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Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens.
- Source :
-
Cardiovascular research [Cardiovasc Res] 2023 Mar 31; Vol. 119 (2), pp. 410-428. - Publication Year :
- 2023
-
Abstract
- Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci, and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent, and frequently, false-negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal, and viral pathogens in blood and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.<br />Competing Interests: Conflict of interest: There is no conflicts of interest of the authors who worked on this publication.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Humans
Echocardiography
Endocarditis, Bacterial diagnosis
Endocarditis, Bacterial drug therapy
Endocarditis, Bacterial epidemiology
Heart Valve Prosthesis microbiology
Endocarditis
Staphylococcal Infections diagnosis
Staphylococcal Infections epidemiology
Staphylococcal Infections therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1755-3245
- Volume :
- 119
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Cardiovascular research
- Publication Type :
- Academic Journal
- Accession number :
- 35420122
- Full Text :
- https://doi.org/10.1093/cvr/cvac055