Isabel Zegri-Reiriz1, Arístides de Alarcón2, Patricia Muñoz3, Manuel Martínez Sellés4, Victor González-Ramallo5, Jose M Miro6, Carles Falces7, Claudia Gonzalez Rico8, Xabier Kortajarena Urkola9, José Antonio Lepe2, Regino Rodriguez Alvarez10, Jose Maria Reguera Iglesias11, Enrique Navas12, Fernando Dominguez13, Pablo Garcia-Pavia14. 1. Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain. 2. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain. 3. Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 4. Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain. 5. Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 6. Department of Infectious Diseases, Hospital Clínic- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. 7. Department of Cardiology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. 8. Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 9. Department of Infectious Diseases, Hospital Universitario de Donostia, San Sebastián, Spain. 10. Department of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain. 11. Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain. 12. Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain. 13. Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain. Electronic address: fdominguezrodriguez@gmail.com. 14. Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain. Electronic address: pablogpavia@yahoo.es.
Abstract
BACKGROUND: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. OBJECTIVES: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. METHODS: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). RESULTS: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. CONCLUSIONS: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
BACKGROUND: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. OBJECTIVES: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. METHODS: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). RESULTS: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. CONCLUSIONS: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
Authors: Juan Lacalzada-Almeida; Maria Manuela Izquierdo-Gomez; Amelia Duque-Gonzalez; Maria Del Mar Alonso-Socas; Rebeca Munoz-Rodriguez Journal: J Med Cases Date: 2022-06-11
Authors: Jordan E Morningstar; Annah Nieman; Christina Wang; Tyler Beck; Andrew Harvey; Russell A Norris Journal: J Am Heart Assoc Date: 2021-06-22 Impact factor: 5.501