Cerebral complications in infective endocarditis

Infective endocarditis (IE) is a life-threatening disease. Cerebral embolization complicates the course in 10-40% of IE episodes. Aims of study were to investigate the frequency of cerebrovascular complications (CVC) in left-sided IE and the influence of protective and risk factors with focus on antiplatelet and anticoagulant therapy. CVC rate was examined by repeated magnetic resonance imaging of the brain and by assaying levels of brain damage markers in cerebrospinal fluid in 60 IE patients in paper I. The overall CVC frequency was 65%, with 35% of the patients experiencing neurological symptoms and 30% characterized as having clinically silent CVC. The risk of neurological deterioration during cardiac surgery after established cerebral embolism was low. In paper II the relationship between symptomatic CVC and established use of antiplatelet therapy was evaluated in 684 definite left-sided IE episodes. Antiplatelet agents were used by 23% of the patients. These patients were older and more often had a history of congestive heart failure. In 25% of all episodes a CVC was seen. There was no statistically significant difference in CVC rate between patients with and without previously established antiplatelet therapy (24% vs. 25%, n.s.). Twelve-month mortality was significantly higher for patients on previously established antiplatelet therapy in the univariable analysis (34% vs. 24%, OR 1.6, 95% CI 1.1-2.4), but after adjustment for covariables the use of antiplatelet therapy was no longer a risk factor. The association between ongoing warfarin therapy and CVC incidence in native valve endocarditis (NVE) was analyzed in paper III. Out of 587 NVE episodes 8% were seen in patients using warfarin on admission. Patients on warfarin suffered from CVC significantly less frequently than patients not on warfarin (6% vs. 26%, 0.2 95% CI 0.06-0.6). In a multivariable model S.aureus etiology (adjusted OR [aOR] 6.3, 95% CI 3.8-10.4) and vegetation length (aOR 1.04, 95% CI 1.01-1.07) were associated with higher CVC frequency. Warfarin use (aOR 0.26, 95% CI 0.07-0.94), history of congestive heart failure (aOR 0.22, 95% CI 0.1-0.52) and previous IE episode (aOR 0.1, 95% CI 0.01-0.79) conferred a lower risk of CVC. Cerebral hemorrhagic complications were few

Cerebral complications in

infective endocarditi

Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

International audienceAbstract Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE

Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association

Aims Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. Methods and results A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were Conclusion Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory

European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections

2015 ESC Guidelines for the management of infective endocarditis

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