Treatment of enterococcal endocarditis requires up to 6 weeks of intravenous (IV) antimicrobial therapy. When susceptible, an ampicillin-based regimen is preferred. Studies evaluating ampicillin stability utilizing high-pressure liquid chromatography have indicated enhanced stability (greater than 24 hours at room temperature), supporting outpatient administration. Thus, we report the successful treatment of a 30-year-old male with tricuspid valve enterococcal endocarditis in an outpatient setting using continuous infusion ampicillin via an ambulatory infusion pump. The patient received daily gentamicin at an outpatient infusion center with the ampicillin dose to be infused over the next 24 hours. Outpatient ambulatory infusion pumps allow for delivery of ampicillin via continuous infusion or pump-programmed pulse dosing. Preparation and administration in an outpatient infusion center may be a viable option to circumvent stability and delivery issues. Furthermore, 81% (34/42) of treatment days were completed outpatient, supporting that this approach may increase access to treatment and help reduce the economic burden to health care.

Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort

UA Open Access Publishing Fund / Molecular diagnostics offers quick access to information but fails to operate at a speed required for clinical decision-making. Our novel methodology, droplet-on-thermocouple silhouette real-time polymerase chain reaction (DOTS qPCR), uses interfacial effects for droplet actuation, inhibition relief, and amplification sensing. DOTS qPCR has sample-to-answer times as short as 3 min 30 s. In infective endocarditis diagnosis, DOTS qPCR demonstrates reproducibility, differentiation of antibiotic susceptibility, subpicogram limit of detection, and thermocycling speeds of up to 28 s/cycle in the presence of tissue contaminants. Langmuir and Gibbs adsorption isotherms are used to describe the decreasing interfacial tension upon amplification. Moreover, a log-linear relationship with low threshold cycles is presented for real-time quantification by imaging the droplet-on-thermocouple silhouette with a smartphone. DOTS qPCR resolves several limitations of commercially available real-time PCR systems, which rely on fluorescence detection, have substantially higher threshold cycles, and require expensive optical components and extensive sample preparation. Due to the advantages of low threshold cycle detection, we anticipate extending this technology to biological research applications such as single cell, single nucleus, and single DNA molecule analyses. Our work is the first demonstrated use of interfacial effects for sensing reaction progress, and it will enable point-of-care molecular diagnosis of infections.

Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...

Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...

complex has been further divided into , , and . is considered to be the least virulent fungi of the complex. Candida endocarditis is uncommon but is associated with a very high mortality rate. Prosthetic or previously damaged valves act as common targets, but native, structurally normal valves are seldom affected. We hereby present a case of endocarditis involving a native aortic valve in an immunocompetent 55-year-old male who was successfully treated with surgical valve replacement and antifungal therapy.

People who inject drugs, particularly opioids, are a growing population, especially in North Philadelphia. This population is at high risk for medical complications that require hospitalization. While hospitalized, this population poses unique challenges to the healthcare system, including high costs and readmission rates, as well as stress and burnout among providers and staff. These patients are at high risk of discharges against medical advice because of complicated social factors as well as inadequate recognition of pain and withdrawal. As the opioid epidemic evolves, previous strategies for managing these patients, which traditionally relied on referral to psychiatry or social work in addition to symptomatic treatment, need to be re-evaluated. Ethically, the decision-making capacity of these patients is frequently called into question, and there is a difficult-to-strike balance between respecting their autonomy and acting with beneficence to provide the best care. There are also public health concerns that come into play. Better acknowledgment of the issues that this population faces, and better management of pain and withdrawal, may improve their outcomes, as well as reduce provider stress and burnout. / Urban Bioethics

Treatment of infective endocarditis can often prove challenging due to its wide range of anatomical presentations. When complicated by an aortic root abscess, patients may require extensive root surgery, which on its own leads to a worse outcome. We present our experience with a surgical technique for reinforcing the aortic annulus with a ring from a Dacron aortic prosthesis placed in the left ventricular outflow tract to avoid the need for root replacement procedures or patch closures of the defect. The technique described in this paper provides a viable alternative to the standard techniques used for the treatment of annular abscesses in aortic valve endocarditis. Due to the relative simplicity and ease of use, this approach may present a means of reducing operation time and possibly postoperative complications of this severe condition.

La maladie rénale peut se manifester avec différents types de pathologies buccales pouvant augmenter les risques de bactériémie. Bien que l’endocardite infectieuse soit une condition rare chez les patients atteints de maladie rénale, elle peut toutefois être retrouvée suite à des infections nosocomiales. Dans le passé, une antibiothérapie prophylactique était prescrite aux patients hémodialysés pour les protéger de l’endocardite infectieuse et de l’infection de l’accès d’hémodialyse. Aujourd’hui, cette recommandation est révolue. Afin de contrer les risques de bactériémie transitoire, une attention particulière doit être apportée aux soins d’hygiène orale à la maison. Le but de l’étude est d’évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les patients atteints de maladie rénale. Objectifs de recherche Les trois objectifs de recherche sont a) d’évaluer les connaissances des parents de patients atteints de maladies rénales sur l’endocardite infectieuse et le lien avec la santé buccodentaire; b) d’évaluer la perception des parents par rapport à la santé buccodentaire de leur enfant et leurs habitudes d’hygiène orale; et c) de comparer l’influence de deux méthodes d’hygiène orale sur l’indice de plaque chez les enfants atteints de maladies rénales. Hypothèses Les deux hypothèses de recherche sont que a) les parents d’enfants atteints de maladies rénales connaissent et adhèrent aux recommandations émises par l’American Heart Association; et que b) l’amélioration de l’indice de plaque chez les patients atteints de maladies rénales est plus grande pour le groupe recevant des instructions par le matériel audiovisuel par rapport à ceux qui les reçoivent par le néphrologue. Méthodologie Suite à l’obtention d’un certificat d’éthique à la recherche du Centre Hospitalier Universitaire Sainte-Justine, 37 des 38 sujets recrutés âgés entre 6 et 16 ans (19 filles et 18 garçons) ont participé à cette étude transversale. Suite à la signature d’un consentement éclairé, les sujets sont assignés par randomisation à l’un des deux groupes d’instructions d’hygiène orale, soit celui sans instructions spécifiques (groupe 1) ou par matériel audiovisuel (groupe 2). Un questionnaire portant sur les connaissances des parents en rapport avec la santé buccodentaire est remis aux parents. Un indice de plaque initial est noté avant l’application des instructions d’hygiène orale reçues. Un indice de plaque final mis en évidence à l’aide de pastilles révélatrices est documenté avec des photographies intra-orales et mesuré par deux observateurs, testés pour la fiabilité intra et inter-observateurs. Résultats Les analyses statistiques ne démontrent aucune différence significative entre les deux groupes d’instructions d’hygiène orale. Les variables à l’étude (âge, sexe, suivi dentaire, fréquence des soins à la maison, connaissances et motivation) ne montrent aucune influence significative sur la qualité de l’hygiène orale des sujets. Seul l’indice de plaque initial est inversement relié à la perception des parents face à la santé buccodentaire de leur enfant : plus le relevé de plaque est bas, plus la santé buccodentaire est perçue comme bonne. Conclusion Selon les résultats de notre étude, il n’existe pas de différence statistiquement significative entre les deux méthodes d’instructions d’hygiène orale. Néanmoins, les deux techniques permettent de diminuer significativement l’indice de plaque chez les enfants atteints de maladies rénales et de conscientiser cette population à l’importance du maintien d’une bonne santé buccodentaire. / Renal diseases are known to cause oral changes that can increase the risk of developping a bacteraemia. Even if infective endocarditis is a rare condition in patients with renal disease, it is associated with nosocomial infections. In the past, antimicrobial therapy was recommended for haemodialysis patients to prevent infective endocarditis and indwelling venous catheter-related infections. The administration of prophylactic antibiotics is no longer supported, given the lack of evidence concerning this approach. To prevent patients from developing a transitory bacteraemia, home oral care has to be improved. The goal of this study is to assess the efficacy of two oral health instruction methods in children with renal disease. Objectives The objectives of this study are to assess the knowledge on infective endocarditis and its link to the oral health of parents with children who present with renal disease; to evaluate the perception of parents in relation with their child’s oral health and their dental behaviour and finally to compare the impact of the oral health instruction methods on the plaque index of children with renal disease. Hypothesis The two hypotheses of this study are a) parents of children suffering from renal diseases know and respect the guidelines published by the American Heart Association and b) that the improvement of the plaque index is better in the group who receives oral health instructions from the audio-visual material compared to the one receiving instructions from the nephrologist. Methods An ethic’s certification was obtained from the Centre Hospitalier Universitaire Sainte-Justine for children. Of the 38 recruited patients, 37 patients (19 girls, 18 boys) ranging in age from 6 to 16 years participated in this transversal study. Consent was obtained prior to randomised assignment to either oral hygiene delivered by means of an audio-visual aid (groupe 1) or by a nephrologist (group 2). A questionnaire investigating parental knowledge on renal disease linked with oral health was administered. An initial plaque index was taken before applying oral health instructions. A final plaque index using disclosing tablets was measured by two observers tested for intra and inter-reliability through intra-oral pictures. Results The statistical analyses do not show any significant differences between the two oral health instruction groups. No significant relation was found between oral health status and age, gender, dental follow up, frequency of home dental hygiene and motivation. The only significant relationship found was as parents perception of their child’s oral health increases, the initial plaque index decreases. Conclusion The results indicate that even if there is no statistically significant difference between the two methods of oral health instruction, both techniques are capable of reducing the plaque index of children suffering from renal disease.

La maladie rénale peut se manifester avec différents types de pathologies buccales pouvant augmenter les risques de bactériémie. Bien que l’endocardite infectieuse soit une condition rare chez les patients atteints de maladie rénale, elle peut toutefois être retrouvée suite à des infections nosocomiales. Dans le passé, une antibiothérapie prophylactique était prescrite aux patients hémodialysés pour les protéger de l’endocardite infectieuse et de l’infection de l’accès d’hémodialyse. Aujourd’hui, cette recommandation est révolue. Afin de contrer les risques de bactériémie transitoire, une attention particulière doit être apportée aux soins d’hygiène orale à la maison. Le but de l’étude est d’évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les patients atteints de maladie rénale. Objectifs de recherche Les trois objectifs de recherche sont a) d’évaluer les connaissances des parents de patients atteints de maladies rénales sur l’endocardite infectieuse et le lien avec la santé buccodentaire; b) d’évaluer la perception des parents par rapport à la santé buccodentaire de leur enfant et leurs habitudes d’hygiène orale; et c) de comparer l’influence de deux méthodes d’hygiène orale sur l’indice de plaque chez les enfants atteints de maladies rénales. Hypothèses Les deux hypothèses de recherche sont que a) les parents d’enfants atteints de maladies rénales connaissent et adhèrent aux recommandations émises par l’American Heart Association; et que b) l’amélioration de l’indice de plaque chez les patients atteints de maladies rénales est plus grande pour le groupe recevant des instructions par le matériel audiovisuel par rapport à ceux qui les reçoivent par le néphrologue. Méthodologie Suite à l’obtention d’un certificat d’éthique à la recherche du Centre Hospitalier Universitaire Sainte-Justine, 37 des 38 sujets recrutés âgés entre 6 et 16 ans (19 filles et 18 garçons) ont participé à cette étude transversale. Suite à la signature d’un consentement éclairé, les sujets sont assignés par randomisation à l’un des deux groupes d’instructions d’hygiène orale, soit celui sans instructions spécifiques (groupe 1) ou par matériel audiovisuel (groupe 2). Un questionnaire portant sur les connaissances des parents en rapport avec la santé buccodentaire est remis aux parents. Un indice de plaque initial est noté avant l’application des instructions d’hygiène orale reçues. Un indice de plaque final mis en évidence à l’aide de pastilles révélatrices est documenté avec des photographies intra-orales et mesuré par deux observateurs, testés pour la fiabilité intra et inter-observateurs. Résultats Les analyses statistiques ne démontrent aucune différence significative entre les deux groupes d’instructions d’hygiène orale. Les variables à l’étude (âge, sexe, suivi dentaire, fréquence des soins à la maison, connaissances et motivation) ne montrent aucune influence significative sur la qualité de l’hygiène orale des sujets. Seul l’indice de plaque initial est inversement relié à la perception des parents face à la santé buccodentaire de leur enfant : plus le relevé de plaque est bas, plus la santé buccodentaire est perçue comme bonne. Conclusion Selon les résultats de notre étude, il n’existe pas de différence statistiquement significative entre les deux méthodes d’instructions d’hygiène orale. Néanmoins, les deux techniques permettent de diminuer significativement l’indice de plaque chez les enfants atteints de maladies rénales et de conscientiser cette population à l’importance du maintien d’une bonne santé buccodentaire. / Renal diseases are known to cause oral changes that can increase the risk of developping a bacteraemia. Even if infective endocarditis is a rare condition in patients with renal disease, it is associated with nosocomial infections. In the past, antimicrobial therapy was recommended for haemodialysis patients to prevent infective endocarditis and indwelling venous catheter-related infections. The administration of prophylactic antibiotics is no longer supported, given the lack of evidence concerning this approach. To prevent patients from developing a transitory bacteraemia, home oral care has to be improved. The goal of this study is to assess the efficacy of two oral health instruction methods in children with renal disease. Objectives The objectives of this study are to assess the knowledge on infective endocarditis and its link to the oral health of parents with children who present with renal disease; to evaluate the perception of parents in relation with their child’s oral health and their dental behaviour and finally to compare the impact of the oral health instruction methods on the plaque index of children with renal disease. Hypothesis The two hypotheses of this study are a) parents of children suffering from renal diseases know and respect the guidelines published by the American Heart Association and b) that the improvement of the plaque index is better in the group who receives oral health instructions from the audio-visual material compared to the one receiving instructions from the nephrologist. Methods An ethic’s certification was obtained from the Centre Hospitalier Universitaire Sainte-Justine for children. Of the 38 recruited patients, 37 patients (19 girls, 18 boys) ranging in age from 6 to 16 years participated in this transversal study. Consent was obtained prior to randomised assignment to either oral hygiene delivered by means of an audio-visual aid (groupe 1) or by a nephrologist (group 2). A questionnaire investigating parental knowledge on renal disease linked with oral health was administered. An initial plaque index was taken before applying oral health instructions. A final plaque index using disclosing tablets was measured by two observers tested for intra and inter-reliability through intra-oral pictures. Results The statistical analyses do not show any significant differences between the two oral health instruction groups. No significant relation was found between oral health status and age, gender, dental follow up, frequency of home dental hygiene and motivation. The only significant relationship found was as parents perception of their child’s oral health increases, the initial plaque index decreases. Conclusion The results indicate that even if there is no statistically significant difference between the two methods of oral health instruction, both techniques are capable of reducing the plaque index of children suffering from renal disease.