observada para o CD da EB, a adição do CM melhorou a digestibilidade em ambos níveis de Ca e Pd, entretanto o CM+fitase melhorou o CD da EB apenas no nível baixo de Ca e P.<br>Two experiments, using 8 to 18 days old Avian -Farm male broiler chicks, were conducted to evaluate the effect of microbial enzymes on the ileal digestibility coefficient (DC) of dry mater (DM), crude protein (CP), energy (E), calcium (Ca) and phosphorus (P) in corn soybean meal diets with different level of Ca and available P (Pa). Chromic oxide (0,5%) was added to the diets, as an indigestible marker, to estimate ileal digestibility. All chicks were killed at the end of the experiments (19 days) to collect the ileal content. The first experiment was a factorial arrangement of 2 x 2, with six replicates (n=240, 10 chicks per unit). Diets were formulated to contain two levels of Ca and Pa normal (1%Ca/0.45%Pa) and low (0.70%Ca/0.32%Pa) x two level of phytase (Phy) enzyme (0 and 1 kg/t of diet). The second experiment was a factorial arrangement of 2 x 3, six replicates (n=360, 10 chicks per unit). Diets were formulated with two levels of Ca and Pa normal (1%Ca/0.45%Pa) and low (0.70%Ca/0.32%Pa) x three combination of a multienzyme complex (MC). The combination were 0 kg/t for the control (C), 2 kg/t (MC) and 2 kg/t of the MC plus 1 kg/t of phy (MC+phy). In the first experiment the diets with Phy had a higher digestibility for DM (5.2%), CP (2.4%) and GE (3,8%). Phytase improve the digestibility of P and Ca in both levels of Ca and Pa. In the second experiment, the addition of the MC improved DC of CP, P and Ca in 3%; 4.7 and 7.8%, respectively. The association of MC + Phy improved Ca and P digestibility. Interaction was observed in the energy digestibility. The addition of the MC improved the digestibility in both Ca and P levels, however the addition of the CM+Phy improved energy DC only in the diets with low Ca and P levels