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The article presents the results of a multicenter study of the etiology, antibiotic sensitivity and pharmacoepidemiology of infective endocarditis in the Russian Federation. The purpose of this study is to analyze the current practice of management of patients with infective endocarditis in conditions of low frequency of etiologically significant pathogens in the Russian Federation. The study included patients of both sexes of all age groups with definite and probable infective endocarditis. 406 cases of infectious endocarditis (240 in retrospect and 166 in the prospective part) were analyzed. Etiologically significant pathogen was isolated in 144 cases (35.5%). The structure of pathogens was dominated by gram (+) cocci (90.3%), most often - Staphylococcus aureus (46.5% of all isolated pathogens). Aminoglycosides (22.8%), parenteral cephalosporins of the III generation (22.1%) and glycopeptides (14.5%) were most frequently used in the course of starting antimicrobial therapy. When changing the mode of antimicrobial therapy, glycopeptides (18.6%), aminoglycosides (15.3%), fluoroquinolones (11.2%) and parenteral cephalosporins of generation III (9.5%) were most often prescribed.

Clinical features of infectious endocarditis (IE) in injection drug users are described with reference to its etiology, pathogenesis, and treatment. The prevalence of IE among different age groups of drug addicts and frequency of its most common etiological variants depending on microflora composition are analysed. Clinical manifestations of IE are considered. A major concern being diagnosis of IE, the most widely used diagnostic criteria and laboratory/instrumental diagnostic tools are discussed. The priority of antibacterial therapy of IE is emphasized and its rational schemes are proposed.

Aim: To assess the importance of renal affection and other systemic manifestations of infectious endocarditis (IE) among factors of unfavourable IE prognosis., Material and Methods: The examination including bacteriological blood test, transthoracic echocardiography was made in 54 patients with IE (35 males and 19 females aged 17-75 years). Transesophageal echocardiography and coagulogram examination were additionally performed in 11 and 45 patients, respectively., Results: Modern methods of statistic processing were employed to study systemic IE manifestations. Among them, prognostically significant were singled out and analysed including renal affection. Clinical variants of renal affection were determined in IE patients and their characteristics were determined: high incidence and severity of erythrocyturia, rare occurrence of arterial hypertension, frequent episodes of acute renal failure. A close correlation is shown between IE-associated renal affection, DIC symptoms and thrombocytopenia. Signs of renal damage in IE patients raise probability of other systemic manifestations including prognostically significant ones. This allows one to consider renal affection as a marker of an unfavourable IE course., Conclusion: A complex of significant factors of IE unfavorable outcome is determined including such systemic manifestations as severe renal affection, thromboembolism, splenomegaly. These factors are of importance in deciding on surgical intervention--valve replacement.

The purpose of the study was to determine peculiarities of the clinico-morphological picture of modern infective endocarditis (IE). The authors generalize the results of 100 morphological studies of acute and subacute IE (AIE and SAIE) within the last 20 years (1985--2005). AIE and SAIE had developed in 52% and 35% of cases, respectively, after operations, medical manipulations and examinations. The development of secondary AIE was favored by congenital heart defects and mitral valvular (MV) prolapse, while secondary SAIE developed in patients with congenital heart defects as well as atherosclerotic and rheumatic heart defects. The feature of contemporary IE is the prevalence of primary clinico-morphological form with isolated aortal valvular (A V) lesion. Morphological changes in organs formed as a result of multiple septic embolism, immunocomplex lesion, panarteritis, and cardiac insufficiency. The occurrence and progress of the latter was caused by prominent AV and MV insufficiency (during several weeks in patients with AIE and several months in SAIE), myocarditis, pericarditis, myocardial dystrophy, and cardiosclerosis.

Ten (1.8%) out of 558 patients with end-stage chronic renal failure on program hemodialysis developed infective endocarditis (IE). The average length of hemodialysis before IE was 17.0 +/- 14.5 months. The main cause of IE was infection of the site of vascular approaches. The diagnosis was difficult; Duke criteria modified by J. Li et al. (2000) allowed evidenced diagnosis of IE only in 30% of cases, while modified criteria offered by the authors did it in 50% of cases. The article discusses rational antibacterial therapy. Hospital lethality in IE is as high as 50%.

The article considers the peculiarities of the development and clinical course of contemporary infective endocarditis (IE). The prevalence of various infective pathogens causing IE over the last decades is analyzed. Modern concepts of the pathogenesis of the disease are covered. The rate of IE complication is analyzed.

Myocardial infarction (MI) developed in 9% of 230 patients with active infectious endocarditis. Development of MI was associated with worsened clinical course and poorer prognosis of infectious endocarditis. MI manifested with pain in 43 and was painless in 57% of these cases. In 29% of patients initial manifestations of MI were disturbances of cardiac rhythm and conduction, and acute left ventricular failure. This precluded timely electrocardiographical diagnosis. However repetitive ECG recordings allowed to confirm MI in all patients. Elevation of enzymes helped to diagnose MI in 81% of cases. Possible causes of MI were shutting of coronary artery ostium by vegetation from an aortic valve cusp (in 47%) and/or lowering of perfusion pressure in coronary arteries because of severe aortic insufficiency (in 62% of patients). Disturbances of hemostasis with activation of its vascular and platelet elements and hypercoagulation found in all patients with infectious endocarditis also facilitated development of MI. The data obtained explain under investigated sides of pathogenesis of MI in infectious endocarditis and allow to find ways for improvement of its diagnosis and therapy.

The study of the incidence and etiological pattern of infectious complications included 376 patients operated for acquired valvular disease. 40,280 bacteriological tests of the materials from the patients obtained during the operations and during the postoperative period as well as 30,113 sanitary bacteriological tests of the specimens from the cardiological operation unit were conducted. The possible use of the results of bacteriological monitoring for prediction of septic complications and optimization of antibiotic prophylaxis and therapy as well as for development and operation of a system of sanitary and hygienic measures for infection prevention was shown and statistically confirmed.

The study has revealed that active forms of infectious endocarditis constitute 30-50% of all septic diseases in hospitals. It is the normal cusps of the valvular apparatus of the left cardiac portion that are predominantly damaged, deformed or destroyed. Endocardial involvement of the right portion of the heart and the pulmonary artery occurs very rarely. Infectious patients develop sepsis more frequently than patients with non-infectious diseases but it takes the form of acute infectious endocarditis less commonly. Currently the clinical course of acute infectious endocarditis is characterized by predominantly ulcerous thrombotic damage of the normal valves with the formation of heart disease, the development of congestive insufficiency of the circulation and thromboembolic complications and the lethal outcome in the first weeks of hospitalization in 95.6% of patients with acute endocarditis in infectious and 56.6% in non-infectious hospitals.