Stroke is a significant cause of morbidity and mortality worldwide, contributing substantially to the global burden of disease. In low- and middle-income countries, stroke tends to occur at younger ages, with infection being one of the notable contributing factors. Previous studies have explored the impact of nontyphoidal Salmonella (NTS) on vascular and blood-related diseases, with animal experiments confirming related mechanisms. This study aims to investigate the association between NTS and cerebrovascular diseases (CVDs), with a focus on identifying specific patient populations more susceptible to stroke due to infection.

This retrospective cohort study utilized the TriNetX database, including 4708 patients infected with NTS compared with a healthy population, with disease risk tracked over 6 months, 1 year, and lifelong periods. The primary outcome was CVDs (ICD-10-CM: I60-I69), while secondary outcomes examined hemorrhagic stroke (ICD-10-CM: I60-I62) and ischemic stroke (ICD-10-CM: I63). Subgroup analyses were conducted based on gender and age at index, with sensitivity analysis performed by comparing hospitalized patients, utilizing different databases, and evaluating the specificity of the NTS-CVD association by examining patients with a higher risk of acute myocardial infarction (AMI).

The lifelong hazard ratios (HRs) for cerebrovascular diseases (CVD), hemorrhagic stroke, and ischemic stroke following NTS infection were 1.606 (95% confidence interval (CI), 1.410-1.830), 1.866 (95% CI, 1.304-2.669), and 1.717 (95% CI, 1.385-2.130), respectively. A significant increase in the risk of hemorrhagic stroke was observed in the short term and mid-term, with HRs of 3.345 (95% CI, 1.091-10.259) and 2.816 (95% CI, 1.184-6.699), respectively. Subgroup analyses indicated statistically significant associations with the primary outcomes across all age groups. Males demonstrated a higher risk of hemorrhagic stroke, with an HR of 1.891 (95% CI, 1.142-3.310), whereas females exhibited a stronger association with ischemic stroke, with an HR of 1.592 (95% CI, 1.189-2.132). These associations remained significant among hospitalized patients, while no significant relationship was observed between NTS infection and AMI. The findings of this study were reproducible in a US-based database.

There is a significant association between NTS and CVD, with a particularly important impact on the occurrence of stroke in younger populations, especially regarding the elevated risk of hemorrhagic stroke.

Increased blood urea nitrogen (BUN) and decreased high-density lipoprotein cholesterol (HDL) are common in infectious diseases. However, the prognostic significance of the BUN-to-HDL ratio (BHR) in patients with infective endocarditis (IE) is yet unknown.

In all, 1441 patients with confirmed IE were included and divided into four groups according to the level of BUN and HDL: BUN > 5.2mmol/L and HDL < 0.7mmol/L (n = 296), BUN > 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 364), BUN ≤ 5.2mmol/L and HDL < 0.7mmol/L (n = 327), and BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 454). BHR was calculated as BUN/HDL. Multivariable analyses were conducted to determine the association of BHR with adverse events.

The in-hospital mortality was 6.4%. Patients with BUN > 5.2mmol/L and HDL < 0.7mmol/L had a significantly higher risk of in-hospital death than those with BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (adjusted odds ratio [aOR] = 4.65, 95% confidence interval [CI]: 1.91-11.35, p = 0.001). The decision curve analysis indicated that the combination of BUN and HDL had higher net benefit than either alone. BHR presented a higher predictive value than BUN (AUC: 0.744 vs 0.693, p = 0.01) or HDL (AUC: 0.744 vs 0.648, p < 0.001) for in-hospital mortality, and the optimal cut-off value was 7.4 (sensitivity, 79.3%; specificity, 60.3%). Furthermore, the cumulative 6-month mortality risk was significantly higher in patients with BHR > 7.4 than those with BHR ≤ 7.4 (log-rank = 93.4, p < 0.001). BHR > 7.4 was an independent risk factor for 6-month mortality in IE (adjusted hazard ratio [aHR] = 3.77, 95%CI: 2.32-6.11, p < 0.001).

BHR offers a high predictive value for short-term mortality in IE, positioning it as a potential stratification tool for critical care triage.

Endocarditis is a life-threatening infection of the heart valves, frequently caused by pathogenic bacteria. The growth of multidrug-resistant bacteria necessitates the development of innovative therapeutic techniques, such as vaccines.

The current study employed core proteome analysis and a computational-based reverse vaccinology approach across multiple bacterial pathogens associated with endocarditis to identify prospective universal vaccine candidates. The core proteome analysis contained 121 highly pathogenic strains from ten distinct pathogens (Streptococcus mutans, Streptococcus viridans, Streptococcus pyogenes, Staphylococcus aureus, Enterococcus faecalis, Streptococcus agalactiae, Gemella morbillorum, Streptococcus pneumonia, Enterococcus faecium, and Streptococcus gallolyticus). The core proteome was subjected to a subtractive proteomics methodology.

Three proteins that were virulent, non-homologous, antigenic, and non-allergenic have been identified as prospective candidates for vaccine development: 30S ribosomal protein S13, 50S ribosomal protein L6, and UMP Kinase. B and T cell epitopes were predicted from vaccine candidate proteins using a range of immune-informatics methods. An in silico vaccine was created by using meticulously chosen epitopes-seven Cytotoxic T lymphocyte (CTL), seven Linear B lymphocyte (LBL), and three Helper T lymphocyte (HTL) epitopes-and subsequently aligning them with the major histocompatibility complex (MHC) molecules (MHC I & MHC II) and human TLR4. A Cholera toxin subunit B (CTB) adjuvant was added to the vaccine to enhance the immunological response. The molecular interactions and binding affinity of the vaccine with TLR4 and MHC molecules were analyzed using molecular dynamics (MD) simulations and molecular docking. To ensure optimal vaccine protein expression, the vaccine was cloned and reverse-translated in E. coli.

This methodology tackles the difficulties presented by the diversity of pathogens and antibiotic resistance, providing a strategic option for developing efficient and durable vaccines against infections associated with endocarditis.

To explore the predictive value of vegetation size on the prognosis of pediatric infective endocarditis (IE).

A total of 27 children diagnosed with IE who were admitted to Kunming Children's Hospital from January 2014 to June 2024 were included. The good prognosis group comprised 10 cases, while the bad prognosis group comprised 17 cases. The receiver operating characteristic (ROC) curve, restricted cubic spline model, and decision curve analysis were utilized to assess the predictive value of vegetation size on the prognosis of pediatric IE.

There were statistically significant differences in vegetation size, hemoglobin, platelet count, and prothrombin time between the two groups (P < 0.05). The ROC curve demonstrated that vegetation size had a high predictive accuracy for the prognosis of pediatric IE (AUC = 0.841, 95% CI: 0.775-0.924). Decision curve analysis indicated that vegetation size held substantial clinical value for predicting the prognosis of pediatric IE. The restricted cubic spline analysis revealed a linear dose-response relationship between vegetation size and prognosis of pediatric IE (nonlinear test, P = 0.084).

Significant differences were observed in vegetation size, hemoglobin, platelet count, and prothrombin time between different prognosis of pediatric IE. Limited evidence indicates that vegetation size is a critical factor in predicting the prognosis of pediatric IE. However, studies with larger sample sizes are needed to confirm the accuracy of these conclusions.

Infective endocarditis (IE) is frequently caused by Staphylococcus aureus (S. aureus) and most commonly affects the aortic valve. Early diagnosis and treatment initiation are challenging because the involved immunological processes are poorly understood due to a lack of suitable in vivo models.

To establish a novel reproducible murine IE model, based on ultrasound-guided wire injury (WI) induced endothelial damage.

IE was established by inducing endothelial damage via ultrasound-guided wire injury followed by bacterial challenge with S. aureus using 104-6 colony-forming units (CFU) 24h to 72h after wire injury. Cross-sections of valvular leaflets were prepared for scanning electron microscopy (SEM) and immunofluorescence microscopy to visualize valvular invasion of macrophages, neutrophils, and S. aureus. Bacterial cultivation was carried out from blood and valve samples. Systemic immune response was assessed using flow cytometry.

Wire injury induced endothelial damage was observed in all mice after wire-injury in SEM imaging. We reliably induced IE using 105 (85%) and 106 (91%) CFU S. aureus after wire injury. Aortic regurgitation was more prevalent in wire injury mice after bacterial challenge. Mice undergoing bacterial challenge responded with significant neutrophilia and elevated pro-inflammatory cytokines in the blood. Immunofluorescence staining revealed significantly increased immune cell accumulations using our proposed model compared to controls.

Echocardiography and ex vivo histological staining demonstrated consistent infective endocarditis induction in our new model, combining a wire injury-induced endothelial damage and S. aureus administration. Further exploration of the initial immune cell response and biomarker expression could potentially identify indicators for early IE diagnosis and novel treatment targets.

Reoperative aortic root surgery after a previous root procedure is technically demanding, which can impact outcomes. Herein, we examined the impact of previous root procedure and operative indication on early outcomes.

From January 2010 to December 2022, 632 patients underwent reoperative aortic root surgery after previous root procedure (true redo root) at our institution. Baseline characteristics, operative details, and in-hospital complications were compared between groups on the basis of type of previous root prosthesis and infective endocarditis indication.

In the whole cohort, the operative mortality was 2.2% and estimated survival was 93%, 80%, and 67% at 1, 5, and 10 years, respectively. Operative mortality was similar between previous homograft, Bentall, Freestyle, valve-sparing root reimplantation, and Ross (2%, 4%, 0%, 4%, and 0%, respectively, P = .4). Reoperations after Bentall and valve-sparing root reimplantation (prosthetic grafts) had greater rates of postoperative complications, such as reoperation for bleeding (15% and 8%, P = .01), delayed chest closure (18% and 8%, P = .02), and pacemaker insertion (13% and 12%, P = .03). Although there was no significant difference in operative mortality among patients with endocarditis versus those with other indications (3% vs 1%, P = .08), the postoperative course showed greater rates of reoperation for bleeding (19% vs 5%, P < .01) and prolonged ventilation (38% vs 18%, P < .01).

At experienced centers, aortic root reoperation (true redo root) can be performed with low operative mortality. Explant of prosthetic graft material and endocarditis are associated with more complicated postoperative course, without significantly increased operative mortality.

Infective endocarditis (IE) and periprosthetic joint infections (PJI) occur due to hematogenous bacterial spread, theoretically increasing the risk for concurrent infections. There is a scarcity of literature investigating this specific association. We aimed to assess the prevalence, comorbidities, and clinical presentation of patients who have simultaneous PJI and IE.

We retrospectively identified 655 patients (321 men, 334 women; 382 total hip arthroplasty, 273 total knee arthroplasty) who developed a PJI from July 1, 2015, to December 31, 2020, at one institution. There were two groups created: patients diagnosed with PJI with IE (PJI + IE) and PJI patients who did not have IE (PJI). We analyzed clinical outcomes and comorbidities.

There were nine patients who had PJI with IE (1.4% of PJI patients). The C-reactive protein (170.9 versus 78, P = 0.026), Elixhauser comorbidity score (P = 0.002), length of hospital stay (10.9 versus 5.7 days, P = 0.043), and the 2-year postdischarge mortality rate (55.6 versus 9.0%, P = 0.0007) were significantly greater in the PJI + IE group. Comorbidities such as iron deficiency anemia (P = 0.03), coagulopathy (P = 0.02), complicated diabetes mellitus (P = 0.02), electrolyte disorders (P = 0.01), neurologic disease (P = 0.004), paralysis (P = 0.04), renal failure (P = 0.0001), and valvular disease (P = 0.0008) occurred more frequently in the PJI + IE group. Modified Duke's criteria were met for possible or definite IE in eight of the nine patients.

Concurrent PJIs and IE, although rare, are a potentially devastating disease state with increased length of hospital stay and 2-year mortality rates. This emphasizes the need for appropriate IE workups in patients who have a PJI. The modified Duke's criteria are effective in establishing a diagnosis for IE in this scenario.

Clarifying the uncertain causal relationship between periodontitis and infective endocarditis using Mendelian randomization analysis, given their historically perceived association and clinical significance.

Genetic variation data for acute periodontitis, chronic periodontitis, aggressive periodontitis, and infective endocarditis were obtained from published GWAS in individuals of European ancestry. Instrumental variables significantly associated with periodontitis were selected and univariable Mendelian randomization was conducted to infer the causal association between periodontitis and infective endocarditis. Multivariable Mendelian randomization was also performed to adjust for potential confounders including smoking, drinking, diabetes, and education.

Our analysis found no evidence of a causal association between periodontitis and infective endocarditis, with odds ratios (ORs) of 0.992 (95% CI: 0.879-1.120), 0.947 (95% CI: 0.738-1.214), and 1.056 (95% CI: 0.916-1.217) for acute periodontitis, chronic periodontitis, aggressive periodontitis, respectively. The robustness of our findings was confirmed by heterogeneity tests, pleiotropy tests, leave-one-out analyses, and MR-PRESSO. In the multivariable MR analysis, adjusting for smoking, drinking, diabetes, and education, the overall patterns between genetic liability to periodontitis and infective endocarditis remained consistent (all P > .05).

Our findings indicate that there is no genetic causal association between periodontitis and infective endocarditis.

Infective endocarditis (IE) has attracted widespread public attention. However, studies on its economic burden remain scarce.

This retrospective study aimed to collect data on the clinical characteristics of patients with IE from electronic medical records and estimate the economic burden with disability-adjusted life years (DALYs). Additionally, the changing trend of IE from 2007 to 2016 and differences between native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) on economic burden were analyzed.

There were 407 patients with IE enrolled in this study. The total DALY loss was 1710.2. The average indirect economic burden ranged from $6253.27 to $14766.34 from 2007 to 2016 showing a stable trend, which was 1.67 to 2.46 times the annual per gross domestic product (GDP). Interestingly, the average indirect economic burden for females ranged from $5941.37 to $17261.07 with a significant upward trend during this period (P = 0.035).The average DALY loss and indirect economic burden were highest in patient aged ≤ 19 (4.82, $21486.12) and lowest in those aged 80-89(0.46, $342.87), decreasing significantly with age(both P<0.001). Finally, there were no significant differences in the average DALY loss and indirect economic burden between the PVE group and NVE group during this period (2.69 vs. 2.63, P = 0.740; $9224.0vs. $11789.4, P = 0.136).

The DALY loss and indirect economic burden associated with IE were notably high, particularly among younger patients and females. These findings highlight the need for targeted preventive care and early interventions, especially for youth and gender-specific strategies, to reduce disparities in IE burden.

 Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement.

 Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed.

 Upon multivariable linear regression, endocarditis (regression coefficient [β] 2.98; 95% confidence interval [CI] 1.51, 4.45; p < 0.001]) and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p = 0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p = 0.001) as well as chronic obstructive pulmonary disease (COPD) (β 1.61; 95% CI 0.66, 2.55; p = 0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p = 0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p = 0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p = 0.006).

 Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and COPD. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

This important topic of infectious endocarditis (IE) has been covered previously with large multicenter studies and reviews of national databases, most of which come from developed countries. While studies on IE in developing countries such as China are rare, a study of IE undergoing cardiac surgery in China was conducted to investigate retrospective risk factors for hospital mortality of cardiac surgery for IE. This study of patients with IE receiving cardiac surgery in the research period at our medical center was performed retrospectively; 896 patients were assigned to the hospital mortality group (n = 48) and none hospital mortality group (n = 848). Forty-eight operative deaths (5.4%) occurred. Binary logistic regression analysis for independent risk factors for hospital mortality indicated that neurological complications preoperative, destructive annulus, preoperative mitral insufficiency, postoperative left ventricular ejection fractions, and paravalvular leak are related to hospital mortality (all P < .001). We identified modifiable risk factors for hospital mortality of cardiac surgery for IE. Early and timely diagnosis and surgery, advancement of surgical techniques, and excellent cardiac protection may decrease hospital mortality for IE.

Infective endocarditis (IE) is a life-threatening infection often challenging to diagnose, particularly in culture-negative cases. Plasma microbial cell-free DNA (mcfDNA) sequencing has shown potential for detecting pathogens in IE. However, its clinical utility, diagnostic impact, and limitations remain debated. This study evaluates its use in diagnosing and managing IE in a tertiary care setting.

This single-center retrospective cohort study included adult patients (≥18 years) who underwent mcfDNA sequencing via the Karius test for suspected IE at Mayo Clinic Rochester between December 2019 and February 2024. Diagnostic classification followed the 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria. Data on demographics, clinical features, routine microbiologic workup, and mcfDNA sequencing results were collected. Statistical analysis was conducted to evaluate diagnostic utility and treatment impact.

Among 141 patients, 66 had a diagnosis of IE, with mcfDNA sequencing identifying pathogens in 60.6% of them, compared with 39.4% with routine workup. mcfDNA sequencing was the sole microbiologic test with positive results in 33.3% of patients, leading to antimicrobial adjustments in 50.0% of that group. Clinically insignificant mcfDNA sequence detection occurred in 28.6% of patients without a diagnosis of IE.

mcfDNA sequencing is a valuable adjunctive tool for diagnosing culture-negative IE and guiding antimicrobial therapy when clinical suspicion is high. However, its utility depends on appropriate clinical context, highlighting the need for careful test interpretation and further prospective studies to assess patient-centered outcomes and cost-effectiveness.

Endocarditis is a pathology which is rarely encountered in clinical practice that presents itself in various manners, thus posing a great challenge for the clinician in the process of formulating a timely diagnosis, especially given its potentially lethal evolution. The diagnosis of infective endocarditis is based on Modified Duke Criteria. A wide array of complications may accompany endocarditis, including septic or thrombotic emboli to various territories - those occluding branches of cerebral arteries result in ischemic strokes, which may be demonstrated by brain imaging and the symptoms which may range from mild mental status alteration to deep coma. Objective: Assessment of brain imaging as a diagnostic tool for bacterial endocarditis.

This is a nested case-control study, in which 84 patients with ischemic stroke were enrolled, half of them having endocarditis related stroke (cases), and the other half stroke due to cardioembolism from other sources or to large-artery atherosclerosis (controls).

Brain imaging revealed statistically significant differences between the two cohorts, endocarditis related stroke being more strongly associated with multiple territories involvement, multiple lesions coexistence, watershed lesions, and a greater extent of ischemia all these may serve as valuable diagnostic clues. Among these findings, the presence of multiple lesions has been the most sensitive tool (Sn = 0.786, Sp = 0.857, LR+ = 5.497, LR- = 0.25), while the involvement of multiple arterial territories had the highest specificity and positive likelihood ratio for endocarditis-related stroke (Sn = 0.738, Sp = 0.929, LR+ = 10.394, LR- = 0.282). A larger ischemic lesion as quantified by pc-ASPECTS score (more than by the ASPECTS score) also increases the likelihood of endocarditis as the cause of ischemic stroke, with an AUROC of 0.7361 (95% CI 0.629-0.843).

Early brain imaging could play a crucial role in endocarditis, helping the clinician to suspect this diagnosis. Further studies are needed to understand the role of early brain imaging when Modified Duke Criteria fail to establish the diagnosis.

Neisseria sicca is commonly found in oral flora and is usually deemed harmless. Neisseria sicca is very rarely associated with infective endocarditis and has a high mortality rate with it. We present a case of infective endocarditis in a 57-year-old male who presented with fever, lethargy, and reduced mobility and was admitted to an acute medical unit of a UK district general hospital. Serial blood cultures grew Neisseria sicca and transoesophageal echocardiography confirmed vegetation on the aortic valve. As per microbiology advice, his antibiotic treatment was adjusted to oral ciprofloxacin and intravenous ceftriaxone for 6 weeks given this organism's sensitivity. The cardiology team arranged outpatient appointments for long-term follow-ups. Involving acute medicine, microbiology, and cardiology teams as part of a multidisciplinary team (MDT) led to good clinical outcomes and patients remained alive and well on follow-ups. So far only 27 cases have been documented and we think our work would increase insights into management strategies for this condition particularly the utilization of the MDT approach.

Fluid flows are dominant features of many bacterial environments, and flow can often impact bacterial behaviors in unexpected ways. For example, the most common type of cardiovascular infection is heart valve colonization by gram-positive bacteria like Staphylococcus aureus and Enterococcus faecalis (endocarditis). This behavior is counterintuitive because heart valves experience high shear rates that would naively be expected to reduce colonization. To determine whether these bacteria preferentially colonize higher shear rate environments, we developed a microfluidic system to quantify the effect of flow conditions on the colonization of S. aureus and E. faecalis. We find that the preferential colonization in high flow of both species is not specific to heart valves and can be found in simple configurations lacking any host factors. This behavior enables bacteria that are outcompeted in low flow to dominate in high flow. Surprisingly, experimental and computational studies reveal that the two species achieve this behavior via distinct mechanisms. S. aureus grows in cell clusters and produces a dispersal signal whose transport is affected by shear rate. Meanwhile, E. faecalis grows in linear chains whose mechanical properties result in less dispersal in the presence of higher shear force. In addition to establishing two divergent mechanisms by which these bacteria each preferentially colonize high-flow environments, our findings highlight the importance of understanding bacterial behaviors at the level of collective interactions among cells. These results suggest that distinct multicellular nanocolony morphologies have previously unappreciated costs and benefits in different environments, like those introduced by fluid flow.

Despite growing evidence for sex-specific differences in cardiovascular disease, sex is poorly considered in the management of infectious endocarditis (IE).

This study aimed to assess sex-specific aspects in diagnosing IE.

All consecutive patients admitted at Ulm University Heart Center with suspected IE between 2009 and 2019 were included. IE was diagnosed using the Duke criteria. Risk factors, clinical presentation and in-hospital outcomes along with the impact of diagnostic delay were compared between male and female patients.

IE was diagnosed in 96 of 118 men (81.4%) and 33 of 45 women (73.3%) (p = 0.121). Time to diagnosis was similar between the groups (p = 0.598). Regarding patient characteristics, men were younger (65.5 vs. 74.3 years, p = 0.006). Men exhibited a higher prevalence of predisposing cardiac conditions (p = 0.012) due to a higher frequency of a history of implantable cardioverter defibrillator implantation (p = 0.004), and were more likely to have poor dental status (p = 0.001), and coronary artery disease (p = 0.002). The incidence of the complications of heart failure with reduced ejection fraction (p = 0.007) and new-onset dialysis (p = 0.012) were higher, the time in the intensive care unit (p = 0.012) longer. Male sex was the only independent risk factor for in-hospital mortality [p = 0.036, HR 4.127 (95%-CI 1.096-15.538)]. Notably, only in the male cohort, a shorter time to diagnosis was associated with a lower mortality rate (p = 0.035, optimal cut-point 3.5 days). Men diagnosed within 3.5 days had a mortality rate of 13.5% compared to 31.8% for those diagnosed later (p = 0.028).

Men with suspected IE are younger, have more predisposing factors and experience a more complicated course of disease, while benefiting from early diagnosis. Therefore, recognizing the heightened risk profile specific to men during diagnosis can help to address their poorer prognosis.

Infective endocarditis is an infectious disease of the heart tissue, mainly affecting heart valves and intracardiac devices. We present the case of a 71-year-old male pacemaker carrier with a history of hepatic cirrhosis, esophageal varices, hepatocellular carcinoma, and severe aortic stenosis, who was admitted to the emergency room and hospitalized due to upper gastrointestinal bleeding. Although upper endoscopy showed no signs of active acute hemorrhage, the patient required a red blood cell transfusion. Upon admission, elevated inflammatory parameters prompted the initiation of empirical therapy with ceftriaxone. Although urinalysis, chest X-ray, thoracoabdominopelvic computed tomography, and transthoracic echocardiogram weren't suggestive of infection, an Enterococcus faecium was isolated in blood cultures. Following an antibiotic switch to daptomycin, based on susceptibility testing, and the patient's hemodynamic stability, he was transferred to a home hospitalization unit for continued care. Despite good clinical and analytical progress, the patient's history of aortic valve stenosis and pacemaker, along with persistently positive blood cultures despite antibiotic therapy and sustained fever, raised a high level of clinical suspicion. This led to the decision to perform a new echocardiogram, which revealed several aortic valve vegetations, allowing the diagnosis of infective endocarditis. Following a multidisciplinary discussion, and in accordance with antibiotic susceptibility tests, linezolid was initiated. After 40 days, although the echocardiogram was still suggestive of aortic valve infiltration due to an infectious process, hemodynamic stability, sustained apyrexia, and sterile blood cultures allowed for a possible discharge on oral therapy with moxifloxacin and rifampicin. Although this is a case of infective endocarditis in a high-risk patient, the chronology is unusual, as endocarditis was not detected in the initial echocardiogram. The diagnosis was only possible after weeks of persistent positive blood cultures, thanks to the medical team's high level of suspicion, which led them to insist on repeating the echocardiogram. In fact, the diagnosis of infective endocarditis remains a challenge to this day. This case highlights the importance of recognizing risk factors and pursuing the diagnosis when clinical suspicion persists, including repeating imaging when necessary to ensure timely diagnosis and appropriate management.

Introduction Infective endocarditis (IE) in patients with septic shock poses diagnostic challenges due to overlapping systemic effects and comorbidities, making early recognition crucial for improving outcomes. This study aimed to characterize the clinical features, diagnostic findings, and outcomes of IE in septic shock to inform better early recognition and management strategies in emergency and critical care settings. Methodology A multicenter observational study was conducted across three tertiary care hospitals in Pakistan over two years, involving 300 patients presenting with septic shock and confirmed IE. Adults aged 18 years or older who met the Sepsis-3 criteria and were diagnosed with IE using the modified Duke criteria were included. Data collected included demographics, clinical characteristics, imaging results, blood cultures, inflammatory markers, treatment plans, and outcomes (e.g., mortality, embolic events, ICU admission). Multivariate analysis identified independent predictors of adverse outcomes, adjusting for confounders such as age and comorbidities. Missing data were addressed using multiple imputations, which allows for the creation of several plausible datasets to account for uncertainty and minimize bias. This method was selected over simpler approaches, such as mean or median imputation, to enhance the robustness of our findings. Results The mean age was 55.20 ± 14.70 years, the incidence of echocardiographic positivity was 96.33% (n=289), and blood culture positivity was 92.67% (n=278). At admission, patients exhibited varying degrees of septic shock severity based on hemodynamic instability, with hypotension (83.33%) being a prominent feature. Fever (90%) and dyspnea (60%) were among the most frequently reported symptoms. Diagnostic challenges were encountered in 12% of cases, where initial differential diagnoses excluded IE but were later revised based on echocardiographic and microbiological confirmation. Pathogens predominantly included Staphylococcus aureus (50%) and Streptococcus species (30%), with polymicrobial infections noted in 8% of cases. Complications included embolic events (33%), heart failure (28%), renal dysfunction (25%), and neurological involvement such as stroke (10%). ICU admission was required in 50% (n=150) of cases, and in-hospital mortality occurred in 17% (n=51). Predictors of adverse outcomes included older age (AOR: 1.05, 95% CI: 1.02-1.08, p=0.001), prior cardiovascular disease (AOR: 2.14, 95% CI: 1.12-4.08, p=0.021), echocardiographic positivity (AOR: 2.43, 95% CI: 1.36-4.34, p<0.001), blood culture positivity (AOR: 2.50, 95% CI: 1.43-4.34, p<0.001), embolic events (AOR: 3.10, 95% CI: 1.86-5.14, p<0.001), and elevated inflammatory markers (AOR: 2.34, 95% CI: 1.43-3.83, p<0.001).  Conclusion This study reveals that early identification of IE in patients with septic shock is essential for improving outcomes. Key findings include the high diagnostic value of echocardiography and blood cultures in confirming IE, with prior cardiovascular disease emerging as a significant predictor of adverse outcomes. Embolic events and elevated inflammatory markers also played critical roles in predicting patient prognosis. A focused approach to early diagnosis, particularly through these key diagnostic tools, is crucial for timely intervention. Prioritizing these factors in clinical practice can help improve patient outcomes, especially in emergency and resource-limited settings.

Background: Infective endocarditis (IE) is an infectious disease caused by the hematogenous dissemination of bacteria into heart valves. Improving the identification of pathogens that cause IE is important to increase the effectiveness of its therapy and reduce the mortality caused by this pathology. Methods: Ten native heart valves obtained from IE patients undergoing heart valve replacements were analyzed. Bacterial invasion in the heart valves was studied by Gram staining of histological sections. Histopathological changes accompanied with bacterial invasion were studied by immunohistochemical analysis of pan-leukocyte marker CD45, platelet marker CD41, and neutrophil myeloperoxidase. The taxonomic diversity of the bacteria was analyzed using 16S rRNA metabarcoding. Results: Gram staining of the histological sections revealed bacterial cells localized on the atrial surface at the leaflet's free edge or on the ventricular surface at the leaflet's base within fibrin deposits in only three of the studied heart valves. Bacterial colonies were co-localized with microthrombi (CD41+ cells) containing single leucocytes (CD45+ cells), represented by segmented neutrophils. As a result of 16S rRNA metabarcoding, we detected the following bacterial genera: Pseudomonas (70% of the studied heart valves), Roseateles (60%), Acinetobacter (40%), Sphingomonas (40%), Enterococcus (30%), Reyranella (20%), Sphingobium (20%), Streptococcus (20%), Agrobacterium (20%), Ralstonia (10%), and Bacillus (10%). Conclusions: A number of opportunistic microorganisms that could not be detected by routine laboratory tests and were not eliminated during antibiotic therapy were identified in the IE-affected heart valves. The obtained results show the importance of 16S rRNA metabarcoding of heart valves removed due to IE not only as an independent diagnostic method but also as a highly accurate approach that complements routine tests for pathogen identification.

For clinicians treating patients with infective endocarditis (IE), identifying the causative microorganisms poses a critical diagnostic challenge. Standard techniques including blood and heart valve cultures often yield inconclusive results. According to the recent 2023 Duke-ISCVID Criteria, molecular methods represent potent tools to enhance this aspect of IE diagnostics and guide subsequent therapeutic strategies.

We retrospectively analyzed data from 124 consecutive patients who underwent heart valve surgery due to suspected IE at München Klinik Bogenhausen. The standard diagnostic pathway, which included blood culture, valve culture, histopathological analysis, and polymerase chain reaction (PCR)/sequencing, was compared with the enhanced diagnostic pathway, which included fluorescence in situ hybridization + PCR/sequencing (FISHseq) instead of PCR/sequencing alone. The aim of this study was to assess the added value of combining standard diagnostics with molecular methods such as PCR/sequencing or FISHseq for the diagnosis of IE and the potential impact on therapy.

Standard diagnostic methods and PCR/sequencing yielded inconclusive results in 57/124 cases (46.0%). FISHseq provided an added value for diagnostics in 79/124 cases (63.7%) and potentially would have impacted therapy in 95/124 (76.6%) of cases. By adding data through direct visualization and characterization of microorganisms, FISHseq reduced the number of inconclusive cases by 86.0%.

The comparison of 2 molecular diagnostic tools for IE from the same heart valve emphasizes the value of molecular methods including molecular imaging by FISH for IE diagnostics and supports the 2023 Duke-ISCVID Criteria.

Infective endocarditis (IE) is a life-threatening condition, and early diagnosis and management are critical. There is emerging evidence on the role of advanced imaging modalities including dedicated cardiac computed tomography (CCT), and 18F-fluorodeoxyglucose positron emission tomography (PET). The updated 2023 European Society of Cardiology (ESC) guidelines have emphasized increased utilization of multimodality imaging in the diagnosis and management of IE. In this review, we elaborate on recent recommendations from the updated 2023 ESC guidelines, with comparisons to the current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, focusing on multimodality imaging in IE.

Infective endocarditis (IE) poses a significant clinical challenge, necessitating nuanced diagnostic tools for early and accurate detection. The diagnostic role of the hybrid technique of single-photon emission tomography-computed tomography with technetium-99 m-hexamethylpropyleneamine oxime-labelled leukocytes ([99mTc]Tc-HMPAO-SPECT/CT) has evolved in recent years. This single-center study assessed whether the recent inclusion in the 2023 European Society of Cardiology modified diagnostic criteria of IE (2023 ESC) of infectious lesions detected with [99mTc]Tc-HMPAO-SPECT/CT affects their diagnostic performance.

Between 2015 and 2019, we enrolled 205 consecutive adults with suspected IE. All participants underwent [99mTc]Tc-HMPAO-SPECT/CT scans (370-740 MBq). Scans were deemed positive in the presence of intracardiac abnormal tracer uptake and/or within the cardiac implantable electronic device. Patients were prospectively followed-up for 12 ± 10 months. Local device infection (LDI) or IE was diagnosed in 75 (36.6 %) patients, while 72 (35.1 %) [99mTc]Tc-HMPAO-SPECT/CT results returned positive. Moreover, extracardiac infectious foci were detected in 25 % of [99mTc]Tc-HMPAO-SPECT/CT scans. The inclusion of both intracardiac and extracardiac lesions detected with [99mTc]Tc-HMPAO-SPECT/CT yields significantly higher sensitivity (p = 0.003) and negative predictive value (NPV) (p = 0.009).

The inclusion of [99mTc]Tc-HMPAO-SPECT/CT into the IE diagnostic work-up improves the appropriate classification of patients. For patients with IE, the extended inclusion of lesions detected with [99mTc]Tc-HMPAO-SPECT/CT in the ESC 2023 diagnostic criteria significantly improves sensitivity and NPV while reducing potential IE misdiagnoses. This pioneering imaging modality is poised to become an integral component of clinical practice, promising to advance IE diagnosis and management.

Septic embolization is a common and potentially life-threatening complication of infective endocarditis (IE), with a prevalence of 22-50%. While acute coronary syndrome secondary to septic embolism is rare, it poses significant risks.

This study examines coronary embolism (CE) in left-sided IE, describing clinical characteristics and outcomes.

We retrospectively analysed 649 patients with non-device-related left-sided IE treated between January 2013 and December 2023 in a high-volume surgical centre. CE was diagnosed via ECG, clinical and laboratory signs of acute coronary syndrome, and confirmed by coronary angiography or magnetic resonance imaging. All patients were treated according to current European Society of Cardiology guidelines. A structured follow-up was performed.

Among patients included in the study, surgery was performed in 514 (79%) patients. Median follow-up duration was 4.7 years. CE occurred in 8 (1.2%) patients, and 6 (80%) of them were treated surgically. We found no significant differences in overall mortality rate between patients with or without CE (p = 0.65). Finally, cerebral embolism was significantly more frequent in patients with than without CE (75% vs 25%, p = 0.006, post-hoc power 87.8%).

CE is a rare but severe complication of IE, significantly associated with cerebral embolism. Early recognition and treatment are crucial to improve patient outcomes. Multicentre studies with larger patient populations are needed to further elucidate risk factors and enhance prognosis for CE in IE patients.

Right-sided heart endocarditis contributes to a small portion of infective endocarditis (IE) cases. Right-sided endocarditis related to undiagnosed congenital heart defects is even more scarce. Prompt diagnosis by transthoracic echocardiography (TTE), aggressive antibiotics from the beginning, and surgical removal of the vegetation for IE help prevent the risk of multi-organ failure and fatal pulmonary embolism. This is a case of a 38-year-old female, with normal medical history and recent vaginal birth at a district hospital four months ago. She was admitted to the hospital because of fever and continuous shortness of breath one month before admission. TTE detected vegetation (10x23 mm) on the left pulmonary artery and patent ductus arteriosus. A CT scan showed several abnormal mobile mixed-echo masses in the left pulmonary artery and partial pulmonary embolism. The patient had surgery to remove the vegetation and close the patent ductus arteriosus. The patient was stable after surgery and discharged two weeks after surgery. She continued two-week oral antibiotics at home and made a follow-up appointment one month later. Pulmonary artery endarteritis associated with patent ductus arteriosus is a rare lesion and has a high risk of death. The diagnosis should be considered in any febrile, septic patient with congenital heart disease. Removing vegetation and aggressive antibiotic treatment should be performed together to improve the outcome.

Acute decompensated valvular disease encompasses a group of complex and challenging conditions, which are often the primary reason for admission to the cardiac intensive care unit and can also complicate the management of other primary cardiac disorders. Critically ill patients with valvular disease also present unique diagnostic and management challenges. Historically, medical and percutaneous interventional therapies have been limited and surgery was the only definitive treatment; however, surgical risk can at times be prohibitive. High-quality evidence to direct management of acute valvular disorders in this population is lacking and societal guidelines largely do not address treatment options for critically ill patients with decompensated valvular disease. In this review, we discuss the clinical presentation and epidemiology of commonly encountered valvular diseases in the modern cardiac intensive care unit, highlight key pathophysiology, detail gaps in evidence, describe the pivotal role of multidisciplinary Heart Teams, and provide guidance for management.

Rheumatic heart disease (RHD) remains the leading cardiac problem affecting pregnant women, especially in low- to middle-income countries. In nearly one-third of the cases, it is detected during pregnancy when they present with complications. Infective endocarditis (IE) in pregnancy is rare, with an incidence of 1 in 100 000 pregnancies, and carries high maternal and fetal morbidity and mortality. Embolisation of the infective vegetation can lead to inoculation of the arterial wall, causing aneurysm, infarction or abscess formation. Being an end artery, splenic artery aneurysm and infarct can complicate IE; it can even be lethal due to ruptured aneurysm with intraperitoneal bleed. We report a patient who presented with IE complicated with a splenic-artery aneurysm during pregnancy, successfully managed by a multidisciplinary team.

Staphylococcus aureus infective endocarditis (IE) in native valves is associated with high mortality rates and is prone to various complications, including embolic strokes, which often result in poor prognoses. Contezolid, a novel oxazolidinone antibiotic, exhibits superior therapeutic efficacy with a reduced risk of hematologic toxicity. However, there are currently no reports on the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) IE accompanied by cerebrovascular complications.

We reported a young female patient with MSSA IE accompanied by cerebrovascular complications. She was diagnosed through blood culture, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cranial imaging, but the therapy using piperacillin-tazobactam and vancomycin failed. Therefore, the combination therapy of cefazolin and linezolid was applied, and her body temperature gradually returned to normal, and the infection symptoms were controlled. However, the platelets (PLT) dropped to 114 × 109/L, so contezolid was used as an alternative therapy. Subsequently, the PLT returned to normal. The patient received contezolid therapy for 3 weeks and was free of adverse events during the 2 years of follow-up.

This was the first case of MSSA IE accompanied by cerebrovascular complications in a young woman, who was successfully treated with an antibiotic regimen containing contezolid, without the need for surgical intervention, demonstrating remarkable efficacy and safety.

Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.

Blood culture-negative endocarditis (BCNE) is a challenging disease because of the significant impact of delayed diagnosis on patients. In this study, excised heart valves and blood serum samples were collected from 50 BCNE patients in two central hospitals in Tehran, Iran. Sera were tested by IFA for the presence of IgG and IgM antibodies against Bartonella quintana and B. henselae. Genomic DNA extracted from the heart valves was examined for Bartonella-specific ssrA gene in a probe-based method real-time PCR assay. Any positive sample was Sanger sequenced. IgG titer higher than 1024 was observed in only one patient and all 50 patients tested negative for Bartonella IgM. By real-time PCR, the ssrA gene was detected in the valve of one patient which was further confirmed to be B. quintana. Bartonella-like structures were observed in transmission electron microscopy images of that patient. We present for the first time the involvement of Bartonella in BCNE in Iran. Future research on at-risk populations, as well as domestic and wild mammals as potential reservoirs, is recommended.

Listeria monocytogenes is a prevalent gram-positive intracellular zoonotic pathogen that is frequently associated with foodborne illnesses and opportunistic infections. This bacterium is responsible for causing various clinical manifestations, including bacteremia, meningitis, and encephalitis, and is primarily transmitted through contaminated food consumption. This study presents two cases of severe endocarditis in patients with heart valve disease caused by L. monocytogenes. Infection was confirmed by blood culture and pathogen culture of the valve pus. Early detection, clinical suspicion, and appropriate treatment are crucial for improving the prognosis of patients with listeriosis. The combination of ampicillin and aminoglycosides remains the most effective treatment for listeriosis.

Background: Sarcopenia, characterized by the loss of skeletal muscle mass, is an emerging comorbidity associated with poor outcomes in cardiovascular surgery. Its impact on mortality in patients undergoing valve surgery for infective endocarditis (IE) remains underexplored. This study investigates the relationship between sarcopenia, measured by the Psoas muscle area index (PMAi), and mortality in patients with IE undergoing valve surgery. Materials and Methods: We retrospectively analyzed 68 patients with IE who underwent valve surgery at a tertiary care center from 2013 to 2021. Sarcopenia was defined as being in the lowest quartile of PMAi, measured via preoperative computed tomography (CT). Baseline characteristics, survival outcomes, and factors influencing mortality were analyzed using Kaplan-Meier survival curves and Cox proportional hazards regression. The predictive value of PMAi for 1-year and 3-year mortality was assessed via receiver operating characteristic (ROC) curves. Results: Sarcopenia was strongly associated with increased mortality at both 1-year (HR: 0.378, p = 0.010) and 3-year follow-ups (HR: 0.457, p = 0.012). Female sex (OR: 275.748, p < 0.001) and older age (OR: 9.995, p = 0.003) were significant predictors of sarcopenia. Chronic kidney insufficiency (CKI) and the use of heart failure medication therapy also significantly impacted survival outcomes. Conclusions: Sarcopenia is a strong independent predictor of short- and mid-term mortality in patients undergoing valve surgery for IE. Routine radiological assessment of sarcopenia using PMAi could improve risk stratification and guide preoperative interventions. Tailored management strategies, especially in older women and patients with CKI, may enhance outcomes in this high-risk population.

Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke.

A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40-0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32-0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40-0.68).2, 4 CONCLUSIONS: MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.

The aim of this study was to assess the clinical significance and prognostic value of the preoperative fibrinogen (FBG) level in patients with native valve infective endocarditis (NVIE) who underwent valve surgery.

This retrospective study included a total of 163 consecutive patients who were diagnosed with NVIE and underwent valve surgery from January 2019 to January 2022 in our hospital. The primary endpoint was all-cause mortality.

All-cause mortality was observed in 9.2% of the patients (n = 15). Body mass index (BMI) was lower in the survival group (p = 0.025), whereas FBG (p = 0.008) and platelet count (p = 0.044) were significantly greater in the survival group than in the death group. Multivariate Cox proportional hazards analysis revealed that FBG (HR, 0.55; 95% CI, [0.32-0.94]; p = 0.029) was an independent prognostic factor for all-cause mortality. Furthermore, Kaplan‒Meier survival curve analysis revealed that patients with low FBG levels (<3.28 g/L) had a significantly greater mortality rate (p = 0.034) than did those with high FBG levels (>3.99 g/L). In the trend analysis, the FBG tertiles were significantly related to all-cause mortality in all three adjusted models, and the p values for trend were 0.017, 0.016, and 0.028, respectively.

Preoperative FBG may serve as a prognostic factor for all-cause mortality, and an FBG concentration less than 3.28 g/L was associated with a greater risk of all-cause mortality in NVIE patients undergoing valve surgery.

Purpose To radiographically characterise dental disease burden and related characteristics of referred patients awaiting cardiovalvular surgery (CVS) in the context of infective endocarditis (IE) risk.Methods Radiographic evidence of dental disease levels was assessed for patients referred for dental assessment pre-CVS using available orthopantomographs (OPTs) prescribed by the cardiology team. This group did not receive any pre-CVS dental intervention or treatment.Results The majority of OPTs were Quality Standard 2 (87.5%). There was radiographic evidence of dentoalveolar disease in those patients proceeding to CVS. Periodontal disease was most prominent, with 79% of patients having advanced bone loss. The mean number of apical lesions was 0.71. Overall decayed, missing, and filled teeth score was 16.4, along with mean missing teeth scores of 7.9. None of the patients have so far developed IE at a minimum of six-month follow-up.Conclusions In our context, the quality of the radiographs requested by non-dental clinicians and delivered by non-dental-school-based radiographic departments is suboptimal and needs to be addressed. This audit should help to inform the debate around the timing and delivery of evidence-based, specialist dental care for CVS patients.

Abiotrophia (ABI) and Granulicatella (GRA) are rare causative pathogens in infective endocarditis (IE). This study aims to describe the epidemiology, clinical characteristics, and outcome of ABI/GRA-IE. The main features of ABI/GRA-IE were compared with Viridans group streptococci (VGS) IE.

From January 2015 to December 2023, a total of 1531 definite IE in Zhongshan Hospital, Fudan University, Shanghai, China were retrospectively enrolled in this study. Clinical and laboratory data were collected.

Forty-five ABI/GRA-IE cases were identified, representing 2.9% of all IE cases in Zhongshan Hospital between 2015 and 2023, compared to 20.1% of VGS-IE. ABI and GRA IE shared similar clinical characteristics. Congenital valvulopathy was reported in 21 (46.7%) ABI/GRA-IE and 85 (28.8%) VGS-IE (P = 0.025). Pulmonary valve was more frequently affected in ABI/GRA-IE (6 [13.3%]) than VGS-IE (7 [2.4%]) (P = 0.002). Congestive heart failure was observed in 30 (66.7%) ABI/GRA-IE and 103 (34.9%) VGS-IE (P < 0.001). Systemic embolization excluding central nervous system (CNS) occurred in 13 (28.9%) ABI/GRA-IE and 39 (13.2%) VGS-IE (P = 0.012). In-hospital mortality was reported as 4.4% in ABI/GRA-IE and 3.7% in VGS-IE (P = 0.854).

GRA/ABI-IE was approximately one-seventh as prevalent as VGS-IE. Congestive heart failure and systemic embolization (excluding CNS) were more frequent in GRA/ABI-IE compared to VGS-IE. Mortality of ABI/GRA-IE in this study was comparable to that of VGS-IE and lower than previously reported results.

Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.

Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.

The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).

In this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

This case involves native mitral valve infective endocarditis in a chronic hemodialysis patient resulting from a catheter-related bloodstream infection (CRBSI). Infective endocarditis in dialysis patients is more common and is associated with higher mortality rates compared to non-dialysis patients. It is also a serious complication of tunneled dialysis catheter infections. The presentation and diagnosis of infective endocarditis in chronic dialysis patients can be challenging and may often be overlooked. This case highlights the importance of maintaining a strong clinical suspicion for infective endocarditis when such patients deteriorate from their baseline status or deviate from the expected response to appropriate treatment.