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Background: Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.Objective: To quantitate the risk for endocarditis from dental treatment and cardiac abnormalities.Design: Population-based, case-control study.Setting: 54 hospitals in the Philadelphia area.Patients: Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.Measurements: Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.Results: During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 [95% CI, 0.4 to 1.5]). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 [CI, 7.4 to 37.4]). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 [CI, 6.4 to 58.4]), congenital heart disease (adjusted odds ratio, 6.7 [CI, 2.3 to 19.4]), cardiac valvular surgery (adjusted odds ratio, 74.6 [CI, 12.5 to 447]), rheumatic fever (adjusted odds ratio, 13.4 [CI, 4.5 to 39.5]), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 [CI, 2.0 to 8.9]). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 [CI, 0.04 to 0.7] over 3 months). Few participants received prophylactic antibiotics.Conclusions: Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to study the influence of diabetes mellitus (DM) on outcomes of infective endocarditis (IE). Outcomes were compared between 150 diabetic and 905 non-diabetic patients with IE from the International Collaboration on Endocarditis Merged Database. Compared to non-diabetic patients, diabetic patients were older (median age 63 vs 57 y, p<0.001), were more often female (42.0% vs 31.9%, p=0.01), more often had comorbidities (41.5% vs 26.7%, p<0.001), and were more likely to be dialysis dependent (12.7% vs 4.0%, p<0.001). S. aureus was isolated more often (30.7% vs 21.7%, p=0.02), and microorganisms from the viridans Streptococcus group less often (16.7% vs 28.2%, p = 0.001) in the diabetic group. There was no difference with respect to the presence of congestive heart failure, embolism, intra-cardiac abscess, new valvular regurgitation, or valvular vegetation. Diabetic patients underwent surgical intervention less frequently (32.0% vs 44.9%, p = 0.003), and had higher overall in-hospital mortality (30.3% vs 18.6%, p = 0.001). On multivariable analysis, DM was an independent predictor of mortality (odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.70), especially in male patients, as diabetic males had higher mortality than non-diabetic males (OR 2.18, CI 1.08-4.35). DM is an independent predictor of in-hospital mortality among patients hospitalized with IE. [ABSTRACT FROM AUTHOR]

Objective: To determine whether asymptomatic bacteriuria in elderly ambulatory women is a marker of increased mortality and, if so, whether it is because of an association with other determinants of mortality or because asymptomatic bacteriuria is itself an independent cause, the removal of which might improve longevity.Design: A cohort study and a controlled clinical trial of the effect of antimicrobial treatment.Setting: A geriatric center and 21 continuing care retirement communities.Participants: Women without urinary tract catheters.Measurements: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria), comorbidity, and mortality.Results: In the observational study, infected residents (n = 318) were older, and sicker, and had higher mortality (18.7 per 100,000 resident-days) than uninfected residents (n = 1173; 10.1 per 100,000 resident-days). However, in a multivariate Cox analysis, infection was not related to mortality (relative risk, 1.1; P > 0.2), whereas age at entry and self-rated health (score 1 [excellent] to 4 [bad or poor]) were strong predictors. In the clinical trial, mortality in 166 treated residents (13.8 per 100,000 resident-days) was comparable to that of 192 untreated residents (15.1 per 100,000 resident-days); the relative rate was 0.92 (95% CI, 0.57 to 1.47). The cure rates among treated and untreated residents were 82.9% and 15.6%, respectively.Conclusion: Urinary tract infection was not an independent risk factor for mortality, and its treatment did not lower the mortality rate. Screening and treatment of asymptomatic bacteriuria in ambulatory elderly women to decrease mortality do not appear warranted. [ABSTRACT FROM AUTHOR]

Previously, others suggested that the failure of cephalothin plus an aminoglycoside to cure enterococcal endocarditis could be overcome, if the peak serum cephalothin level exceeded the MIC of the enterococcus by several fold. Therefore, rabbits with enterococcal endocarditis were treated with gentamicin and either penicillin or cephalothin at doses providing peak serum levels about 5 and 10 times the MIC of the enterococcus. Of these regimens, only cephalothin at doses providing peak levels 10 times the MIC of the enterococcus resulted in high valve sterilization (100%) and survival rates (90%). Cephalothin and gentamicin should not be used to treat human enterococcal endocarditis, because the dose of cephalothin required for cure would appear to be prohibitively high. [ABSTRACT FROM PUBLISHER]

Patients receiving gentamicin (25) or tobramycin (29) were evaluated in a randomized, prospective, double-blind study. Sequential serum samples for creatinine determination and urine samples for urinalysis, β-2-microglobulin, and -acetyl-glucosaminidase assays were obtained to assess the frequency of nephrotoxicity and to evaluate measures possibly predicting impaired renal function. Each aminoglycoside induced measurable decrements in renal function. Although the mean total dose per kg and mean serum trough levels were slightly higher in the tobramycin group, there was a trend towards greater toxicity in those receiving gentamicin, whether measured as a mean increase in serum creatinine during therapy, as an elevation of 0·3 mg/dl or more in serum creatinine, or as at least a doubling of the serum creatinine. Adjusted for the dose or the serum trough level of aminoglycoside, increments in serum creatinine concentration were observed more often with gentamicin. The differences were minor and their clinical significance remains unestablished. The development of casts correlated with nephrotoxicity, but the remaining parameters were not helpful as predictors of renal functional impairment. Each aminoglycoside must be used cautiously, following previous guidelines, to lessen the incidence of toxicity. Dosage should be decreased when urinary casts appear. [ABSTRACT FROM PUBLISHER]

Describes a case of infection from the use of leeches in medicine. Information on the therapeutic use of leeches for ailments; Description of the common medical leech; Discussion on the association of leech to infections.

Discusses an epidemiologic study of bacteriuria in an elderly population. Complications of bacteriuria; Association between bacteriuria and decreased survival in elderly persons; Efficacy of antimicrobial therapy for asymptomatic bacteriuria.