Journal of Clinical Medicine

Journal Browser

► Journal Browser

Special Issue Information

Dear Colleagues,

Endocarditis is a rare disease, and the outcome remains poor despite improvement in diagnosis and treatment strategies. Expert endocarditis centers and endocarditis teams have reduced endocarditis mortality by improving diagnosis and surgical timing. However, epidemiological and clinical patient characteristics are changing rapidly because of an aging population and the widespread development and implantation of percutaneous cardiac devices. In this setting, clinicians require specific studies addressing optimal diagnosis and therapeutic strategies. The sensitivity of the Duke criteria in diagnosing endocarditis, as related to intracardiac prosthesis or devices, has been improved with the use of cardiac CT and PET CT; however, there is a price to pay in the reduction in specificity. Multimodality imaging with or without a merging approach should be investigated to counterbalance this decrease in specificity. Standardization of imaging criteria using parametric imaging is also needed to simplify the interpretation of the results, reduce inter- and intra-observer bias and improve the reproducibility of the approach. This is a key point because cardiac surgery is mainly based on imaging findings, which remain partly subjective. New microbiological techniques should also be investigated, particularly the potential utility of metagenomic sequencing for improving the etiologic diagnosis of blood-culture-negative results or those affected by fastidious bacteria endocarditis. Importantly, more investigation is needed to define the role of adaptive antibiotic regimens in preventing renal and neurological toxicity in the aging population. Studies should address the efficiency of suppressive antibiotherapy regimens, since a larger proportion of patients may be treated medically, and clearly define the place of cardiac surgery.

Prof. Dr. Pascal Lim
Dr. Raphaël Lepeule
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Related Special Issue

Published Papers (2 papers)

Download All Papers

Research

11 pages, 273 KiB

Open AccessArticle

Evaluation of Infective Endocarditis in Children: A 19-Year Retrospective Study in Taiwan

by Shao-Ju Chien, Yi-Ju Tseng, Ying-Hua Huang, Hsi-Yun Liu, Yi-Hua Wu, Ling-Sai Chang, Yao-Hsu Yang and Ying-Jui Lin

J. Clin. Med. 2023, 12(6), 2298; https://doi.org/10.3390/jcm12062298 - 15 Mar 2023

Cited by 1 | Viewed by 1436

Abstract

Background: Infective endocarditis (IE) is an important cause of morbidity and mortality in pediatric patients with heart disease. Little literature has explored differences in the presentation of endocarditis in children with and without heart disease. This study aimed to compare the clinical outcomes and determine the risk of in-hospital death in the study population. Methods: Data were retrospectively collected from 2001 to 2019 from the Chang Gung Research Database (CGRD), which is the largest collection of multi-institutional electronic medical records in Taiwan. Children aged 0–20 years with IE were enrolled. We extracted and analyzed the demographic and clinical features, complications, microbiological information, and outcomes of each patient. Results: Of the 208 patients with IE, 114 had heart disease and 94 did not. Compared to those without heart disease, more streptococcal infections (19.3% vs. 2.1%, p < 0.001) and cardiac complications (29.8% vs. 6.4%, p < 0.001) were observed in patients with heart disease. Although patients with heart disease underwent valve surgery more frequently (43.9% vs. 8.5%, p < 0.001) and had longer hospital stays (28.5 vs. 12.5, p = 0.021), their mortality was lower than that of those without heart disease (3.5% vs. 10.6%, p = 0.041). Thrombocytopenia was independent risk factor for in-hospital mortality in pediatric patients with IE (OR = 6.56, 95% CI: 1.43–40.37). Conclusion: Among pediatric patients diagnosed with IE, microbiological and clinical features differed between those with and without heart disease. Platelet counts can be used as a risk factor for in-hospital mortality in pediatric patients with IE. Full article

(This article belongs to the Special Issue Infections, Complications and Management of Endocarditis: Part II)

11 pages, 1776 KiB

Open AccessArticle

Coxiella burnetii and Bartonella Endocarditis Diagnosed by Metagenomic Next-Generation Sequencing

by Weiteng Wang, Oudi Chen, Weijiang Liu, Lixi Gan, Xin Li, Qingyan Ma, Xuejiao Hu and Xuhua Jian

J. Clin. Med. 2022, 11(23), 7150; https://doi.org/10.3390/jcm11237150 - 1 Dec 2022

Cited by 3 | Viewed by 1508

Abstract

(1) Background: Culture-negative endocarditis is challenging to diagnose. Here, we retrospectively identified 23 cases of Coxiella burnetii and Bartonella endocarditis by metagenomic next-generation sequencing. (2) Methods: Twenty-three patients with culture-negative endocarditis were retrospectively enrolled from Guangdong Provincial People’s Hospital (n = 23) between April 2019 and December 2021. Metagenomic next-generation sequencing was performed on blood (n = 22) and excised cardiac valvular tissue samples (n = 22) for etiological identification, and Sanger sequencing was performed for pathogenic diagnostic verification. The demographic and clinical data of the 23 patients were obtained from hospital electronic health records. (3) Results: A total of 23 male patients (median age, 56 years (interquartile range, 16)) with culture-negative endocarditis were diagnosed with Coxiella burnetii (n = 21) or Bartonella (n = 2) species infection by metagenomic next-generation sequencing. All patients underwent cardiac surgery. The resected tissue exhibited both a significantly higher number of unique suspected pathogen read-pairs and more unique pathogen read-pairs than the blood specimens. The results of Sanger sequencing tests on all remaining tissue and blood specimens were positive. Oral doxycycline was added to the antibiotic regimen for at least 1.5 years according to etiology. A total of 21 patients (91%) were discharged, and 20 patients were healthy at the 21-month (interquartile range, 15) follow-up visit. One patient exhibited endocarditis relapse with the same pathogen from inadequate antibiotic administration. The last 2 patients (9%) developed septic shock and multiple organ dysfunction syndrome postoperatively and died shortly after discharge. (4) Conclusions: CNE caused by C. burnetii and Bartonella species is challenging to diagnose and exhibits poor outcome due to delayed treatment. In response, mNGS, characterized by high sensitivity and rapid results, is an effective alternative for the etiological identification of C. burnetii and Bartonella endocarditis. Full article

(This article belongs to the Special Issue Infections, Complications and Management of Endocarditis: Part II)

► Show Figures