The prophylaxis of infective endocarditis: a joint position study of the Italian Federation of Cardiologists and the Italian Society of Infectious and Tropical Diseases.

Background: Antibiotic prophylaxis of patients believed to be at a risk of developing infective endocarditis has been recently revisited with limited indications compared with the previous body of knowledge in use by the medical community. As a consequence, most of the healthcare specialists in cardiology and infectious diseases have doubts related to the enormous change that has been proposed. In this study, we report the results of an Italian consensus of experts in cardiology and infectious diseases, with the aim to offer a national document that illustrates the reasons for such a change through the review of the basis of infective endocarditis prophylaxis, the historical background, and the reasons for the change, providing practical conclusions and illustrating grey areas.

Italian health idiocies.

We present a case of rather bizarre Italian health administrative contradiction: the greater the dysfunction the greater the productivity, efficiency and efficacy.

Infective endocarditis in the real world: the Italian Registry of Infective Endocarditis (Registro Italiano Endocardite Infettiva - RIEI).

In the last 30 years, major improvements have been made in understanding the pathogenesis, diagnosis and treatment of infective endocarditis. Nevertheless, mortality still remains high, close to 30-40% at 1 year, and its reduction remains the main challenge. Moreover, important epidemiological changes have been recorded.

B-type natriuretic peptide as a marker of asymptomatic re-stenosis after coronary implantation of a paclitaxel-eluting stent.

Background: The aim of the present study was the detection of asymptomatic coronary re-stenosis after percutaneous coronary intervention (PCI).

Methods: We studied 26 subjects who had been recently implanted with a paclitaxel-eluting coronary stent by both a conventional exercise test and the determination of plasma B-type natriuretic peptide (BNP) levels.

Results: At control coronary angiography, nine months after initial PCI, six patients had re-stenosis and 20 were re-stenosis free.

[New etiologies responsible for infective endocarditis with negative blood cultures].

The prevalence of infective endocarditis with negative blood cultures varies in the different series from 5 to 25%. There are certain explanations of negative blood culture endocarditis: previous incorrect antibiotic therapy before obtaining blood samples (antibiotic treatment inhibits the growth of germs, and therefore bacteremia, without sterilizing the vegetations); infective endocarditis due to fastidious microorganism, that is of difficult cultivation and identification; infective endocarditis due to cell-dependent organism (e.g.

[An alarming problem in the therapy of infective endocarditis: the development of antibiotic-resistant strains].

We shall focus on infective endocarditis due to Enterococcus spp and Staphylococcus aureus, both able to develop resistance to antibiotics with different mechanisms. Vancomycin-resistant strains produce some of the most challenging nososocomial infections. Enterococci develop resistance practically to all classes of antibiotics.

Sinus arrest associated with dipyridamole infusion.

We describe a case of prolonged sinus arrest resolved by external cardiac massage following intravenous infusion of dipyridamole, during a thallium myocardial perfusion test. The arrhythmia, presumably due to an acute drug adverse effect, had not been previously described (to our knowledge) as a complication of dipyridamole stress testing.

Right-sided infective endocarditis with acquired tricuspid valve stenosis associated with transvenous pacemaker: a case report.

Five years prior to presentation, a 29-year-old woman received a transvenous pacemaker (DDD) for sick sinus syndrome and nodo-hisian pathology. After pacemaker insertion, she complained of recurrent febrile episodes. Her pacemaker related endocarditis was quite unusual for the infecting organism (a micrococcus) and for an acquired tricuspid valve stenosis.

Utility of echocardiography in the diagnosis of aortic dissection involving the ascending aorta.

We report our prospective experience with sensitivity, specificity, predictive values and efficiency of echocardiography in diagnosing AD involving the ascending aorta (type A). We studied two groups of patients with both echocardiography and aortography. Group 1 was made up by 46 consecutive patients with clinical suspicion of AD.

Systolic anterior motion of the mitral valve in patients with hypertrophic cardiomyopathy. Disappearance after treatment with amiodarone.

We used amiodarone as the only drug in three consecutive patients with hypertrophic cardiomyopathy, marked systolic anterior motion of the mitral valve on M-mode echocardiogram, and paroxysmal atrial fibrillation. The effective control of atrial fibrillation was associated with good symptomatic relief and with reduction until disappearance of the systolic anterior motion of the mitral valve. These data were confirmed in a follow-up of 46, 30 and 30 months.

[Role of echocardiography in the diagnosis of aortic dissection].

We evaluated sensitivity, specificity and predictive values of echocardiography in detecting aortic dissection. We studied in the same period of time two groups of consecutive patients with good quality echocardiographic examination. Group I, with high prevalence of the disease (76%), was composed of 25 patients; 19 patients with aortic dissection (11 of the type A and 8 of the type B) and 6 patients with clinical and echocardiographic suggestion of aortic dissection which was not confirmed by angiography.

Blood culture and echocardiography in diagnosis of infective endocarditis: microbiological and clinical observations.

Short retrospective review of 77 cases of bacterial endocarditis, observed in the 1980-84 period, and diagnosed by means of echography and blood culture. Alfa haemolytic streptococcus strains were isolated (47.6% of 42 isolated strains) followed by Staphylococcus aureus (16.

[Prognostic value of echocardiographic finding of valvular vegetations in patients with infectious endocarditis].

42 consecutive patients with infective endocarditis on native valves, according to Pelletier and Petersdorf's criteria of definite (13 pts), probable (12 pts.) and possible (17 pts) endocarditis, were identified and prospectively followed-up with M-mode and two-dimensional echocardiography, since 1980. We compared: 1) these three groups; 2) survivors not referred for surgery versus surgical patients plus nonsurvivors; 3) patients who suffered embolic events versus those who did not; 4) patients with severe-moderate heart failure versus those with no failure or mild failure; 5) patients with aortic valve echocardiographic vegetations versus those with mitral valve vegetations.

Systolic anterior motion of the mitral valve. An unusual echocardiographic feature of mitral valve endocarditis.

An unusual M-mode echocardiographic feature of mitral valve endocarditis is described: systolic anterior motion of the mitral valve, likely due to mitral valve vegetations, protruding during systole into the left ventricular outflow tract. The presence of mitral valve vegetation was confirmed at operation.

[Diagnostic value of echocardiographic examinations in the evaluation of patients with infectious endocarditis of aortic and/or mitral valve localization].

We estimated sensitivity, specificity, predictive value and efficiency of echocardiography in detecting vegetations and ruptured valves in patients with aortic and/or mitral valves infective endocarditis. We studied two groups of patients, in whom both high quality echocardiography examination and surgical inspection of heart valves were available. Group I: 16 patients (32 valves) with aortic and/or mitral valves endocarditis and surgical demonstration of vegetations and/or ruptured valves.