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In this randomized, controlled trial conducted at Danish cardiac centers, intravenous antibiotic therapy was compared with partial oral antibiotic therapy for the treatment of bacterial endocarditis. The outcomes were similar in the two groups.

The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. PROSPERO registration number CRD42018115943.

Background Early-onset prosthetic valve endocarditis (EO-PVE) is linked to poor in-hospital outcomes. Staphylococcus spp. poses a significant concern due to its higher mortality rates compared to other major infectious agents. Objectives Provide a more detailed, comprehensive evaluation of the clinical characteristics and in-hospital mortality predictors related to staphylococcal EO-PVE. Methods This observational, retrospective, single-center study was conducted at a tertiary hospital in Brazil from 1997 to 2019, spanning a 22-year period. A total of 105 consecutive cases of left-heart staphylococcal EO-PVE were analyzed. Results There was a predominance of coagulase-negative staphylococci prosthetic valve endocarditis (CoNS PVE) over Staphylococcus aureus prosthetic valve endocarditis (SAPVE) (76% and 24%, respectively). Prosthetic valve replacement for EO-PVE treatment was performed in 73% of cases. In-hospital mortality was 49%, with SAPVE associated with a higher in-hospital mortality than CoNS PVE (80% versus 43%, p  < 0.001). In-hospital mortality predictors identified by univariate analysis included older age ( p  < 0.001), aortic prosthetic endocarditis ( p  < 0.001), peri-annular abscess ( p  = 0.002), SAPVE ( p  < 0.001), NYHA functional class III/IV ( p  = 0.02), previous combined myocardial revascularization with valve replacement surgery ( p  = 0.02), left ventricular dysfunction ( p  < 0.001), leukocytosis ( p  = 0.02), and higher C-reactive protein levels ( p  = 0.006). In a multivariate analysis, SAPVE was identified as an independent risk factor for in-hospital mortality (odds ratio [OR] 10.2; p  = 0.006), whereas prosthetic valve replacement was associated with improved in-hospital survival (OR 0.2; p  = 0.04). Conclusion Staphylococcal EO-PVE is associated with increased in-hospital mortality, particularly in SAPVE cases. In this study, all non-operated SAPVE patients died primarily due to fulminant septic shock. Prosthetic valve replacement was significantly linked to in-hospital survival, and only 5.7% of the study population survived without cardiac surgical intervention. Clinical trial number Not applicable.

An 81-year-old male patient in Germany had prosthetic valve endocarditis caused by Pasteurella dagmatis after a domestic cat bite. We surgically treated a paravalvular abscess and administered definitive antibiotic therapy consisting of penicillin G and levofloxacin. The patient was discharged from the intensive care unit in good condition 21 days after the surgery.

Background In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. Methods Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. Results The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p  = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. Conclusions The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.

Background Actinotignum schaalii is an emerging urogenital pathogen rarely reported as a cause of endocarditis. Case presentation A 54-year-old man developed recurrent embolic strokes seven and eight years post-Bentall procedure with mechanical aortic valve. Blood cultures grew Gram-positive bacilli, initially misidentified as Corynebacterium spp. , later confirmed as Actinotignum schaalii . Cardiac CT revealed a 12 mm × 15 mm × 20 mm perivalvular abscess fistulizing into the sinus of Valsalva and prosthetic graft. 18 F-FDG PET/CT confirmed intense hypermetabolism around the prosthesis. Despite targeted amoxicillin therapy, intraoperative exploration revealed complete Bentall conduit dehiscence from extensive aorto-mitral trigone destruction. Reconstruction was deemed unfeasible, and the patient died following multidisciplinary decision to limit interventions. No urological source was identified. Conclusions Actinotignum schaalii can cause indolent prosthetic valve endocarditis with devastating perivalvular complications. Prolonged blood culture incubation is crucial for early diagnosis in patients with prosthetic material and unexplained embolic events. Clinical trial Not applicable.

Purpose Most data regarding infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) comes from TAVI registries, rather than IE dedicated cohorts. The objective of our study was to compare the clinical and microbiological profile, imaging features and outcomes of patients with IE after SAVR with a biological prosthetic valve (IE-SAVR) and IE after TAVI (IE-TAVI) from 6 centres with an Endocarditis Team (ET) and broad experience in IE. Methods Retrospective analysis of prospectively collected data. From the time of first TAVI implantation in each centre to March 2021, all consecutive patients admitted for IE-SAVR or IE-TAVI were prospectively enrolled. Follow-up was monitored during admission and at 12 months after discharge. Results 169 patients with IE-SAVR and 41 with IE-TAVI were analysed. Early episodes were more frequent among IE-TAVI. Clinical course during hospitalization was similar in both groups, except for a higher incidence of atrioventricular block in IE-SAVR. The most frequently causative microorganisms were S. epidermidis , Enterococcus spp. and S. aureus in both groups. Periannular complications were more frequent in IE-SAVR. Cardiac surgery was performed in 53.6% of IE-SAVR and 7.3% of IE-TAVI (p=0.001), despite up to 54.8% of IE-TAVI patients had an indication. No differences were observed about death during hospitalization (32.7% vs 35.0%), and at 1-year follow-up (41.8% vs 37.5%), regardless of whether the patient underwent surgery or not. Conclusion Patients with IE-TAVI had a higher incidence of early prosthetic valve IE. Compared to IE-SAVR, IE-TAVI patients underwent cardiac surgery much less frequently, despite having surgical indications. However, in-hospital and 1-year mortality rate was similar between both groups.

Background Histoplasma capsulatum infective endocarditis (IE) is rare and often fatal, especially in prosthetic valve patients, due to delayed diagnosis and limited therapeutic options. This case demonstrates the utility of AngioVac for managing large fungal vegetations, underscores the importance of considering fungal IE in culture-negative cases, and highlights the role of a multidisciplinary approach in high-risk patients. Case summary We report a 76-year-old female with a bioprosthetic aortic valve who presented with persistent culture-negative fever, splenic infarcts, and large vegetations on her prosthetic valve. Extensive diagnostic workup confirmed fungal endocarditis after AngioVac-assisted debulking revealed H. capsulatum on tissue cultures. Despite prompt initiation of antifungal therapy and multidisciplinary management, her course was complicated by recurrent embolic events, septic shock, and eventual death. Conclusion This case underscores the importance of considering fungal IE in culture-negative cases, especially in high-risk patients such as those with prosthetic valves. It also highlights the role of advanced diagnostic techniques and minimally invasive interventions like AngioVac in managing complex cases, despite their limitations.

Francisella tularensis endocarditis is rare and difficult to diagnose, and only a few cases have been described. We report two new cases of endocarditis due to F. tularensis subsp. holarctica, with a favorable evolution after appropriate antibiotic therapy and valve replacement surgery, and review the 5 other cases reported in the literature. This rare infection may be suspected based on the local epidemiology and the patient’s exposure factors. A regimen of ciprofloxacin and gentamicin, combined with surgical valve replacement if necessary, appears to be effective in treating F. tularensis endocarditis.

Propionibacterium spp. are a rare cause of infective endocarditis (IE). The diagnosis is difficult because the bacteria are slow-growing and growth in blood cultures is often misinterpreted as contamination from the skin flora. The aim of this study was to describe all cases of Propionibacterium spp. endocarditis in the Swedish national registry of IE. The registry was searched for all cases of IE from 1995 to 2016 caused by Propionibacterium spp. Data concerning clinical characteristics, treatment, and outcome were registered. A total of 51 episodes of definitive prosthetic valve endocarditis (PVE) caused by Propionibacterium spp. were identified, comprising 8% of cases of PVE during the study period. Almost all cases (n = 50) were male. The median time from surgery to diagnosis of IE was 3 years. Most patients were treated mainly with beta-lactams, partly in combination with aminoglycosides. Benzyl-penicillin was the most frequently used beta-lactam. A total of 32 patients (63%) underwent surgery. Overall, 47 patients (92.1%) were cured, 3 (5.9%) suffered relapse, and 1 (2.0%) died during treatment. IE caused by Propionibacterium spp. almost exclusively affects men with a prosthetic valve and findings of Propionibacterium spp. in blood cultures in such patients favors suspicion of a possible diagnosis of IE. In patients with prosthetic valves, prolonged incubation of blood cultures up to 14 days is recommended. The prognosis was favorable, although a majority of patients required cardiac surgery during treatment. Benzyl-penicillin should be the first-line antibiotic treatment option for IE caused by Propionibacterium spp.