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Microorganisms
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The Infective Endocarditis
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The Infective Endocarditis

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: 31 January 2025 | Viewed by 10467

Special Issue Editors

Prof. Dr. Jose M. Miro

E-Mail Website
Guest Editor
1. Infectious Diseases Service, Hospital Clínic—IDIBAPS, University of Barcelona, Barcelona, Spain
2. CIBERINFEC Investigator, Instituto de Salud Carlos III, Madrid, Spain
Interests: infective endocarditis
Dr. Guillermo Cuervo

E-Mail Website
Guest Editor
Senior Specialist of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
Interests: infective endocarditis

Special Issue Information

Dear Colleagues,

Cardiovascular infections are life-threatening diseases with high morbidity and mortality, despite the advances in diagnosis, antimicrobial therapy and the role of cardiac surgery. Infective endocarditis (IE) is the most severe cardiovascular infection and is a constantly changing disease. In the next 10 years, IE will increase in the elderly population and patients with intracardiac devices (prosthetic valves, cardiac implantable electronic devices and TAVI) and in persons who inject drugs (PWID).  Improving strategies of prevention in the community and in hospitals (bacteremia-zero protocols) is key for avoiding IE. The endocarditis team (IE Team) plays an important role in improving patients’ diagnoses and outcomes. Diagnoses will be faster and more accurate with the new molecular biology and nuclear medicine tools and neurological complications will be reduced with mechanical thrombectomy. Staphylococcal and enterococcal infections are the leading IE etiologies. Antibiotic treatment schema will change the initial IV induction phase followed by oral antibiotic consolidation. Surgery plays an important role in the curation of these infections, as it is needed in around 50% of cases. The new aims in the surgical field include improving indications and timing. Machine learning and AI can help us to achieve some of these goals. As stated before, IE remains a disease of high morbidity and mortality, with far-reaching effects on the quality of life of survivors. In addition, vascular graft infections and LVAD infections are increasing and their management is challenging.

For this Special Issue, we invite you to submit contributions on infective endocarditis and cardiovascular infections, including experimental models, epidemiology, genetic susceptibility, infection mechanisms, staphylococcal and enterococcal endocarditis, endocarditis in the elderly, in people with CIED and prosthetic valves and TAVI and in PWID and novel medical and surgical treatment strategies, vascular graft infections and LVAD infections.

Prof. Dr. Jose M. Miro
Dr. Guillermo Cuervo
Guest Editors

Manuscript Submission Information

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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. Microorganisms 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 (IE)
  • native valve endocarditis
  • TAVI endocarditis
  • prosthetic valve endocarditis
  • staphylococcal endocarditis
  • enterococcal endocarditis
  • molecular biology diagnosis
  • cardiac PET/CT diagnosis
  • vascular graft infections
  • LVAD infections
  • endocarditis in the elderly
  • endocarditis in PWID
  • oral antimicrobial treatment of IE
  • cardiac surgery of IE
  • cardiovascular infections
  • cardiac implantable electronic device (CIED)-IE

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Published Papers (10 papers)

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Research

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16 pages, 2451 KiB  
Article
Diagnostic Benefit of Molecular Imaging in Patients Undergoing Heart Valve Surgery for Infective Endocarditis
by Dustin Greve, Emma Sartori, Hector Rodriguez Cetina Biefer, Stefania-Teodora Sima, Dinah Von Schöning, Frieder Pfäfflin, Miriam Songa Stegemann, Volkmar Falk, Annette Moter, Judith Kikhney and Herko Grubitzsch
Microorganisms 2024, 12(9), 1889; https://doi.org/10.3390/microorganisms12091889 - 13 Sep 2024
Viewed by 709
Abstract
(1) Background: The successful treatment of infective endocarditis (IE) relies on detecting causative pathogens to administer targeted antibiotic therapy. In addition to standard microbiological cultivation of pathogens from tissue obtained during heart valve surgery, the potential of molecular biological methods was evaluated. (2) [...] Read more.
(1) Background: The successful treatment of infective endocarditis (IE) relies on detecting causative pathogens to administer targeted antibiotic therapy. In addition to standard microbiological cultivation of pathogens from tissue obtained during heart valve surgery, the potential of molecular biological methods was evaluated. (2) Methods: A retrospective study was performed on heart valve tissue from 207 patients who underwent heart valve surgery for IE. FISHseq (fluorescence in situ hybridization combined with 16S rRNA gene PCR and sequencing) was performed in addition to conventional culture-based microbiological diagnostics. The diagnostic performance of FISHseq was compared with the conventional methods and evaluated in the clinical context. (3) Results: Overall, FISHseq provided a significantly higher rate of specific pathogen detection than conventional valve culture (68.1% vs. 33.3%, p < 0.001). By complementing the findings from blood culture and valve culture, FISHseq was able to provide a new microbiological diagnosis in 10% of cases, confirm the cultural findings in 24.2% of cases and provide greater diagnostic accuracy in 27.5% of cases. FISHseq could identify a pathogen in blood-culture-negative IE in 46.2% of cases, while valve culture provided only 13.5% positive results (p < 0.001). (4) Conclusions: This study demonstrates that using FISHseq as an additional molecular biological technique for diagnostics in IE adds substantial diagnostic value, with potential implications for the treatment of IE. It provides pathogen detection, especially in cases where conventional microbiological cultivation is negative or inconclusive. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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11 pages, 266 KiB  
Article
Trend in Infective Endocarditis in Bulgaria: Characteristics and Outcome, 17-Years, Single Center Experience
by Bistra Dobreva-Yatseva, Fedya Nikolov, Ralitsa Raycheva, Petar Uchikov and Mariya Tokmakova
Microorganisms 2024, 12(8), 1631; https://doi.org/10.3390/microorganisms12081631 - 9 Aug 2024
Viewed by 887
Abstract
Background: Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. Methods: This study is retrospective, single-centered, and includes 270 patients [...] Read more.
Background: Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. Methods: This study is retrospective, single-centered, and includes 270 patients diagnosed with IE for the period 2005–2021. We compared two periods, 2005–2015 (n = 119) and 2016–2021 (n = 151), to find the characteristics changes. Results: The study included 177 (65.5%) male patients. In the second period, there is a significant increase in age from 62 (44–73) to 67 (53–75), (p = 0.023); in the Charlson comorbidities index (CCI) from 3 (1–4) to 4 (2–6), (p = 0.000); in cases with chronic kidney diseases (CKDs) from 15 (12.6%) to 55 (36.9%), (p = 0.001); coronary arterial diseases (CADs) from 20 (16.85%) to 44 (29.1%), (p = 0.018); and atrial fibrillation (AF) from 13 (10.9%) to 36 (23.8%), (p = 0.006). Ejection fraction decreased significantly in the second period from 63 (56–70) to 59 (51–66), (p = 0.000). Almost half of the patients 123 (45.6%) had no known predisposing cardiac condition, and 125 (46.3%) had an unknown port of entry. IE was community-acquired in 174 (64.4%), healthcare-associated in 72 (26.7%), and injection-drug-use-related IE in 24 (8.9%). The study population included 183 (67.8%) native valve IE, 85 (31.5%) prosthetic IE, and 2 (0.74%) intracardiac-device-related IE. The hemocultures were positive in 159 (59.6%), and the most frequent pathogenic agent was staphylococci—89 (33.3%) (Staphylococcus aureus—44 (16.5%) and coagulase negative staphylococci—45 (16.8%)). Only 54 (20%) of patients underwent early surgery. The all-cause 30-day mortality rate was 67 (24.8%). There is no significant difference between the two periods in terms of the characteristics listed above. Conclusions: The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions, and entry door. The most common pathogen was the Staphylococcus spp. The 30-day mortality rate remains high. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
11 pages, 1170 KiB  
Article
The Role of Microbes in Surgical Decision Making for Infective Endocarditis: Mitral Valve Repair or Replacement?
by Elisa Mikus, Mariafrancesca Fiorentino, Diego Sangiorgi, Renato Pascale, Antonino Costantino, Chiara Nocera, Simone Calvi, Elena Tenti, Elena Tremoli, Alberto Tripodi and Carlo Savini
Microorganisms 2024, 12(7), 1320; https://doi.org/10.3390/microorganisms12071320 - 28 Jun 2024
Cited by 1 | Viewed by 713
Abstract
Background: The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology. Methods: All 251 patients undergoing mitral valve surgery for [...] Read more.
Background: The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology. Methods: All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained. Results: The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071). Conclusions: Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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16 pages, 265 KiB  
Article
Infective Endocarditis—Characteristics and Prognosis According to the Affected Valves
by Bistra Dobreva-Yatseva, Fedya Nikolov, Ralitsa Raycheva and Mariya Tokmakova
Microorganisms 2024, 12(5), 987; https://doi.org/10.3390/microorganisms12050987 - 14 May 2024
Cited by 2 | Viewed by 913
Abstract
Background: Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. Objective: The objective of this study was to investigate the characteristics and prognosis of IE according to the affected valves. Materials and methods: This study was retrospective and [...] Read more.
Background: Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. Objective: The objective of this study was to investigate the characteristics and prognosis of IE according to the affected valves. Materials and methods: This study was retrospective and single-centered, and it included 270 patients with a diagnosis of IE, for the period 2005–2021, who received treatment at the University Hospital “St. Georgi” in Plovdiv, Bulgaria. Results: Single-valve IE (SIE) was found in 82.6% (n-223), multivalvular IE (MIE) in 16.66% (n = 45) and device IE (CDRIE) in 0.74% (n = 2) of patients. The most commonly affected valve was the aortic valve, in 44.8% (n = 121). The predominant multivalvular involvement was aortic–mitral valves (AV-MV) (13.7%, n = 37). The patients with tricuspid valve (TV) IE were significantly younger, at 39 (30) years, and were more frequently male (80.8%). Mortality was higher in MIE than in SIE (31.1% vs. 23.8%) and was the highest in multivalve aortic–tricuspid (AV-TV) IE (75%). Early surgery was performed most in AV-MV IE, in 29.7% (n = 11). The Charlson comorbidity index (CCI) was significantly higher in MV 4 (4) and AV 3 (3) vs. TV IE 1 (5) (p = 0.048 and p = 0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p = 0.0001). The most common causative agents were of the Staphylococcus group. Staphylococcus aureus more often affected TV alone (46.2%, n = 124) vs. AV (9.9%, n = 14; p = 0.0001) and vs. MV (22.6%, n = 17; p = 0.022); Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE (22.7%, n = 17) vs. AV-MV (2.7%, n = 1; p = 0.007). Streptococci were represented in a low percentage and only in left-sided IE, more frequently in AV-MV (18.9%, n = 7) vs. AV (6.6%, n = 8; p = 0.025). Conclusions: The aortic valve is the most frequently affected valve, as single-valve IE or as multivalve AV-MV, with the predominant causative agents being of the Staphylococcus group. AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
12 pages, 2693 KiB  
Article
Clinical Profile and Prognosis of Patients with Left-Sided Infective Endocarditis with Surgical Indication Who Are Not Operated
by María de Miguel, Javier López, Isidre Vilacosta, Carmen Olmos, Carmen Sáez, Gonzalo Cabezón, Pablo Zulet, Adrián Jerónimo, Daniel Gómez, Paloma Pulido, Adrián Lozano, Andrea Oña, Itziar Gómez-Salvador and J. Alberto San Román
Microorganisms 2024, 12(3), 607; https://doi.org/10.3390/microorganisms12030607 - 19 Mar 2024
Cited by 2 | Viewed by 1163
Abstract
Approximately a quarter of patients with infective endocarditis (IE) who have surgical indication only receive antibiotic treatment. Their short-term prognosis is dismal. We aimed to describe the characteristics of this group of patients to evaluate the mortality according to the cause of rejection [...] Read more.
Approximately a quarter of patients with infective endocarditis (IE) who have surgical indication only receive antibiotic treatment. Their short-term prognosis is dismal. We aimed to describe the characteristics of this group of patients to evaluate the mortality according to the cause of rejection and type of surgical indication and to analyze their prognostic factors of mortality. From 2005 to 2022, 1105 patients with definite left-sided IE were consecutively attended in three tertiary hospitals. Of them, 912 (82.5%) had formal surgical indication according to the most recent European Guidelines available in each period of the study and 303 (33%) only received medical treatment. These were older, had more comorbidities and higher in-hospital (46% vs. 24%; p < 0.001) and one year mortality (57.1% vs. 27.6%; p < 0.001) than operated patients. The main reason for surgical rejection was high surgical risk (57.1%) and the highest mortality when the cause were severe neurological conditions (76%). When the endocarditis team took the decision not to operate (25.5% of the patients), in-hospital (7%) and one-year mortality (17%) were low. In-hospital mortality associated with each surgical indication was 67% in heart failure, 53% in uncontrolled infection and 45% in prevention of embolisms (p < 0.001). Heart failure (OR: 2.26 CI95%: 1.29–3.96; p = 0.005), Staphylococcus aureus (OR: 3.17; CI95%: 1.72–5.86; p < 0.001) and persistent infection (OR: 5.07 CI95%: 2.85–9.03) are the independent risk factors of in-hospital mortality. One third of the patients with left-sided IE and formal surgical indication are rejected for surgery. In-hospital mortality is very high, especially when heart failure is the indication for surgery and when severe neurological conditions the reason for rejection. Short term prognosis of patients rejected by a specialized endocarditis team is favorable. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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18 pages, 841 KiB  
Article
Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study
by Encarnación Gutiérrez-Carretero, Eduardo Arana-Rueda, Antonio Ortiz-Carrellán, Alonso Pedrote-Martínez, Mariano García-de-la-Borbolla and Arístides De Alarcón
Microorganisms 2024, 12(3), 537; https://doi.org/10.3390/microorganisms12030537 - 7 Mar 2024
Viewed by 1299
Abstract
Background: Cardiac device infections are serious adverse events associated with considerable morbidity and mortality, significant costs, and increased healthcare utilization. The aim of this study is to calculate the costs of treatment of cardiac implantable electrostimulation device (CIED)-related infections for different types of [...] Read more.
Background: Cardiac device infections are serious adverse events associated with considerable morbidity and mortality, significant costs, and increased healthcare utilization. The aim of this study is to calculate the costs of treatment of cardiac implantable electrostimulation device (CIED)-related infections for different types of infection (local or systemic) and therapeutic approaches. Patients and Methods: Single-center cohort (1985–2018). The costs of the CIED-related infections were analyzed according to initial treatment (antimicrobial treatment exclusively, local approach, or transvenous lead extraction (TLE)). Total costs (including those for hospitalization stay, drugs, extraction material, and newly implanted devices) were assigned to each case until its final resolution. Results: A total of 380 cases (233 local and 147 systemic infections) were analyzed. The average cost of systemic infection was EUR 34,086, mainly due to hospitalization (78.5%; mean: 24 ± 14 days), with a mortality rate of 10.8%. Local infection had a mortality rate of 2.5% (mainly related to the extraction procedure) and an average cost of EUR 21,790, which was higher in patients with resynchronization therapy devices and defibrillators (46% of total costs). Surgical procedures limited to the pocket for local infections resulted in a high rate of recurrence (87%), evolved to systemic infections in 48 patients, and had a higher cost compared to TLE (EUR 42,978 vs. EUR 24,699; p < 0.01). Conclusions: The costs of treating CIED-related infections are high and mainly related to the type of treatment and length of hospitalization. Complete device removal is always the most effective approach and is a cost-saving strategy. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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15 pages, 2684 KiB  
Article
Microbiological Etiology in Patients with IE Undergoing Surgery and for Patients with Medical Treatment Only: A Nationwide Study from 2010 to 2020
by Peter Laursen Graversen, Lauge Østergaard, Marianne Voldstedlund, Malthe Faurschou Wandall-Holm, Morten Holdgaard Smerup, Lars Køber and Emil Loldrup Fosbøl
Microorganisms 2023, 11(10), 2403; https://doi.org/10.3390/microorganisms11102403 - 26 Sep 2023
Cited by 2 | Viewed by 1119
Abstract
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 [...] Read more.
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 and examined the microbiological etiology of IE according to treatment choice. To identify factors associated with surgery during initial admission, we used the Aalen–Johansen estimator and an adjusted cause-specific Cox model. One-year mortality stratified by microbiological etiology and treatment choice was assessed using unadjusted Kaplan–Meier estimates and an adjusted Cox proportional hazard model. A total of 6255 patients were included, of which 1276 (20.4%) underwent surgery during admission. Patients who underwent surgery were younger (65 vs. 74 years) and less frequently had cerebrovascular disease, cardiovascular disease, diabetes, and chronic kidney disease. Patients with Staphylococcus aureus IE were less likely to undergo surgery during admission (13.6%) compared to all other microbiological etiologies. One-year mortality according to microbiological etiology in patients who underwent surgery was 7.0%, 5.3%, 5.5%, 9.6%, 13.2, and 11.2% compared with 24.2%, 19.1%, 27,6%, 25.2%, 21%, and 16.9% in patients who received medical therapy for Staphylococcus aureus, Streptococcus spp., Enterococcus spp., coagulase-negative Staphylococci, “other microbiological etiologies”, and blood culture-negative infective endocarditis, respectively. Patients with IE who underwent surgery differed in terms of microbiology, more often having Streptococci than those who received medical therapy. Contrary to expectations, Staphylococcus aureus was more common among patients who received medical therapy only. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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11 pages, 1017 KiB  
Article
Does Quality of Life in Survivors of Surgery for Acute Left-Sided Infective Endocarditis Differ from Non-Endocarditis Patients?
by Alejandro Fernández-Cisneros, Aida Andreu, Marta Hernández-Meneses, Jaume Llopis, Elena Sandoval, Daniel Pereda, Jorge Alcocer, Manuel Castellá, Jose M. Miró and Eduard Quintana
Microorganisms 2023, 11(4), 1058; https://doi.org/10.3390/microorganisms11041058 - 18 Apr 2023
Viewed by 1282
Abstract
Surgery for left-sided infective endocarditis (IE) has been demonstrated to improve patients’ survival rates but information about quality of life (QoL) after surgery is scarce. The aim of this study was to assess the postoperative outcomes and QoL after surgery for IE patients [...] Read more.
Surgery for left-sided infective endocarditis (IE) has been demonstrated to improve patients’ survival rates but information about quality of life (QoL) after surgery is scarce. The aim of this study was to assess the postoperative outcomes and QoL after surgery for IE patients compared to patients undergoing cardiac surgery for non-IE indications. Adult patients with definite acute left-sided IE were matched 1:1 to patients who underwent cardiac surgery for non-endocarditic purposes from 2014 to 2019. QoL was assessed using the SF-36 survey at the last follow-up. A total of 105 patients were matched. The IE group had higher rates of preoperative stroke (21% vs. 7.6%, p = 0.005) and higher stages of NYHA class (p < 0.001), EuroSCORE II (12.3 vs. 3.0, p < 0.001) and blood cell count abnormalities (p < 0.001). The IE group had higher incidence of low cardiac output syndrome (13.3% vs. 4.8%, p = 0.029), dialysis (10.5% vs 1.0%, p = 0.007) and prolonged mechanical ventilation (16.2% vs. 2.9%, p = 0.002) after surgery. At the last follow-up, subcomponents of the SF-36 QoL survey were not different between the groups. Patients who underwent cardiac surgery for IE demonstrated a higher risk profile with a higher rate of postoperative complications. Once recovered from the acute phase of the disease, the reported QoL at follow-up was comparable to that of matched cardiac patients operated for non-IE purposes. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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Review

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13 pages, 1050 KiB  
Review
Streptococcus equi Subspecies zooepidemicus Endocarditis and Meningitis in a 62-Year-Old Horse Rider Patient: A Case Report and Literature Review
by Giacomo Franceschi, Alessandra Soffritti, Matteo Mantovani, Margherita Digaetano, Federica Prandini, Mario Sarti, Andrea Bedini, Marianna Meschiari and Cristina Mussini
Microorganisms 2024, 12(11), 2201; https://doi.org/10.3390/microorganisms12112201 - 31 Oct 2024
Viewed by 531
Abstract
The present article presents a case report and literature review concerning the Streptococcus equi subspecies zooepidemicus (SEZ), a rare zoonotic pathogen in humans. The case involves a 62-year-old man with no prior heart disease, presenting with endocarditis, pneumonia, and meningitis following close contact [...] Read more.
The present article presents a case report and literature review concerning the Streptococcus equi subspecies zooepidemicus (SEZ), a rare zoonotic pathogen in humans. The case involves a 62-year-old man with no prior heart disease, presenting with endocarditis, pneumonia, and meningitis following close contact with a horse. The patient underwent urgent aortic valve replacement due to severe valvular damage caused by the infection. Blood and cerebrospinal fluid cultures confirmed the presence of SEZ, and the patient was treated with a combination of antibiotics, followed by a successful step-down to oral therapy using linezolid. A review of 25 additional Streptococcus equi endocarditis cases highlights the rarity of the condition, its association with animal contact, and its tendency to cause multi-site infections, such as pneumonia and meningitis. Early diagnosis, appropriate antibiotic therapy, and, in severe cases, surgical intervention are critical for a favorable outcome. This report emphasizes the importance of recognizing zoonotic infections in at-risk populations and the potential need for public health surveillance in these scenarios. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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Other

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13 pages, 2265 KiB  
Systematic Review
Combination Therapy Is Not Associated with Decreased Mortality in Infectious Endocarditis: A Systematic Review and Meta-Analysis
by Parisa Farahani, Felicia Ruffin, Mohammad Taherahmadi, Maren Webster, Rachel E. Korn, Sarah Cantrell, Lana Wahid, Vance G. Fowler, Jr. and Joshua T. Thaden
Microorganisms 2024, 12(11), 2226; https://doi.org/10.3390/microorganisms12112226 - 2 Nov 2024
Viewed by 678
Abstract
Untreated infective endocarditis (IE) is uniformly fatal. The practice of combination antibiotic therapy for IE is recommended by treatment guidelines but largely unsupported by high-quality evidence. This study aimed to assess the efficacy of combination antibiotic therapy compared to monotherapy in IE through [...] Read more.
Untreated infective endocarditis (IE) is uniformly fatal. The practice of combination antibiotic therapy for IE is recommended by treatment guidelines but largely unsupported by high-quality evidence. This study aimed to assess the efficacy of combination antibiotic therapy compared to monotherapy in IE through a systematic review and meta-analysis. We systematically searched MEDLINE, Embase, Cochrane, Web of Science, and CINAHL from inception to 29 July 2024. Studies reporting mortality outcomes of combination therapy versus monotherapy in adult patients with IE were included. Non-English papers and studies with less than 10 patients in the combination therapy group were excluded. Two reviewers independently assessed the studies and extracted relevant data. Summaries of odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using random-effects models. Out of 4545 studies identified, 32 studies (involving 2761 patients) met the inclusion criteria for the meta-analysis. There was no significant difference in the risk of all-cause mortality between the monotherapy and combination therapy groups (OR = 0.90; 95% CI = 0.67–1.20). Similar results were observed in subgroup analyses based on mortality time points, bacterial species, publication date, and type of study. Studies conducted in Europe reported a statistically significant decrease in overall mortality risk with combination therapy (OR = 0.67; 95% CI = 0.51–0.89), though this result was driven entirely by a single outlier study. Combination antibiotic therapy in patients with IE was not associated with reduced mortality. Full article
(This article belongs to the Special Issue The Infective Endocarditis)
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