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Introduction: Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. Methods: The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. Results: IE cases from 13 European countries were included. Two periods were considered: 2000–2006 and 2008–2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern–Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49–74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p< 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. Conclusions: Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE). Graphical Abstract:

A woman was diagnosed with von Willebrand disease after several physician evaluations. The first sign was frequent nosebleeds when she was a child. The next was prolonged menstrual cycle of 21 days which started when she was 13 years old. The disease was discovered by Finnish doctor Erik von Willebrand in 1926 after a 13-year-old girl died on her fourth menstrual cycle. The disease, unlike hemophilia, which occurs in males only, occurs in both males and females. Postpartum bleeding can occur three to four weeks after delivery but can be helped by DDAVP and Factor VIII concentrates., Since early childhood, Karen Miller suffered from frequent nosebleeds and easy bruising. 'My nosebleeds would start before I left to go to kindergarten,' she recalled. 'My morn would have to [...]

Heart transplant remain the definitive therapy for end-stage heart failure but is limited by the availability of suitable donors. Ventricular assist devices (VAD) are designed as mechanical pumps to supplement or replace the function of damaged ventricles and maintain appropriate blood flow in patients with end-stage heart failure. Survival rates continue to increase in patient with VAD but infection remains a major cause of morbidity and mortality in VAD patients. The authors describe the current concepts regarding definitions, diagnosis, microbiology and principles of management in VAD-associated infections. The authors have also summarised the prevention strategies for infections in VAD patients.

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ABSTRACTThe use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This was a prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (cohort A) to those treated with standard-of-care (SOC) antibiotics (cohort B). The primary outcome was in-hospital mortality. Time to clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed. There were 29 and 149 patients included in cohort A and cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg of body weight/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In cohort A, median time to clearance of methicillin-resistant S. aureus(MRSA) bacteremia was 1.0 day, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance compared to SOC (1.0 versus 5.0 days; P< 0.01). Regimens with higher daptomycin doses were not associated with increased incidence of AEs. In conclusion, higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens.

ABSTRACTMycobacterium bovisis naturally resistant to the antituberculosis drug pyrazinamide (PZA). To determine whether allMycobacterium tuberculosiscomplex isolates demonstrating PZA monoresistance were truly M. bovis, we examined the phenotype and genotype of isolates reported as PZA monoresistant in five counties in California from January 1996 through June 1999. Isolates reported by local laboratories to be PZA monoresistant were sent to the state reference laboratory for repeat susceptibility testing using the BACTEC radiometric method and to the Centers for Disease Control and Prevention for pncAsequencing and PCR-restriction fragment length polymorphism (RFLP) analysis of the oxyRgene. Of 1,916 isolates, 14 were reported as PZA monoresistant and 11 were available for retesting. On repeat testing, 6 of the 11 isolates were identified as PZA-susceptible M. tuberculosis, 1 was identified as PZA-monoresistant M. bovis, and 1 was identified as M. bovisBCG. The three remaining isolates were identified as PZA-monoresistant M. tuberculosis. Sequencing of the pncAandoxyRgenes genotypically confirmed the two M. bovisand the six susceptible M. tuberculosisspecies. Each of the three PZA-monoresistant M. tuberculosisisolates had different, previously unreported,pncAgene mutations: a 24-bp deletion in frame after codon 88, a base substitution at codon 104 (Ser104Cys), and a base substitution at codon 90 (Ile90Ser). This study demonstrates that PZA monoresistance is not an absolute marker ofM. bovisspecies but may also occur in M. tuberculosis, associated with a number of different mutational events in the pncAgene. It is the first report of PZA-monoresistant M. tuberculosisin the United States.

Mycobacterium chimaerais a slow-growing nontuberculous Mycobacteriumspecies belonging to the Mycobacterium aviumcomplex (MAC). It has been identified globally as the cause of a large outbreak of cardiovascular infections following open heart surgery, but it can also cause respiratory infections in individuals with underlying structural pulmonary disease. Invasive M. chimaerainfections are associated with poor clinical responses, and the optimal antibiotic treatment regimen for these infections is not known.