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Introduction: Infective endocarditis (IE) is endothelial damage of the endocardium, which is caused by infection. The etiologic agents' highest mortality and morbidity rates are associated with staphylococcus aureus (S. aureus). Accordingly, the knowledge of different risk factors for IE caused by the S. aureus is necessary.Material and methods: This study is an observational-analytical retrospective cohort study on 139 patients with staphylococcus aureus bacteremia (SAB), who referred to a cardiac center during 2011-2019. This study aimed to evaluate the risk factors in 48 patients with staphylococcus aureus endocarditis, who were selected from139 patients with S. aureus bacteremia. Results: The mean age (±SD) of the patients is 56.61 (±16.58), and85 (61.2%) persons are male. Forty-eight patients (34.5%) are diagnosed with staphylococcus aureus endocarditis regarding Duke criteria. In this study, the following risk factors were significantly associated with S. aureus endocarditis: age (p=0.003), long-term bacteremia (p=0.041), prosthetic heart valve (p=0.016), pre-existing IE (p=0.048), and embolic events (p=0.039).Conclusion: According to the findings, a significant number of patients with staphylococcus aureus bacteremia (SAB) have IE with different risk factors. Future studies with a larger sample size are recommended to detect IE risk factors.

Infective endocarditis in neonates can be fatal. Adjunctive rifampin therapy might be effective as salvage therapy in critically ill patients with Staphylococcus aureus native valve endocarditis (NVE). We present a case of a full‐term neonate with NVE who had a favorable clinical outcome after adding rifampin to standard therapy., Adding rifampin in a critically ill neonate with native valve Staphylococcus aureus endocarditis might be effective and lifesaving. Further studies are needed to determine rifampin's effect on neonatal Staphylococcus aureus native valve endocarditis.

A 74-year-old male with a past medical history of mechanical aortic valve replacement presented with abdominal pain and fever. Blood cultures revealed methicillin-resistant Staphylococcus aureus (MRSA) and the patient was started on target antibiotics. Initial transthoracic echocardiogram and transesophageal echocardiogram (TEE) did not show any vegetations or significant valvular regurgitation. No other sources of infection were identified. Five days after the initial TEE, a repeat TEE revealed new areas of thickening and echolucency seen anterior to the mechanical aortic valve, suggestive of aortic root abscess (AoRA). It also extended down the mitral-aortic intervalvular fibrosa and was associated with mitral valvular vegetation. Due to worsening clinical status and persistent bacteremia on appropriate antibiotics, a high index of suspicion for infective endocarditis (IE) remained after the initial TEE. As such, the repeat TEE was obtained only five days after and demonstrated clear evidence of rapidly growing endocarditis and abscess formation. This case uniquely demonstrates how rapid MRSA endocarditis may progress and emphasizes its high mortality. This case highlights the importance of a low threshold for repeat imaging when the index of suspicion for endocarditis remains high despite negative imaging.

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Staphylococcus aureus is the major cause of endocarditis, and its mortality has remained high despite therapeutic procedures over time. A case of left-sided native valve endocarditis caused by methicillin-sensitive Staphylococcus aureus which responded well to moxifloxacin monotherapy is described. An 83-year-old woman with a history of current hospitalization presented with fatigue and fever. Transthoracic echocardiography depicted vegetation, and blood cultures were positive for Staphylococcus aureus. After a 14-day intravenous administration of moxifloxacin, a good clinical response was achieved, and antibiotic regimen transitioned to oral moxifloxacin for an additional four-week therapy.

We present a case of a 10-year-old male with Staphylococcus aureus mitral endocarditis who was initially misdiagnosed with multisystem inflammatory syndrome associated with coronavirus disease 2019, with eventual fatal outcome due to brain hemorrhage after cardiac intervention. Our case differs from recent studies, in which microbleeds did not increase the risk of hemorrhagic stroke or global mortality risk.

Introduction The shift toward value-based health care drives physicians to examine opportunities to optimize use of healthcare resources. There is discordance between providers' use of cardiovascular imaging (CVI) in assessing patients for infective endocarditis (IE) with Staphylococcus aureus bacteremia (SAB). An evidence-based algorithm was created to minimize variation of CVI use. The primary objective was to ensure sensitivity of the algorithm to recommend CVI in patients suspected of IE. Methods A retrospective review evaluated patients at Ochsner Medical Center who developed SAB between 1/1/13 and 12/31/14. Predefined patient demographics, use of CVI, outcomes, and 12-week follow-up for readmission after first positive blood culture were collected from chart review. The created algorithm was applied retrospectively to determine its sensitivity and specificity in recommending the right CVI test. Results 181 patients admitted were admitted with SAB, of which 114 (63%) were male. There were 115 TTEs and 55 TEEs performed. Out of 15 patients diagnosed with IE, 3 were found on TTE and 12 were found on TEE. The algorithm would have recommended a TEE in all 15 patients who had high-risk features for IE and a true diagnosis of IE, suggesting a sensitivity of 100% and specificity of 74.7% for the algorithm to have recommended a highly sensitive CVI modality. Conclusion This algorithm optimizes CVI for diagnosing IE in patients with SAB. As healthcare adapts to a value-based system, use of best-practice algorithms will promote consistency in practice among providers and help optimize patient outcomes and use of resources.

Summary A 42-year-old intravenous drug user presented with seizures and septicaemia. CT and MRI were suggestive of multiple brain and systemic emboli, and blood and CSF cultures were positive for Staphylococcus aureus. Initial transthoracic echocardiogram did not show any abnormalities but subsequent transoesophageal echocardiography showed two masses in the left and the right ventricle. The LV mass was large, irregular, non-mobile and attached to the basal anterolateral LV segment abutting but not involving the mitral valve. (Fig. 1). The RV mass was smaller and mobile and appeared attached to the primary chordae of anterior tricuspid valve leaflet, not encroaching the valve or affecting its function (Fig. 2). Once commenced on antibiotic treatment the patient’s condition improved, and there were no further embolic events. There was no valvular damage and sequential echo studies showed significant reduction in vegetation size. Although the formal echocardiographic definition of vegetation includes non-oscillating masses on any endocardial surface (1), primary mural endocarditis without valvular involvement is considered extremely rare (2). The diagnosis is supported by the septic and embolic clinical picture but requires awareness of this uncommon presentation. The present case is even more unusual in view of the biventricular mural localisation of the vegetations, a pattern that has been mentioned in only very few case reports (3, 4).

Background/Introduction Infective endocarditis (IE) remains one of the deadliest cardiac diseases. Despite optimal antibiotic and surgical treatment, still one in three patients do not survive Staphylococcus aureus (S. aureus) IE. In order to cause this disease, bacteria need to first overcome shear stress and adhere to cardiac valves. Secondly, they need be able to progress into a complex lesion. Previously, we have shown that S. aureus adheres to cardiac valves via platelets and von Willebrand factor. However, the process of progression from initial bacterial adhesion to a complex vegetation, particularly how bacteria bypass the immune system and thrive in the host environment, remains unclear. Purpose We aimed to determine the role of neutrophils and neutrophil extracellular traps (NETs) in IE progression using a novel mouse model. Methods We intravenously injected mice with S. aureus and locally stimulated the endothelium with histamine, resulting in IE lesions that originate on inflamed heart valves. After three days we determined the development of IE on the aortic valves with Gram staining and echocardiography. We investigated the presence of NETs in 14 mice by immunostaining for citrullinated histone H3 (H3Cit), extracellular DNA, and myeloperoxidase. Of these 14 mice, 9 developed endocarditis. In a separate set of experiments, we investigated the role of neutrophils in IE development by injecting a neutrophil-depleting or control antibody 24h before surgery. Results Echocardiography revealed real IE lesions attached on inflamed aortic valves. Mice with endocarditis had significantly (P=0.005) more detectable H3Cit (9/9) than those without (1/5). More specifically, four mice had H3Cit+ neutrophils within thrombi, indicating early NETosis. Seven mice had an extracellular H3Cit staining pattern within the thrombus. These extracellular H3Cit-positive regions were associated with DNA and myeloperoxidase, indicating the presence of a network of NETs. When we depleted neutrophils, mice developed significantly more endocarditis (7/16 vs. 1/15, P=0.03). Conclusion Endocarditis lesions contained NETs or neutrophils undergoing NETosis, and neutrophil depletion led to increased IE incidence. Further investigating these two players in IE could potentially provide new strategies to combat this deadly disease. Acknowledgement/Funding FWO SB

Described herein is a 63-year-old man who developed methicillin-sensitive Staphylococcus aureus endocarditis on a previously anatomically normal mitral valve. The resulting vegetations were so large that severe mitral stenosis resulted. The development of valve stenosis due exclusively to infective endocarditis is extremely rare.

Background Staphylococcus aureus infective endocarditis (IE) associated with injection of new psychoactive substances (NPS) in Edinburgh from 2014 to 2016 was observed. We compared these infections with a series of S. aureus IE cases in a non-injecting population within Edinburgh. Methods NPS-associated S. aureus IE diagnosed between 1 January 2014 and 31 May 2016 in persons who inject drugs (PWID) were compared with a series of S. aureus IE cases from non-PWID. Results There was a fourfold increase in the annual incidence of S. aureus IE, mainly due to NPS use in PWID. A larger vegetation diameter was seen on echocardiogram in PWID vs non-PWID (median 1.7 cm vs 0.65 cm; p = 0.009) with more embolic complications in PWID (15 PWID vs 1 non-PWID; p = 2.1 x 10-7) but no difference in 90-day mortality (2 PWID vs 4 non-PWID; p = 0.39). Conclusions NPS-associated S. aureus IE correlated with complications, such as deep organ embolic abscesses, that were different from non-PWID S. aureus IE. The alarming increase in incidence resolved with targeted public health and legislative measures.

Background Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness that occurs in both pregnant and non-pregnant women. Several other conditions can mimic the disease, which makes the diagnosis challenging. Case We describe a case of severe Staphylococcus aureus endocarditis that initially presented as peripartum TTP in a 39-year-old woman at 29+6 weeks' gestation. We give an overview of the diagnostic considerations and management of thrombocytopenia in pregnancy and review the literature related to TTP and peripartum infective endocarditis. Conclusion Given the significant differences in definitive therapies for the spectrum of thrombocytopenic conditions that occur in pregnancy, timely and accurate diagnosis of TTP is critical for optimal management.

Rupture of papillary muscles due to infective endocarditis is a very rare event. We report a case of anterolateral papillary muscle rupture caused by Staphylococcus aureus endocarditis, due to direct bacterial invasion of the papillary muscle, resulting in severe mitral regurgitation.

We tested the ability of clavulanic acid to restore the efficacy of cefazolin against Staphylococcus aureus TX0117, which exhibits the cefazolin inoculum effect (CzIE). In the rat infective endocarditis model, the coadministration of cefazolin plus clavulanic acid resulted in a significant reduction of bacterial counts (7.1 ± 0.5 log 10 CFU/g) compared to that with cefazolin alone (2 ± 0.6 log 10 CFU/g; P < 0.0001).

Background The risk of infective endocarditis (IE) is markedly increased in patients receiving chronic hemodialysis compared with the general population, but outcome data are sparse. The present study investigated causes and risk factors of mortality in a hemodialysis-treated end-stage kidney disease- (ESKD) and a non-ESKD population with staphylococcus (S.) aureus endocarditis. Methods Hemodialysis-treated ESKD patients with S. aureus endocarditis were identified from Danish National Registries and Non-ESKD patients from The East Danish Database on Endocarditis. For establishing the cause of death The Danish Registry of Cause of Death was used. Independent risk factors of outcome were identified in multivariable Cox regression models. Results One hundred twenty-one hemodialysis patients and 190 non-ESKD patients with S. aureus endocarditis were included during 1996–2012 and 2002–2012, respectively. The all-cause in-hospital mortality was 22.3% in hemodialysis- and 24.7% in non-ESKD patients. One-year mortality, excluding in-hospital mortality, was 26.4% in hemodialysis patients and 15.2% in non-ESKD patients. The hazard ratio of all-cause mortality in hemodialysis was 2.64 (95% CI 1.70–4.10) at > 70 days after admission compared with non-ESKD. Age (HR 1.03 (95% CI 1.02–1.04)) and diabetes mellitus (HR 2.17 (95% CI 1.54–3.10)) were independent risk factors of all-cause mortality. The hazard ratio of cardiovascular death in hemodialysis was 3.20 (95% CI 1.78–5.77) at > 81 days after admission compared with non-ESKD. Age and diabetes mellitus were independently related to cardiovascular death. Conclusion All-cause in-hospital mortality rates were similar in hemodialysis and non-ESKD patients with S. aureus endocarditis whereas one-year mortality rates were significantly increased in the hemodialysis population. Electronic supplementary material The online version of this article (10.1186/s12882-018-1016-0) contains supplementary material, which is available to authorized users.

Background Patients with complicated S. aureus bacteremia (SaB) require a transesophageal echocardiogram (TEE) to rule out endocarditis. Risks of TEE may exceed benefits in patients with a low pretest probability of endocarditis. Given our prior findings that endovascular bacterial burden drives elevated serum IL-10 concentrations, we hypothesize that time to positive blood culture and IL-10 serum concentrations may be used to risk stratify patients for selection of TEE. We compared time to positive blood culture and serum IL-10 in patients with negative and positive TEE. Methods Patients with SaB were included if they had a diagnosis of primary, endovascular infection source of bacteremia identified by an infectious diseases consult team and a TEE performed. A retrospective chart review was done to identify the time to positivity (hours) of patient blood cultures grown aerobically or anaerobically and TEE results. Sera collected at clinical presentation of these patients were tested for biomarkers IL-10 and IL-1β. Mann–Whitney U test compared the data between the two groups. Results This study included 66 patients with SaB: 17 with negative TEE and 49 with positive TEE. Patients with a positive TEE confirming endocarditis had a faster time to positive blood cultures compared with patients with negative TEE (P = 0.031; figure). IL-10 serum concentrations were significantly higher in patients with positive TEE (26.2 pg/mL) vs. negative TEE (14.39 pg/mL). Time-to-positivity in blood culture was linearly associated serum IL-10 concentrations (P = 0.044; figure). Serum IL-1β concentrations were also higher in TEE positive vs. TEE negative patients (32.1 vs. 14.7 pg/mL, P = 0.067) Conclusion These data lend further evidence to link high endovascular bacterial burden (measured by shorter time to positive blood culture) and serum IL-10 concentrations. As anticipated, patients with positive TEE had significantly shorter time to blood culture positivity and higher IL-10 serum concentrations than those with negative TEE. With further study on a larger number of patients, time to positive blood cultures and serum biomarkers like IL-10 may be used to risk stratify patients for performance of TEE, as well as to select antimicrobial therapy and to adjust treatment duration. Disclosures All authors: No reported disclosures.

Rationale: Neonatal infectious endocarditis (IE) in a healthy heart is rare. The infectious agents most frequently found in newborns are Staphylococcus aureus and fungi. Infection at the site of central intravenous catheter is generally thought to be the cause of this pathology. Patient concerns: We present 2 cases of premature newborns whose condition is evolving positively. They presented S aureus endocarditis during their first week of life. Diagnosis: Modified Duke diagnostic criteria—from clinical, echocardiogram and microbiological findings—based on those used for adults, can be used for children and newborns, but the very low prevalence of neonatal IE often delays diagnosis. Diagnosis on the basis of transthoracic heart ultrasound requires an extension report, given the very high embolic risk. Intervention: In the large majority of cases, long-term antibiotic therapy efficaciously treats the infection, although sometimes surgery is necessary. These 2 newborns needed only antibiotic therapy. Outcome: Despite the various complications, especially embolic, these 2 children are followed and are doing well. Lessons: Long-term pediatric heart monitoring combined with prophylactic antibiotics are essential, according to the European Society of Cardiology guidelines.

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) as well as newly discovered S. aureus strains with reduced susceptibility to vancomycin mandates development of new antistaphylococcal agents. This review summarizes currently available and forthcoming antimicrobials for treatment of S. aureus endocarditis.No new antimicrobial has been proven superior to antistaphylococcal penicillins for treatment of methicillin-sensitive S. aureus (MSSA) endocarditis. Vancomycin has become standard treatment for MRSA but poor outcomes have been reported, both with susceptible and intermediately resistant S. aureus strains (VISA). Linezolid has successfully treated individual cases of MRSA endocarditis, but limitations include long-term safety. Daptomycin has recently been proven effective and well tolerated for MSSA and MRSA bacteremia, including right-sided endocarditis. New glycopeptides, including dalbavancin and telavancin, as well as the new cephalosporin ceftobiprole, have not yet been studied for treatment of endocarditis but appear active against MRSA and potentially VISA.Antistaphylococcal penicillins remain the treatment of choice for MSSA. Of the currently available newer agents, daptomycin appears to have the most rapid bactericidal activity and provides a much-needed alternative to vancomycin for treatment of MRSA or MSSA bacteremia and right-sided endocarditis.

Background Staphylococcus aureus is a common cause of endocarditis. Previous studies have shown that the mortality rate associated with S aureus endocarditis remains high, and methicillin resistance is becoming more prevalent. Methods Over the past 4 years, 283 patients with suspected endocarditis were referred to the cardiology department of Grady Memorial Hospital for echocardiography. Their clinical course and demographic information was entered into a database. Among these patients, 87 (30.6%) were confirmed to have endocarditis, with 41 (47.1%) of them culture positive for either methicillin-resistant (MRSA) or methicillin-sensitive S aureus (MSSA). Of these patients, 14 were MRSA culture positive, and 27 were MSSA culture positive. These two groups were compared with respect to demographic information and morbidity and mortality outcomes. Results The MRSA and MSSA groups were found to be similar upon analysis in all baseline characteristics. There was a nonstatistical trend among the two groups in origin of infection, as the MRSA group tended toward nosocomial infection more often. Outcomes, including surgery, death, and complications were also found to be similar between the two groups. Conclusions There does not seem to be difference in the outcome of MRSA versus MSSA endocarditis. Nosocomial infection may predispose patients to MRSA endocarditis, but a larger study with a greater sample size is necessary to evaluate these questions more accurately.

A 28-year-old woman underwent bioprosthetic tricuspid valve replacement (TVR) and mitral valve repair for congenital tricuspid valve dysplasia. Two months later she developed Staphylococcus aureus endocarditis and underwent mitral valve replacement and redo-TVR, with a complicated postoperative course. Prosthetic tricuspid valve leaflet thickening with failure of coaptation and torrential regurgitation was noted at 2 year …

Isolated sinus of Valsalva (SV) aneurysm is a rare condition that may arise in patients with congenital ventricular septal defects (VSD). Small VSDs are often left untreated because of high rate of spontaneous closure. However, complications such as aortic regurgitation and infective endocarditis may occur as complications of small VSDs. We present the case of a 19-year-old man with a history of VSD, who presented with Staphylococcus aureus endocarditis and a contained rupture of the SV into the right ventricle, which was successfully treated. In the light of this case, we believe that even small VSDs should be assessed regularly and treated before such drastic complications occur.

Staphylococcus aureus is a leading cause of infective endocarditis in people who inject drugs (PWID). The management of S aureus endocarditis (SAE) in PWID can be problematic. The objective of this retrospective observational study was to assess the epidemiology, clinical characteristics, an

Ein 52jahriger Patient mit bekannter koronarer Herzerkrankung wurde mit akuter Aortenklappenendokarditis hervorgerufen durch Staphylococcus aureus mit Temperaturen bis 39,5°C aufgenommen. Wegen einer vorangegangenen perkutanen transluminalen Koronarangioplastie (PTCA) war der Patient mit Ticlopidin (Tiklyd®) vorbehandelt. Es fand sich bei Aufnahme ein C-reaktives Protein von 389mg/l. Die Spiegelbestimmungen von Interleukin-6 (IL-6) und Interleukin-2-Rezeptor (IL-2-Rez.) sowie der polyklonalen Immunglobuline und der monoklonalen antimyolemmalen Antikorper (AMLA) bestatigten eine starke humorale Entzundungsreaktion. Es trat zu keiner Zeit wahrend der Behandlung eine Leukozytose auf (Hochstwert 9,8 G/l). Bei echokardiographisch nachweisbarer Vegetation an der Aortenklappe und positiven Blutkulturen wurde die Diagnose einer durch Staphylococcus aureus hervorgerufenen akuten Aortenklappenendokarditis gestellt. Daraufhin erfolgte eine antibiotische Therapie mit Imipenem, Gentamicin und Vancomycin; nach 5 Tagen zusatzlich mit Clarithromycin. Nach 24 Tagen wurde der Patient fieberfrei. Das C-reaktive Protein (CRP) fiel von 389mg/l auf 6mg/l; ebenso fielen die gemessenen Interleukine deutlich. Die Medikation mit Ticlopidin verhinderte offenbar bei diesem Patienten das Auftreten einer Leukozytose. Zwar wurden Agranulozytosen und Panzytopenien unter Ticlopidingabe beschrieben, aber eine Kasuistik, die bei einer floriden staphylokokken-induzierten Endokarditis keine adaquate zellulare Immunantwort dokumentiert, ist unseres Wissens bisher nicht bekannt. Daher sollte der Einsatz von Ticlopidin zur Thrombozytenaggregationshemmung mit der eventuellen Folge einer geschwachten zellularen Immunantwort unter kritischer Indikationsstellung erfolgen, zumal heute mit Clopidogrel eine Alternative zur Verfugung steht.

We present a case of a 39 year-old female with a history of intravenous drug use (IVDU), diagnosed with staphylococcus aureus endocarditis. On initial presentation, the transthoracic echocardiogram showed evidence of multivalvular involvement and severe aortic regurgitation. She was started on

Previously, we have shown that aspirin administration reduces the bacterial density and weight of aortic vegetations in a rabbit model of Staphylococcus aureus endocarditis. In the present paper, we sought to determine if ticlopidine, another potent inhibitor of platelet aggregation, also influences the development of endocarditis. Animals received either no ticlopidine (control), or oral doses of 10, 50, and 100 mg/kg daily. The 10 and 100 mg/kg treated groups had a statistically significant reduction of the vegetative weight as compared with the untreated controls. Although the 50 mg/kg dose did not result in a statistically significant difference (P = 0.058) in weight when compared with control, this dose also produced a substantial reduction in aortic value vegetation weights. None of the ticlopidine doses tested significantly altered the bacterial density relative to untreated controls. These findings suggest that ticlopidine alters the development of cardiac vegetations and may be useful agent for the prevention and/or treatment of infective endocarditis.