Search Results (153)

Biofilms are structured communities of microorganisms encased in a self-produced extracellular matrix, and they represent one of the most widespread forms of microbial life on Earth. Their presence poses serious challenges in both environmental and clinical settings. In natural and industrial systems, biofilms contribute to water contamination, pipeline corrosion, and biofouling. Clinically, biofilm-associated infections are responsible for approximately 80% of all microbial infections, including endocarditis, osteomyelitis, cystic fibrosis, and chronic sinusitis. A particularly critical concern is their colonization of medical devices, where biofilms can lead to chronic infections, implant failure, and increased mortality. Implantable devices, such as orthopedic implants, cardiac pacemakers, cochlear implants, urinary catheters, and hernia meshes, are highly susceptible to microbial attachment and biofilm development. These infections are often recalcitrant to conventional antibiotics and frequently necessitate surgical revision. In the United States, over 500,000 biofilm-related implant infections occur annually, with prosthetic joint infections alone projected to incur revision surgery costs exceeding USD 500 million per year—a figure expected to rise to USD 1.62 billion by 2030. To address these challenges, surface modification of medical devices has emerged as a promising strategy to prevent bacterial adhesion and biofilm formation. This review focuses on recent advances in chemical surface functionalization using non-antibiotic agents, such as enzymes, chelating agents, quorum sensing quenching factors, biosurfactants, oxidizing compounds and nanoparticles, designed to enhance antifouling and mature biofilm eradication properties. These approaches aim not only to prevent device-associated infections but also to reduce dependence on antibiotics and mitigate the development of antimicrobial resistance. Full article

Gingival recession is a common problem, particularly affecting oral health and esthetics, and its treatment involves surgical root coverage procedures. The aim of this narrative review is to evaluate the role of systemic antibiotic therapy in mucogingival surgery for recession treatment. The available literature does not support routine antibiotic use in systemically healthy patients undergoing recession coverage surgery. Indications for prophylactic antibiotics are restricted to individuals at high risk of infective endocarditis and immunocompromised patients with elevated susceptibility to surgical site infections. Although mucogingival surgeries are performed in a non-sterile environment, the risk of infection remains low when proper aseptic techniques and good preoperative tissue preparation are applied. The review emphasizes the importance of making clinical decisions that consider the patient’s health status and are aligned with current recommendations. It also emphasizes the necessity for prospective studies to evaluate antibiotics’ effect on recession coverage procedures outcome. To bridge the gap between contemporary evidence and clinical practice and to foster responsible use of antibiotics in periodontal plastic surgery, the authors of this review integrate current evidence and clinical guidelines into a practical tool designed to assist clinicians in making reasoned, evidence-based decisions. Full article

Background: Infective endocarditis after transcatheter aortic valve replacement (TAVR-IE) is a rare but severe complication associated with high morbidity and mortality. The optimal treatment strategy—surgical explantation versus medical therapy—remains uncertain, particularly given the technical demands of TAVR removal and the advanced age of many affected patients. Methods: We conducted a systematic review and meta-analysis of studies comparing the surgical and medical management of TAVR-IE. Primary outcomes included 30-day mortality and 1-year survival. Secondary analyses explored microbiological profiles, patient demographics, prosthesis type, postoperative complications, and surgical indications. A qualitative synthesis of surgical explantation techniques and reconstructive strategies was also performed based on recent consensus recommendations. Results: Three studies comprising 1557 patients with TAVR-IE were included; 155 (10.0%) underwent surgical treatment. Thirty-day mortality was comparable between groups (surgical: 9.7%; medical: 8.4%), while the pooled odds ratio for one-year survival did not reach statistical significance (OR: 1.91, 95% CI: 0.36–10.22; I² = 88%). However, single-center outcomes demonstrated markedly improved survival with surgery (96% vs. 51%). The most common surgical indications included severe valvular dysfunction (50.3%), aortic root abscess (26.5%), and large vegetations (21.3%), in line with current guideline recommendations. Postoperative complications included acute renal failure (10%) and longer hospitalizations (19.8 vs. 18 days), although these were not statistically different. Contemporary explant strategies—such as the Double Kocher, Tourniquet, and Y-incision aortic enlargement techniques—were highlighted as critical tools for surgical success. Conclusions: While underutilized, surgical intervention for TAVR-IE may offer significant survival benefits in select patients, particularly when guided by established indications and performed at high-volume centers. Outcomes depend heavily on timing, surgical expertise, and appropriate patient selection. As TAVR expands to younger populations, TAVR-IE will become increasingly relevant, necessitating early multidisciplinary involvement and broader familiarity with advanced explant techniques among cardiac surgeons. Full article

Background: Non-cholera Vibrio species are rare waterborne pathogens that can cause severe infections. Among these, few cases of Vibrio metschnikovii infections have been reported, especially in the gastrointestinal tract, with no cardiac tissue involvement as a result. Following the PRISMA checklist, we conducted a literature review, and thirteen articles for twenty-two cases overall were included: seven cases of sepsis (in three cases, the echocardiographic results were negative), seven cases of pneumonia, two skin infections, eleven cases of diarrhoea, and a gastroenteritis outbreak. This report documents the expanding clinical spectrum and the role played by V. metschnikovii in infective endocarditis. Case report: A 28-year-old male patient was referred to the cardiac surgery unit for urgent mitral valve replacement due to suspicion of infective endocarditis. Microbiological tests yielded negative results. Following recovery and discharge with antimicrobial therapy for 6 weeks, the patient experienced prosthesis detachment, necessitating re-hospitalisation for an emergency valve replacement. Vibrio metschnikovii was identified on the prosthesis valve through PCR and successfully treated with ciprofloxacin. However, a spontaneous rupture of the ascending thoracic aorta led to a neurological injury. Discussion: This case represents the first case of valve infection caused by Vibrio metschnikovii, characterised by diagnostic and therapeutic challenges and the involvement of the great vessels. Also considered in this case, for a disease with a median age of 58 years (11–83) and a male-to-female ratio of 2.2, were one male neonate and six cases for whom neither sex nor age was indicated. Excluding gastrointestinal cases, the septic forms are associated with high morbidity, although the single case described involved a young and healthy subject. Risk factors for the pathogen or predisposing/pathological conditions for endocarditis did not emerge. The routes and the time of infection could not be determined, deepening the possibility of occupational exposure via the patient’s position as a boat worker. Poor sensitivity to third-generation cephalosporins has been reported in the literature: the absence of an antibiogram does not allow for a comparison, although resolution was achieved with ciprofloxacin. Conclusion: The rising global incidence of non-cholera Vibrio infections, driven by environmental changes, calls for urgent research into the factors behind their pathogenicity and infection routes. Diagnostic complexities have emerged together with clinical severity. Full article

Background: Aortic valve infective endocarditis (IE) complicated by an aortic root abscess is a challenging problem that leads to increased morbidity and mortality. Aortic root repair or replacement are two potential treatment options. We aimed to compare patients undergoing aortic root repair or replacement with short- and mid-term outcomes. Methods: Consecutive patients with active aortic valve IE complicated by aortic root abscess undergoing cardiac surgery from January 2012 to January 2022 were included. Patients receiving aortic root repair were compared to patients undergoing aortic root replacement. Endpoints included overall mortality, incidence of recurrent IE and re-intervention during a two-year follow-up period. Inverse propensity weighting was employed to adjust for confounders. Results: Seventy-three patients with aortic valve IE with root abscess underwent surgical therapy. Fifty-six patients received aortic root repair and seventeen patients underwent aortic root replacement. Patients undergoing root replacement had significantly higher surgical risk (EuroSCORE II: 9 versus 19, p = 0.02) and extended disease (circumferential annular abscess: 9% versus 41%, p < 0.01). Inverse propensity weighted analysis revealed no relationship between surgical strategy and outcome. Weighted regression analysis revealed EuroSCORE II and disease extension as significant predictors of 30-day and 2-year mortality. Conclusions: In patients with aortic valve IE with root abscess, root repair is mostly performed in lower-risk patients with limited disease extension. Short- and mid-term mortality, recurrent endocarditis and reintervention were comparable between surgical strategies during follow-up. Surgical risk and disease extension, rather than surgical strategy, seem to be significant predictors of short- and mid-term mortality. Full article

Background/Objectives: After years of work in the field of aortic arch surgery, the technique has evolved, making this procedure relatively safe, with lasting results. Due to the increasing long-term survival and overall aging of the patient population, more patients require aortic arch reoperation. In the present study, the safety of aortic arch reoperations was analyzed in the long term, focusing on risk factors for mortality. Methods: Between 1999 and 2023, 108 patients were included in our study who underwent reoperation on aortic arch after prior operation on the aorta, the aortic valve, or a combination of both. The exclusion criteria were being aged under 18 years and transcatheter aortic valve implantation as a previous intervention. The principal outcome was the incidence of mortality, and additional outcomes of interest included cardiac re-reoperation, bleeding, a new aortic type B dissection, infective endocarditis, readmission due to a cardiac cause, coronary intervention and neurovascular complications, pacemaker implantation, and temporary mechanical circulatory support. Results: The mean age was 56 ± 14 years, and 75% (81/108) of patients were male. In our study, we found age (p ≤ 0.01) and history of coronary artery disease (p = 0.01) to be preoperative risk factors for adverse outcomes. The mean time between the index operation and reoperation was 6.84 years (1.61–14.94). Indications for reoperation included dilatation (HR = 0.49, p = 0.05), rupture or false aneurysm (HR = 2.08, p= 0.08), dissection (HR = 1.41, p = 0.30), and endocarditis (HR = 1.49, p = 0.41). A main risk factor was the need for a salvage reoperation (p ≤ 0.01). Also, a longer operation (p = 0.04), cardiopulmonary bypass (p ≤ 0.01), and ventilation time (p ≤ 0.01), bleeding complications (p ≤ 0.01), and requiring temporary mechanical circulatory support (p = 0.04) were linked to higher mortality. The overall survival was 82% after 1 year, 73% after 5 years, and 56% after 10 years. In the multivariate Cox regression analysis, age (HR = 1.04, p ≤ 0.01), the need for a salvage operation (HR = 5.38, p = 0.01), a prolonged ventilation time (HR = 1.08, p = 0.04), and bleeding complications (HR = 3.76, p = 0.03) were associated with higher mortality. In the ROC analysis, an age over 57.5 years was associated with significantly lower overall survival (p ≤ 0.01). Conclusions: Aortic arch reoperations can be performed with acceptable long-term outcomes, but perioperative factors significantly influence early mortality. Salvage operations, bleeding complications, and prolonged ventilation were strong predictors of adverse outcomes. Older age, particularly >57.5 years, was independently associated with increased mortality risk. Full article

Background/Objectives: Although there is a general consensus that patients should have dental evaluation before heart valve surgery, data on the extent and complications of this evaluation are scarce. The objective was to analyze safety and feasibility of dental evaluation in patients undergoing heart valve surgery. Methods: A retrospective chart review of patients referred for dental evaluation prior to heart valve surgery in 2021–2023 was conducted. Demographic, medical, and dental data were recorded. The number and type of dental procedures and their complications were recorded, along with the number of appointments and the time required to achieve dental clearance for heart valve surgery. Results: One hundred and fifty-three patients were referred in the observed period. The predominant procedure was tooth extraction, accounting for 76 (49.7%) cases. Complications were recorded in 3 (1.9%) patients, with delayed bleeding being the most prevalent issue, occurring in 2 (1.3%) patients. The median time required to obtain dental clearance for cardiosurgical procedure was 1 day, with 124 (81%) patients obtaining clearance in a single appointment. No dental emergencies were observed during hospital admission for the cardiosurgical procedure. Conclusions: Our results suggest that dental evaluation before heart valve surgery can be conducted in a reasonable amount of time with a low complication rate and without the need to delay cardiosurgical procedures. Full article

Background: This study aims to evaluate the impact of critical illness, defined as the need for preoperative intensive care unit (ICU) admission for invasive monitoring or organ support, on cardiac surgery outcomes for patients with acute infective endocarditis (IE). Methods: A retrospective analysis of prospectively collected data from patients treated between 1 January 2017 and 30 May 2024 at a single Australian tertiary cardiothoracic centre was performed. Data were collected from the Australian and New Zealand Cardiothoracic Society (ANZCTS) database and the Australian and New Zealand Intensive Care Adult Patients Database (ANZICS-APD). Results: Among 342 patients who underwent cardiac surgery for IE, 32 (9.4%) were critically ill. The critically ill patients were admitted to the ICU before surgery with a diagnosis of septic or cardiogenic shock, with 86% (n = 30) requiring mechanical ventilation. Compared to the non-critically ill cohort, critically ill patients were more likely to have a history of intravenous drug use (IVDU) (41% vs. 14%, p = 0.03) and a younger age (median age 49 years [42–56] vs. 61 years [44–70], p = 0.03), and although methicillin-sensitive Staphylococcus aureus (MSSA) was the most common causative organism in both groups, it was found significantly more often in the critically ill cohort (66% and 27%, p = 0.001). The median EuroSCORE II was comparable between the groups (2.1 [1.3–10] vs. 2.8 [1.3–5.7], p = 0.69); however, the APACHE III (57 [49–78] vs. 52 [39–67], p = 0.03) and ANZROD scores (0.04 [0.02–0.09] vs. 0.013 [0.004–0.038], p = 0.00002) were significantly higher in the critically ill patients. The overall 30-day mortality rates were similar between the groups (13% vs. 5%, p = 0.60). The median ICU length of stay (LOS) was significantly longer for the critically ill patients (5 days [IQR 2–10 days] vs. 2 days [1–4 days], p = 0.0004), with a similar hospital LOS (23 days [IQR 14–36] vs. 21 days [12–34], p = 0.46). Renal replacement therapy was three times higher in the critically ill (34% vs. 11%, p = 0.0001). Reoperations for bleeding were similar between the groups (16% vs. 11%, p = 0.74). Conclusions: Despite being associated with higher ANZROD and APACHE III scores, a longer ICU length of stay, and higher use of renal replacement therapy, critical illness did not have an impact on the EuroSCORE II, hospital length of stay, or reoperation rates for bleeding or 30-day mortality among patients with IE undergoing cardiac surgery. The lessons from this study will guide and inform the development of better infective endocarditis databases and registries. Full article

Mycobacterium chimaera infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, and respiratory symptoms that emerged seven years after they underwent heart surgery for prosthetic aortic valve replacement. A kidney biopsy revealed non-caseating necrotizing granulomatous interstitial nephritis, which was initially diagnosed as idiopathic granulomatous interstitial nephritis. The patient was treated with intravenous corticosteroids since no active infections, including mycobacterial infections, were detected. The negativity of the Mycobacterium molecular test following the kidney biopsy delayed the diagnosis of a Mycobacterium chimaera disseminated infection with endocarditis, myositis, cerebral, and kidney involvement, as blood cultures were available only after six weeks. The patient was started on antimicrobial therapy with azithromycin, moxifloxacin, rifampicin, and ethambutol while prednisone was tapered down, leading to an improvement in kidney function, blood count, and blood calcium level. Our case suggests that a Mycobacterium chimaera infection should be considered for patients with a history of cardiac surgery and granulomatous interstitial nephritis even in the absence of mycobacteria in a kidney biopsy. Full article

Background: This study evaluates the outcomes of isolated mitral valve surgery for infective endocarditis performed via conventional full sternotomy or minimally invasive right minithoracotomy. While minimally invasive surgery (MIS) is well-established for elective mitral procedures, its role in infective endocarditis remains less explored due to the complexity of the disease. Methods: A retrospective analysis of 134 patients who underwent isolated mitral valve surgery for infective endocarditis between January 2010 and March 2024 was conducted. Patients were divided into two groups based on the surgical approach: full sternotomy (n = 94) and MIS via right minithoracotomy (n = 40). Variables analyzed included preoperative characteristics, intraoperative details, and postoperative outcomes, such as mortality, complications, and hospital stay duration. Given significant baseline differences, inverse probability weighting was applied for comparability. Results: Mitral valve replacement was performed in 77% of cases. After adjustment, the MIS group demonstrated shorter intensive care unit stays (p = 0.018), with no significant differences in in-hospital mortality (p = 0.145) or total hospitalization length (p = 0.151). Conclusions: Minimally invasive mitral valve surgery is a safe and effective alternative to sternotomy in infective endocarditis, offering comparable outcomes with shorter ICU stays. Further research is needed to refine patient selection and validate these findings. Full article

Background: While the relationship between recent dental treatment and the development of endocarditis is largely undisputed, the relationship between poor dental status and the development of infective endocarditis has not yet been proven beyond doubt. We have therefore analyzed this hypothetical connection using our established endocarditis register (B.E.R.). Patients and Methods: A total of 72 patients who underwent dental treatment (TREAT) and 55 patients with a desolate dental status (DESOLATE) were found in our database of 530 patients subsequently developing infective endocarditis necessitating valve surgery. A propensity score analysis was performed comparing TREAT as well as DESOLATE with matched patients without these conditions as CONTROL. Results: TREAT showed significantly more often Strept. mitis (26.9%) as well as other Streptococci (36.54%, p = 0.001) compared to CONTROL (3.51% and 10.53%, respectively), whereas Staphylococci and E. faecalis were found more often in CONTROL than in TREAT (S. aureus: 22.81% vs. 15.38%, n.s.; other Staphylococci 14.04% vs. 1.92%, p = 0.033; E. faec.: 26.32% vs. 9.62%, p = 0.045). DESOLATE showed significantly more Strept. mitis compared to CONTROL (27.91% vs. 4.88%, p = 0.007). Early mortality was 23.7% in the TREAT group, while it was 15.25% in the CONTROL group and 17.02% in the DESOLATE group vs. 20.83% in the CONTROL patients. Conclusions: The current results suggest that adequate endocarditis prophylaxis to prevent bacteremia may not be carried out in patients undergoing dental treatment and may occur spontaneously in patients with poor dental care. Both situations require new strategies to avoid such severe consequences. Full article

Background: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional surgery. Methods: A retrospective, multicenter analysis of 204 patients with aortic IE was conducted, excluding emergency cases requiring immediate intervention. Patients were stratified into EARLY (≤7 days) and LATE (>7 days) surgical groups. Primary endpoints included in-hospital mortality and major adverse events, while secondary endpoints assessed long-term survival, recurrence, and reintervention rates. Results: No significant differences in in-hospital mortality were observed between groups (16% in both). The LATE group exhibited a trend toward increased permanent pacemaker implantation (16% vs. 8.2%; p = 0.100) and a higher incidence of postoperative atrial fibrillation (36% vs. 24%, p = 0.048). Infective endocarditis recurrence and long-term survival did not significantly differ between groups. Predictors of one-year mortality included chronic kidney disease, annular abscess, extracorporeal membrane oxygenation (ECMO) use, and prolonged mechanical ventilation. Conclusions: These findings suggest that early surgery, following a short course of antibiotics, does not compromise outcomes nor increase recurrence risk, challenging the conventional preference for delayed intervention in non-emergency IE cases. Full article

Background: Infective endocarditis is a severe, life-threatening condition which affects the endocardial lining of the heart. Right-sided IE typically affects the tricuspid valve and, less commonly, the pulmonary valve, often in association with intravenous drug use and intracardiac devices. Enterococcus faecalis, a significant pathogen in healthcare settings, is frequently resistant to several antibiotics, complicating treatment. Results: We present the case of a 69-year-old man diagnosed with isolated pulmonary valve endocarditis, with no identifiable risk factors, good oral hygiene, and no recent dental procedures. In our case, the E. faecalis strain, initially susceptible to ampicillin, acquired resistance during high-dose ampicillin and gentamicin therapy, leading to cardiac surgery and prolonged antibiotic treatment. Conclusions: IPE is rare, emphasizing the need for heightened clinical awareness and thorough diagnostic evaluation, especially in patients with endocarditis symptoms and known risk factors. Although ampicillin resistance in E. faecalis is uncommon, its emergence during treatment presents a challenge, necessitating careful antibiotic stewardship to improve outcomes. Full article

Background: To study whether infective endocarditis patients (IE-patients) with visceral embolic events (VEEs) at admission are at greater risk of developing visceral infectious aneurysms (VIAs) in left-sided infective endocarditis (LSIE) patients. Methods: We compared the data of prospectively collected 474 consecutive LSIE-patients (2005–2020) with and without VIAs. A whole-body-CTA was part of the initial work-up for all patients. Results: A total of 24 patients (5.1%) with VIA were included, of whom 19 (79.2%) had at least one VEE, compared to a proportion of 34% (p < 0.001) in IE-patients without VIAs. Both groups also differed in terms of vegetation size (>15 mm: 48% vs. 18%, p < 0.001), microorganisms, Streptococcus spp. (68.5% vs. 42%, p = 0.003), rare microorganisms (36% vs. 8.3%, p < 0.001) and concomitant extra-visceral infectious aneurysms (42% vs. 12.8%, p < 0.001). Cardiac surgery was performed in 21 patients (87.5%) and in-hospital mortality occurred in 2 (8%). Conclusions: This study shows a different profile of VIA–LSIE patients compared to LSIE-patients without. Streptococcus species were the most frequent causal agents. Our study indicates that the presence of VEEs in LSIE-patients could suggest an increased risk of VIA. This study also shows the need for further abdominal-CTA in all cases of left sided IE to detect asymptomatic visceral aneurysms. Full article

Background: Infective endocarditis (IE) is a serious public health concern due to its high morbidity and lethality. This study investigates epidemiological trends in aortic valve endocarditis, focusing on sex-related differences in microbial etiology and surgical outcomes over a 15-year period. Methods: From January 2010 to January 2024, 608 patients underwent cardiac surgery for IE at our center. Of these, 274 patients received isolated aortic valve replacement. This retrospective, single-center study analyzes these cases. Results: Despite a decline in overall aortic valve replacement surgeries, a significant increase in surgeries due to aortic valve endocarditis was observed (p < 0.001). Both sexes showed a rising incidence of aortic valve endocarditis, with females undergoing surgery at an older age, particularly in native valve cases (p = 0.008). In prosthetic valve cases, this age difference was less pronounced (p = 0.050). While sex did not influence microbial etiology in native valve endocarditis, females with prosthetic valves were more frequently infected by Streptococcus (p = 0.033). Staphylococcus aureus infections increased in native valves (p = 0.016). Conclusions: Over 15 years, surgical aortic valve endocarditis has risen in both sexes. Males are more often affected by native valve cases, while females develop it later. Neither gender nor microbial etiology independently predicts death. Full article