Our objective was to assess the clinical factors that would reliably distinguish methicillin-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) endocarditis. A retrospective cohort study of clinical features and mortality in patients with MRSA and MSSA endocarditis between March 1986 and March 2004 was performed in a 750-bed, tertiary care teaching hospital. A total of 32 patients (10 MRSA [31.3%] vs 22 MSSA [68.7%]) were evaluated. Their mean age and sex ratio (male/female) were as follows: 30.8 +/- 16.0 vs 24.4 +/- 19.6 years old and 6/4 vs 13/9, for MRSA and MSSA infective endocarditis (IE), respectively. Univariate and multivariate analyses revealed that persistent bacteremia was significantly more prevalent in MRSA IE (OR, 10.0 [1.480- 67.552]; p, 0.018). There was a higher mortality trend for MRSA IE (50.0%) than for MSSA IE (9.1%) (p=0.019). However, persistent bacteremia was not associated with higher mortality (p > 0.05). These results indicate that if persistent bacteremia is documented, the likelihood of MRSA endocarditis should be viewed as high, and the patient's anti- staphylococcal therapy should be prolonged and/or changed to a more "potent" regimen.
Adult ; Bacteremia/drug therapy/microbiology ; Cohort Studies ; Comparative Study ; Endocarditis, Bacterial/drug therapy/*microbiology ; Female ; Humans ; Male ; *Methicillin Resistance ; Middle Aged ; Retrospective Studies ; Staphylococcal Infections/drug therapy/*microbiology ; Staphylococcus aureus/*drug effects

No abstract available.
Aged ; Anti-Bacterial Agents/therapeutic use ; Aortic Valve/*microbiology/surgery/ultrasonography ; Cross Infection/diagnosis/*microbiology/therapy ; Diffusion Magnetic Resonance Imaging ; Endocarditis, Bacterial/diagnosis/*microbiology/therapy ; Heart Valve Prosthesis Implantation ; Humans ; Klebsiella Infections/diagnosis/*microbiology/therapy ; Klebsiella pneumoniae/drug effects/*enzymology/pathogenicity ; Male ; Microbial Sensitivity Tests ; Predictive Value of Tests ; Sepsis/diagnosis/*microbiology/therapy ; Treatment Outcome ; beta-Lactamases/*metabolism

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.
Adult ; Anti-Bacterial Agents/*therapeutic use ; Bioprosthesis/adverse effects/*microbiology ; Endocarditis, Bacterial/*drug therapy/physiopathology ; Gentamicins/therapeutic use ; Gram-Negative Bacterial Infections/*drug therapy/physiopathology ; Heart Valve Prosthesis/adverse effects/*microbiology ; Humans ; Male ; Mitral Valve ; Recurrence ; Stenotrophomonas maltophilia/*drug effects ; Treatment Outcome ; Trimethoprim-Sulfamethoxazole Combination/*therapeutic use ; Vancomycin/therapeutic use

Bacteremia ; etiology ; Catheterization ; adverse effects ; Child ; Coagulase ; metabolism ; Cross Infection ; etiology ; Drug Resistance, Bacterial ; drug effects ; Endocarditis, Bacterial ; etiology ; Humans ; Methicillin ; pharmacology ; Quinolones ; pharmacology ; Staphylococcal Infections ; complications ; drug therapy ; microbiology ; Staphylococcus ; classification ; drug effects ; pathogenicity ; Urinary Tract Infections ; etiology ; Vancomycin ; pharmacology

No abstract available.
Anti-Bacterial Agents/therapeutic use ; Biopsy ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal ; Endocarditis, Bacterial/complications/diagnosis/drug therapy/*microbiology ; Fluorescent Antibody Technique ; Heart Septal Defects, Ventricular/*complications/diagnosis/surgery ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Valve Stenosis/*complications/diagnosis ; Purpura, Schoenlein-Henoch/diagnosis/drug therapy/*etiology ; Risk Factors

Abscess ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Aortic Valve ; diagnostic imaging ; microbiology ; pathology ; Echocardiography, Transesophageal ; methods ; Edema, Cardiac ; diagnostic imaging ; drug therapy ; pathology ; Endocarditis, Bacterial ; diagnostic imaging ; drug therapy ; Gentamicins ; therapeutic use ; Humans ; Male ; Mitral Valve ; diagnostic imaging ; pathology ; Tricuspid Valve ; diagnostic imaging ; pathology ; Vascular Fistula

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Aortic Valve/pathology ; Bartonella quintana/genetics/*isolation & purification ; Ceftriaxone/therapeutic use ; Drug Therapy, Combination ; Dyspnea/etiology ; Echocardiography ; Endocarditis, Bacterial/*diagnosis/drug therapy/microbiology ; Female ; Gentamicins/therapeutic use ; Humans ; RNA, Ribosomal, 16S/genetics ; Republic of Korea ; Sequence Analysis, RNA

No abstract available.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Ceftriaxone/pharmacology/therapeutic use ; Echocardiography ; Endocarditis, Bacterial/*diagnosis/drug therapy/microbiology ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Micrococcaceae/drug effects/*isolation & purification ; Middle Aged ; RNA, Ribosomal, 16S/chemistry/metabolism ; Republic of Korea