amphotericin-b and Endocarditis--Bacterial

The current incidence of infective endocarditis (IE) is estimated as 7 cases per 100,000 population per year and continues to increase. The prognosis is significantly influenced by proper diagnosis and adequate therapy. In cases with unconfirmed IE, transesophageal echocardiography is the imaging technique of choice. Culture-negative endocarditis requires either termination of antimicrobial treatment initiated without mircobiological test results and reevaluation of blood samples or serological/molecular biological techniques to identify the causative organism. Antimicrobial therapy should be established only after quantitative sensitivity tests of antibiotics (minimal inhibitory concentrations, MIC) and guided by drug monitoring. In the first 3 weeks after primary manifestation, an index embolism is frequently followed by recurrencies. If vegetations can still be demonstrated by echocardiography after an embolic event, a surgical intervention should seriously be considered. Cerebral embolic events are no contraindication for cardiac surgery, as long as a cerebral bleeding has been excluded by cranial computed tomography immediately preoperatively and the operation is performed before a significant disturbance of the blood-brain barrier (<72 hours) has manifested. A significant prognostic improvement has also been demonstrated for patients with early surgical intervention suffering from myocardial failure due to acute valve incompetence, acute renal failure, mitral kissing vegetations in primary aortic valve IE, and in patients with sepsis persisting for more than 48 hours despite adequate antimicrobial therapy.

Topics: Aminoglycosides; Amphotericin B; Antifungal Agents; Drug Combinations; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Flucytosine; Humans; Penicillins; Prognosis; Vancomycin

Topics: Amphotericin B; Ampicillin; Aspergillus; Blood; Candida; Culture Media; Drug Resistance; Endocarditis, Bacterial; Flucytosine; Haemophilus; Heart Valve Prosthesis; Humans; Microbial Sensitivity Tests; Penicillin G; Staphylococcus; Streptococcus

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Topics: Amphotericin B; Cephalothin; Diagnosis, Differential; Endocarditis; Endocarditis, Bacterial; Humans; Infections; Mycoses; Penicillins; Streptomycin; Tetracycline; Vancomycin

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Endocarditis, Bacterial; Fatal Outcome; Female; Hepatic Encephalopathy; Humans; Liver Abscess; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Treatment Failure; Ultrasonography

The case is presented of a native valve endocarditis caused by Candida sake in a 34-year-old farmer with no history of intravenous drug abuse or pre-existing valvular abnormality. The patient presented with septicemia and multiorgan dysfunction syndrome (MODS). Clinical and diagnostic work-up revealed findings of severe aortic regurgitation and large vegetations on the aortic valve. Preoperatively, the patient was treated for three weeks with amphotericin B; when the MODS had improved, open-heart surgery with valve replacement was performed. Intravenous amphotericin B was continued postoperatively for three more weeks; a subsequent decision was taken to administer lifelong suppressive antifungal therapy.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male

Prosthetic valve endocarditis (PVE) caused by Candida species is associated with high morbidity and mortality. A combination of surgical resection and antifungal drug therapy is the golden standard for treatment, yet surgical intervention is not possible in all cases of Candida PVE. We report a case of PVE due to Candida albicans cured by medical treatment alone. This case suggests that, in some instances, Candida PVE can be managed medically with antifungal therapy. Such a conservative approach should be applied with caution and necessitates very close follow-up on a long-term basis.

Topics: Amphotericin B; Antifungal Agents; Aortic Valve; Candida albicans; Candidiasis; Endocarditis, Bacterial; Female; Fluconazole; Heart Valve Prosthesis; Humans; Middle Aged; Treatment Outcome

Aspergillus native valve endocarditis in patients who have not had cardiac surgery is uncommon. We report 3 cases and review 58 other adult patients reported in the English-language literature. Sixty-seven percent of the patients had underlying immunosuppression. The clinical features were fever (74%), embolic episodes (69%), a new or changing heart murmur (41%), and sudden visual loss (13%). Patients with mural endocarditis were more often immunosuppressed, especially due to solid organ transplants, but had lower frequency of heart murmurs and embolic episodes. Echocardiography revealed a vegetation in 78% of all the cases in which it was performed. Examination and culture of biopsy material often helped to establish a diagnosis of Aspergillus infection. Twenty-five patients had an antemortem diagnosis. These patients received a mean cumulative amphotericin B dose of 27 mg/kg. Twenty percent (3/15) of patients who received combined surgical and medical therapy survived, compared to none of those who received medical therapy alone (p = 0.08). Patients who survived were not immunosuppressed. We conclude that native valve aspergillus infective endocarditis is uniformly fatal without surgical intervention and antifungal therapy.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Diagnosis, Differential; Endocarditis, Bacterial; Female; Heart Valves; Humans; Immunocompromised Host; Male; Middle Aged; Prognosis

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Aortic Valve; Endocarditis, Bacterial; Gentamicins; Humans; Male; Mitral Valve; Substance-Related Disorders; Vancomycin

Topics: Amphotericin B; Candidiasis; Endocarditis, Bacterial; Fluconazole; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged

Fluconazole and amphotericin B were compared in the prophylaxis and treatment of Candida albicans aortic endocarditis in a rabbit model. In the prophylaxis study, catheterized rabbits received, prior to intravenous (i.v.) challenge with C. albicans (2 x 10(7) blastospores), either no therapy, single-dose i.v. amphotericin B (1 mg/kg of body weight), single-dose fluconazole (50 mg/kg or 100 mg/kg i.v. or intraperitoneally [i.p.]), or fluconazole (50 mg/kg or 100 mg/kg i.v. or i.p.) with a second dose 24 h after inoculation. A single dose of amphotericin B was significantly more effective than either the one- or two-dose regimens of fluconazole at both 50 mg/kg (P less than 0.001 and P less than 0.03, respectively) and 100 mg/kg (P less than 0.01 and P less than 0.001, respectively) in the prevention of C. albicans endocarditis. In parallel treatment studies of established C. albicans endocarditis, i.v. amphotericin B (1 mg/kg) or i.p. fluconazole (50 mg/kg) was begun 24 or 60 h postinfection and continued daily for 9 or 12 days. At these dose regimens, amphotericin B was consistently more effective than fluconazole in reducing fungal vegetation densities, regardless of the timing of initiation of therapy. We also examined the efficacy of fluconazole at a daily dose of 100 mg/kg i.p. administered for 21 days in the treatment of established C. albicans endocarditis. When therapy was continued for 2 weeks or longer, fluconazole was more effective than no drug and approximately twice as effective as 12 days of amphotericin B in reducing intravegetation fungal densities. Our results suggest that amphotericin B is superior to fluconazole in both the prophylaxis and treatment of C. albicans endocarditis in the rabbit model. These findings may relate to the predominantly fungistatic activity of fluconazole against C. albicans in vitro.

Topics: Amphotericin B; Animals; Candidiasis; Endocarditis, Bacterial; Female; Fluconazole; Half-Life; Injections, Intraperitoneal; Injections, Intravenous; Rabbits

Valvular endocarditis caused by Aspergillus is a lethal disease. Only two survivors, both with infections of prosthetic valves, have been reported in the world literature. This report describes a patient with an Aspergillus valvular endocarditis on a native valve with embolization to the right axillary, left iliac, and left popliteal arteries and the distal aorta. Diagnosis was made from a thromboembolectomy specimen. Treatment consisted of removal of the peripheral arterial emboli, mitral valve replacement, and prolonged intravenous infusion of high-dose amphotericin B. The patient presently has the longest survival period of any patient with an Aspergillus infection on a native heart valve. The importance of early diagnosis and aggressive operative management by the vascular surgeon needed to properly treat these patients is emphasized.

Topics: Adult; Amphotericin B; Aortic Diseases; Aspergillosis; Axillary Artery; Embolism; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Iliac Artery; Mitral Valve; Popliteal Artery

The fungicidal effect of amphotericin B and 5-fluorocytosine (5-FC) on fungi incorporated into blood and fibrin clots was investigated. Amphotericin B was ineffective against fungi incorporated into blood clots, but effective in the eradication of fungi in fibrin clots. 5-FC was ineffective both against fungi incorporated in blood clots as well as in fibrin clots. The combination of 5-FC and amphotericin B was likewise ineffective against fungi incorporated into blood clots. The failure of these drugs to penetrate blood clots may explain the treatment failure in fungal endocarditis.

Topics: Amphotericin B; Blood; Blood Platelets; Candida; Cytosine; Embolism; Endocarditis, Bacterial; Fibrin; Flucytosine; Humans; Models, Biological

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Cardiac Surgical Procedures; Endocarditis, Bacterial; Flucytosine; Humans; Injections; Postoperative Complications; Substance-Related Disorders

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Endocarditis, Bacterial; Endophthalmitis; Fundus Oculi; Humans; Male; Natamycin; Streptococcus

The bacteriological spectrum of infective endocarditis is very different when the disease occurs spontaneously from when it follows shortly after cardiac surgery or is associated with narcotic abuse or haemodialysis. It is therefore suggested that two categories of the illness, naturally occurring and extraneous, are recognized. The great majority of cases of naturally occurring infective endocarditis are caused by organisms highly sensitive to penicillin. Oral therapy is nearly always effective in such cases and amoxycillin given with probenecid is recommended as the regime of choice. Extraneous infective endocarditis is most often caused by staphylococci, with Gram-negative bacilli and fungi also quite frequent infecting agents. Intravenous and oral therapy with a variety of antibiotics is discussed in the management of this group.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Bacteria; Cardiac Surgical Procedures; Child; Cloxacillin; Endocarditis; Endocarditis, Bacterial; Erythromycin; Fusidic Acid; Gentamicins; Humans; Kanamycin; Middle Aged; Probenecid; Renal Dialysis; Staphylococcal Infections

Topics: Acute Kidney Injury; Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Colistin; Deafness; Endocarditis, Bacterial; Female; Humans; Kanamycin; Kidney; Kidney Function Tests; Male; Middle Aged; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections; Urea; Vancomycin

Topics: Adult; Amphotericin B; Aortic Valve; Candidiasis; Endocarditis, Bacterial; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male

Topics: Adult; Amphotericin B; Candidiasis; Endocarditis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Endocarditis, Bacterial; Histoplasmosis; Humans; Lymph Nodes; Male; Mediastinal Diseases; Mitral Valve; Prednisone

Topics: Amphotericin B; Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Enterobacter aerogenes; Enterobacteriaceae; Erythromycin; Escherichia coli Infections; Kanamycin; Penicillin G; Penicillins; Proteus Infections; Pseudomonas Infections; Ristocetin; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Adrenal Cortex Hormones; Amphotericin B; Candida; Candidiasis; Endocarditis; Endocarditis, Bacterial; Humans; Pathology; Penicillins; Streptomycin; Toxicology

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Chloramphenicol; Endocarditis; Endocarditis, Bacterial; Humans; Kanamycin; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin