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Pathogens
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Updates in Infective Endocarditis
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Updates in Infective Endocarditis

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Bacterial Pathogens".

Deadline for manuscript submissions: 22 August 2024 | Viewed by 14581

Special Issue Editors

Dr. Hussam Tabaja

E-Mail Website1 Website2
Guest Editor
Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
Interests: cardiovascular infections; orthopedic infections; hardware-associated infections; antimicrobial resistance; mycobacterial infections
Dr. Maryam Mahmood

E-Mail Website
Guest Editor
Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
Interests: cardiovascular infections; HIV; transplant infectious diseases

Special Issue Information

Dear Colleagues,

Infective Endocarditis (IE) is an uncommon yet debilitating condition that has received considerable attention in the medical field over the past century. The crude incidence of IE is anywhere between 2 and 10 cases per 100,000 people. The epidemiology of IE is dynamic and has changed over the last few decades owing to changes in the epidemiology of rheumatic heart disease and to the increased use of cardiovascular devices. What was once a disease of young adults now predominantly affects patients above the age of 50 years, particularly in the industrialized world. Moreover, IE has shifted from its commonly subacute form caused by viridans group Streptococci to a largely acute infection caused by Staphylococcus aureus and other virulent Gram-positive pathogens. Therefore, IE remains an aggressive disease with marked morbidity and mortality. The 1-year mortality from IE can reach up to 30%-40% overall and may even be higher when caused by S. aureus. 

Early diagnosis and treatment of IE provides the best chance for reduced morbidity and mortality. Despite the scientific advances made in understanding IE, it remains a challenging infection to diagnose. In fact, as low as 20% of clinically diagnosed cases were classified as definite IE in some studies. Many uncertainties also remain about the optimal therapeutic approach to IE. This includes both surgical, novel percutaneous interventions and antimicrobial therapies. Physicians in the field require updates on contemporary advances in IE management. The most recent scientific statement from the American Heart Association and the Infectious Diseases Society of America date back to 2015, as do the relevant guidelines from the European Society of Cardiology. Since then, important developments in IE research have occurred that warrant discussion. This Special Issue will serve the purpose of updating clinicians on the epidemiology, diagnosis, and management of IE in the current era. 

The focus of this Issue will be on advances made in the following areas of research, though research in other areas within IE is welcome. 

  • Trends in the epidemiology of IE
  • Pathogen-specific risks for IE
  • Culture-negative IE
  • Risk scores for echocardiography
  • Diagnostic imaging in IE
  • Microbiologic diagnosis of IE
  • Dogma and uncertainties in antimicrobial therapy for IE
  • Surgical management of IE
  • AngioVac for IE
  • Phage therapy for IE
  • Antibiotic prophylaxis for dental procedures
  • IE in people who inject drugs
  • IE complicating Transcutaneous Aortic Valve Replacement (TAVR).

Dr. Hussam Tabaja
Dr. Maryam Mahmood
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • infective endocarditis
  • cardiovascular infection
  • echocardiography
  • nuclear scan
  • positron-emission tomography
  • AngioVac
  • phage therapy
  • transcutaneous aortic valve replacement
  • TAVR

Published Papers (5 papers)

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Research

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10 pages, 1163 KiB  
Article
A Population-Based Evaluation of Polymicrobial Staphylococcus aureus Bacteremia
by Joya-Rita Hindy, Juan A. Quintero-Martinez, Brian D. Lahr, Daniel C. DeSimone and Larry M. Baddour
Pathogens 2022, 11(12), 1499; https://doi.org/10.3390/pathogens11121499 - 08 Dec 2022
Cited by 1 | Viewed by 1068
Abstract
Objective: To provide an evaluation of incidence and six-month mortality rates of polymicrobial Staphylococcus aureus bacteremia (p-SAB) in the United States (US). Methods: A retrospective population-based study of all incident adults with monomicrobial SAB (m-SAB) and p-SAB in Olmsted County, Minnesota (MN) from [...] Read more.
Objective: To provide an evaluation of incidence and six-month mortality rates of polymicrobial Staphylococcus aureus bacteremia (p-SAB) in the United States (US). Methods: A retrospective population-based study of all incident adults with monomicrobial SAB (m-SAB) and p-SAB in Olmsted County, Minnesota (MN) from 1 January 2006, through 31 December 2020, was conducted. Demographics, clinical characteristics, in-hospital outcomes, and six-month survival were compared between groups. Results: Overall, 31 incident p-SAB cases occurred during the 15-year study period, corresponding to an overall age- and sex-standardized incidence rate of 1.9/100,000 person-years (95% CI, 1.3–2.6). One-third of p-SAB cases were due to MRSA, and almost one-half (15/31) were caused by Gram-positive bacteria. As compared to the 541 cases with incident m-SAB, p-SAB patients were more likely to have a catheter-related infection (p = 0.008) and less likely to be community-acquired cases (p = 0.027). The unadjusted risk of six-month mortality was greater in the p-SAB group (14/31, 45.2%) compared to the m-SAB group (144/541, 26.6%) (HR = 1.94, 95% CI = 1.12–3.36, p = 0.018). After adjusting for relevant covariates, this difference approached significance (HR = 1.93, 95% = CI 0.96–3.87, p = 0.064). Conclusions: To our knowledge, the current investigation represents the only US population-based study evaluating p-SAB patients. We found lower incidence rates for p-SAB than previously reported, with almost one-half of the cases caused by Gram-positive bacteria. Furthermore, these patients had poor survival compared to incident m-SAB cases. Full article
(This article belongs to the Special Issue Updates in Infective Endocarditis)
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11 pages, 653 KiB  
Article
Molecular and Serological Diagnostic Approach to Define the Microbiological Origin of Blood Culture-Negative Infective Endocarditis
by Amira H. El-Ashry, Khaled Saad, Ahmed A. Obiedallah, Amira Elhoufey, Hamad Ghaleb Dailah and Mohammed Salah A. Hussein
Pathogens 2022, 11(11), 1220; https://doi.org/10.3390/pathogens11111220 - 22 Oct 2022
Cited by 3 | Viewed by 1757
Abstract
Blood culture-negative infective endocarditis (BCNIE) poses a significant challenge in determining the best antibiotic regimen for this life-threatening infection, which should be treated with as specific and effective a regimen as feasible. The goal of this study was to determine the prevalence of [...] Read more.
Blood culture-negative infective endocarditis (BCNIE) poses a significant challenge in determining the best antibiotic regimen for this life-threatening infection, which should be treated with as specific and effective a regimen as feasible. The goal of this study was to determine the prevalence of BCNIE among definite infective endocarditis (IE) cases and to study the impact of a molecular and serological diagnostic approach in defining the microbiological origin of BCNIE. This study included 94 definite IE cases. Serum and blood samples from BCNIE patients were tested using serological, broad-range PCR, and sequencing assays. Valve tissue sections obtained from 42 operated patients were subjected to culture and molecular studies. BCNIE accounted for 63 (67%) of the cases. Of these cases, blood PCR followed by sequencing could diagnose 11 cases. Zoonotic infective endocarditis was detected in 7 (11%) patients by serology and PCR (four Brucella, two Bartonella, and one Coxiella). Sequencing of valve PCR bands revealed 30 positive cases. Therefore, the percentage of BCNIE with unidentified etiology was reduced from 67% to 27.7% through a combination of all diagnostic procedures utilized in our study. Blood and valve PCR and sequencing assays are valuable techniques for the etiological diagnosis of BCNIE, especially in cases with previous antibiotic therapy. However, these tests should be used as part of a larger diagnostic strategy that includes serology, microscopy, and valve culture. The use of an automated blood culture system, and proper blood culture collection before ordering antibiotics, will guide IE etiological diagnosis. Full article
(This article belongs to the Special Issue Updates in Infective Endocarditis)
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Review

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12 pages, 444 KiB  
Review
Updates in Culture-Negative Endocarditis
by Jack McHugh and Omar Abu Saleh
Pathogens 2023, 12(8), 1027; https://doi.org/10.3390/pathogens12081027 - 10 Aug 2023
Cited by 4 | Viewed by 4982
Abstract
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial [...] Read more.
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial endocarditis with sterilized blood cultures due to previous antibiotic treatment, endocarditis caused by fastidious microorganisms, and true BCNE caused by intracellular organisms that cannot be cultured using traditional techniques. Non-infectious causes such as nonbacterial thrombotic endocarditis should also be considered. Diagnostic approaches involve thorough patient history; blood and serum testing, including appropriate handling of blood cultures; serological testing; and molecular techniques such as targeted and shotgun metagenomic sequencing. Where available, evaluation of explanted cardiac tissue through histopathology and molecular techniques is crucial. The therapy for BCNE depends on the likely causative agent and the presence of prosthetic material, with surgical intervention often required. Full article
(This article belongs to the Special Issue Updates in Infective Endocarditis)
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0 pages, 417 KiB  
Review
Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis
by Jennifer L. Adema, Aileen Ahiskali, Madiha Fida, Krutika Mediwala Hornback, Ryan W. Stevens and Christina G. Rivera
Pathogens 2023, 12(5), 703; https://doi.org/10.3390/pathogens12050703 - 12 May 2023
Cited by 2 | Viewed by 3266 | Correction
Abstract
Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals’ experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction [...] Read more.
Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals’ experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides. Full article
(This article belongs to the Special Issue Updates in Infective Endocarditis)
17 pages, 684 KiB  
Review
Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management
by Johnny Zakhour, Fatima Allaw, Suha Kalash, Saliba Wehbe and Souha S. Kanj
Pathogens 2023, 12(2), 255; https://doi.org/10.3390/pathogens12020255 - 05 Feb 2023
Cited by 1 | Viewed by 2634
Abstract
Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a [...] Read more.
Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, the duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood. Full article
(This article belongs to the Special Issue Updates in Infective Endocarditis)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Who needs an echocardiogram in patients with gram-positive bacteremia. A systematic review
Author: Hernández-Meneses
Highlights: Performing TEE must be determined by the pre-test probability for IE. The pre-test probability for IE is determined by host predisponent factors, bacteriemia causal microorganisms, and its duration. Several clinical scores were developed to classify patients between high and low probability for IE. The ideal clinical score should safely exclude the TEE requirement in low-risk gram-positive bacteremic patients.

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