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Multidisciplinary Endocarditis Perspectives
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Multidisciplinary Endocarditis Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (25 March 2024) | Viewed by 10037

Special Issue Editor

Dr. Giovanni La Canna

E-Mail Website
Guest Editor
Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy
Interests: echocardiography; valvular heart disease; hypertrophic cardiomyopathy; mitral valve prolapse; endocarditis; post-radiation heart disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Endocarditis is a complex clinical pathology with a high mortality rate despite diagnostic and therapeutic improvements. In recent years, we have seen significant changes in its epidemiological and clinical profile, with a variation in the population at risk and increase in nosocomial forms of endocarditis with antibiotic-resistant or fastidious bacteria. Endocarditis is a great simulator when it occurs with an embolic event that might lead diagnosis towards other pathologies, or it may in turn be simulated by disparate diseases. Rapid diagnostic recognition and appropriate therapy are crucial to eradicate the infection, prevent embolism, and treat cardiac failure. Guidelines provide useful support, even though they are based mainly on the opinions of experts rather than on randomized studies, with some inconsistencies between medical scientific societies. Diagnostic and therapeutic management is therefore an important clinical challenge that often requires a tailored approach. Multi-specialist involvement with structured pathways may optimize the outcome.

This Special Issue focuses on multidisciplinary perspectives of endocarditis, including:

- The new scenario of prevention;

- New insights into the development of infective endocarditis;

- Diagnostic work-up;

- Clinical pathway of embolic syndrome;

- Management challenges;

- Clinical pathway of blood culture negative endocarditis;

- Extra-cardiac complications: other specialists on the pitch;

- Clinical pathway for cardiac device infections; 

- The emerging challenge of endocarditis during the COVID-19 epidemic;

- Transcatheter implanted cardiac valve endocarditis: an emerging issue in the elderly population;

- Endocarditis and cancer.

Dr. Giovanni La Canna
Guest Editor

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Related Special Issue

Published Papers (5 papers)

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Research

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12 pages, 945 KiB  
Article
Impact of Enterococci vs. Staphylococci Induced Infective Endocarditis after Transcatheter Aortic Valve Implantation
by Tomasz Gasior, Felix J. Woitek, Antonia Schroth, Mohamed Abdel-Wahab, Lisa Crusius, Stephan Haussig, Philipp Kiefer, Piotr Scislo, Zenon Huczek, Maciej Dabrowski, Adam Witkowski, Anna Olasinska-Wisniewska, Marek Grygier, Marcin Protasiewicz, Damian Hudziak, Utz Kappert, David Holzhey, Wojtek Wojakowski, Axel Linke and Norman Mangner
J. Clin. Med. 2023, 12(5), 1817; https://doi.org/10.3390/jcm12051817 - 24 Feb 2023
Cited by 1 | Viewed by 1860
Abstract
Background: The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. Methods: TAVI-IE patients from 2007 to 2021 [...] Read more.
Background: The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. Methods: TAVI-IE patients from 2007 to 2021 were included in this analysis. The 1-year mortality was the primary outcome measure of this retrospective multi-center analysis. Results: Out of 163 patients, 53 (32.5%) EC-IE and 69 (42.3%) SC-IE patients were included. Subjects were comparable with regard to age, sex, and clinically relevant baseline comorbidities. Symptoms at admission were not significantly different between groups, except for a lower risk for presenting with septic shock in EC-IE than SC-IE. Treatment was performed in 78% by antibiotics alone and in 22% of patients by surgery and antibiotics, with no significant differences between groups. The rate of any complication, in particular heart failure, renal failure, and septic shock during treatment for IE, was lower in EC-IE compared with SC-IE (p < 0.05). In-hospital (EC-IE: 36% vs. SC-IE: 56%, p = 0.035) and 1-year mortality (EC-IE: 51% vs. SC-IE: 70%, p = 0.009) were significantly lower in EC-IE compared with SC-IE. Conclusions: EC-IE, compared with SC-IE, was associated with a lower morbidity and mortality. However, absolute numbers are high, a finding that should trigger further research in appropriate perioperative antibiotic management and improvement of early IE diagnosis in the case of clinical suspicion. Full article
(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)
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Review

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52 pages, 917 KiB  
Review
New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended
by Alessandra Oliva, Francesco Cogliati Dezza, Francesca Cancelli, Ambrogio Curtolo, Antonio Falletta, Lorenzo Volpicelli and Mario Venditti
J. Clin. Med. 2023, 12(24), 7693; https://doi.org/10.3390/jcm12247693 - 14 Dec 2023
Viewed by 1795
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines [...] Read more.
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice. Full article
(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)
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11 pages, 1479 KiB  
Review
Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis
by Hussam Ali, Sara Foresti, Guido De Ambroggi, Riccardo Cappato and Pierpaolo Lupo
J. Clin. Med. 2023, 12(21), 6908; https://doi.org/10.3390/jcm12216908 - 2 Nov 2023
Viewed by 1133
Abstract
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system’s resources. Infective endocarditis (IE) represents one of the most threatening CIED-related [...] Read more.
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system’s resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors’ experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients’ management and clinical outcomes. Full article
(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)
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18 pages, 567 KiB  
Review
Diagnostic Work-Up in Patients with Nonbacterial Thrombotic Endocarditis
by Antonio Tonutti, Iside Scarfò, Giovanni La Canna, Carlo Selmi and Maria De Santis
J. Clin. Med. 2023, 12(18), 5819; https://doi.org/10.3390/jcm12185819 - 7 Sep 2023
Cited by 4 | Viewed by 2265
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis that occurs in patients with predisposing conditions, including malignancies, autoimmune diseases (particularly antiphospholipid antibody syndrome, which accounts for the majority of lupus-associated cases), and coagulation disturbances for which the correlation with classical determinants is [...] Read more.
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis that occurs in patients with predisposing conditions, including malignancies, autoimmune diseases (particularly antiphospholipid antibody syndrome, which accounts for the majority of lupus-associated cases), and coagulation disturbances for which the correlation with classical determinants is unclear. The condition is commonly referred to as “marantic”, “verrucous”, or Libman–Sacks endocarditis, although these are not synonymous, representing clinical–pathological nuances. The clinical presentation of NBTE involves embolic events, while local valvular complications, generally regurgitation, are typically less frequent and milder compared to infective forms of endocarditis. In the past, the diagnosis of NBTE relied on post mortem examinations, while at present, the diagnosis is primarily based on echocardiography, with the priority of excluding infective endocarditis through comprehensive microbiological and serological tests. As in other forms of endocarditis, besides pathology, transesophageal echocardiography remains the diagnostic standard, while other imaging techniques hold promise as adjunctive tools for early diagnosis and differentiation from infective vegetations. These include cardiac MRI and 18FDG-PET/CT, which already represents a major diagnostic criterion of infective endocarditis in specific settings. We will herein provide a comprehensive review of the current knowledge on the clinics and therapeutics of NBTE, with a specific focus on the diagnostic tools. Full article
(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)
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21 pages, 23908 KiB  
Review
Early Biological Valve Failure: Structural Valve Degeneration, Thrombosis, or Endocarditis?
by Fabio Fazzari, Andrea Baggiano, Laura Fusini, Sarah Ghulam Ali, Paola Gripari, Daniele Junod, Maria Elisabetta Mancini, Riccardo Maragna, Saima Mushtaq, Gianluca Pontone, Mauro Pepi and Manuela Muratori
J. Clin. Med. 2023, 12(17), 5740; https://doi.org/10.3390/jcm12175740 - 3 Sep 2023
Cited by 6 | Viewed by 2212
Abstract
Biological valve failure (BVF) is an inevitable condition that compromises the durability of biological heart valves (BHVs). It stems from various causes, including rejection, thrombosis, and endocarditis, leading to a critical state of valve dysfunction. Echocardiography, cardiac computed tomography, cardiac magnetic resonance, and [...] Read more.
Biological valve failure (BVF) is an inevitable condition that compromises the durability of biological heart valves (BHVs). It stems from various causes, including rejection, thrombosis, and endocarditis, leading to a critical state of valve dysfunction. Echocardiography, cardiac computed tomography, cardiac magnetic resonance, and nuclear imaging play pivotal roles in the diagnostic multimodality workup of BVF. By providing a comprehensive overview of the pathophysiology of BVF and the diagnostic approaches in different clinical scenarios, this review aims to aid clinicians in their decision-making process. The significance of early detection and appropriate management of BVF cannot be overstated, as these directly impact patients’ prognosis and their overall quality of life. Ensuring timely intervention and tailored treatments will not only improve outcomes but also alleviate the burden of this condition on patients’ life. By prioritizing comprehensive assessments and adopting the latest advancements in diagnostic technology, medical professionals can significantly enhance their ability to manage BVF effectively. Full article
(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)
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