tetracycline and Endocarditis--Bacterial

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Aortic Valve Stenosis; Bacteremia; Brevibacterium; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Emergencies; Endocarditis, Bacterial; Facial Dermatoses; Gentamicins; Humans; Levofloxacin; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Recurrence; Tetracycline; Vancomycin; Wound Infection

The human race has had to endure infections for as long as it has been on earth, and has developed efficient natural defence mechanisms to combat them. Modern medicine aims to augment these natural mechanisms, to help speed up resolution of infection and decrease morbidity and mortality.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cephalosporins; Dental Care for Chronically Ill; Drainage; Endocarditis, Bacterial; Erythromycin; Focal Infection, Dental; Humans; Ludwig's Angina; Penicillins; Periodontal Abscess; Premedication; Retropharyngeal Abscess; Tetracycline

An overview of infection as it applies to the oral and maxillofacial region has been provided. The following conclusions are drawn: odontogenic infections are caused by microbes found in the host's oral flora; cultures of purulent material generally will yield three to six anaerobes and one aerobe, (the aerobe is usually a Streptococcus species); Gram stains of purulent material can aid in therapeutic strategies; anaerobic as well as aerobic cultures are necessary to isolate all pathogens; pathogens found in infections of bite wounds reflect the oral flora of the aggressor; early postoperative wound infections are caused by the host's own flora, whereas later infections may be caused by hospital-acquired bacteria; and hepatitis B and herpes simplex virus are occupational hazards. Recommendations have been made for antimicrobial prophylaxis and for treatment. We recognize that some of these selections may be controversial. For instance, the value of prophylactic antibiotics in orthognathic surgery is not well defined; recommendations were made only in certain instances. However, in severe penetrating maxillofacial injuries with devitalized tissue, recommendations for antibiotics were for broad and prolonged coverage. In this instance, use of antibiotics is considered therapeutic and not prophylactic. In each instance, we tried to validate the selection. Our rationale has been to choose the antibiotics most active against the likely pathogens; additionally, consideration was given to drug toxicity and adverse reactions. We regard penicillin as the preferred agent for prophylaxis and treatment of most odontogenic infections. Alternative drugs include cephalosporins, doxycycline, and clindamycin. Erythoromycin and tetracycline are considered less effective than the former agents. Finally, we believe that successful treatment of infection depends as much on changing the microenvironment of the infected tissue by debridement and drainage as on appropriate antimicrobial therapy.

Topics: Actinomycosis; Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Bacteroides Infections; Cephalosporins; Endocarditis, Bacterial; Erythromycin; Humans; Jaw Diseases; Maxillofacial Injuries; Mouth Diseases; Staphylococcal Infections; Surgical Wound Infection; Tetracycline; Tooth Diseases; Virus Diseases

Topics: Adolescent; Adult; Ampicillin; Arthritis, Infectious; Dermatitis; Endocarditis, Bacterial; Female; Gonorrhea; Humans; Male; Meningitis; Neisseria gonorrhoeae; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Skin Diseases, Infectious; Tetracycline

Topics: Abortion, Septic; Abscess; Aminoglycosides; Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Brain Abscess; Cephalosporins; Chloramphenicol; Clindamycin; Endocarditis, Bacterial; Erythromycin; Female; Humans; Lincomycin; Lung Abscess; Penicillins; Pregnancy; Sepsis; Tetracycline

Topics: Aged; Arteriosclerosis; Cell Wall; Cryptococcus; Edetic Acid; Endocarditis, Bacterial; Escherichia coli; Haemophilus Infections; Humans; Immunity, Cellular; L Forms; Lysostaphin; Male; Penicillins; Protoplasts; Salmonella; Sepsis; Spheroplasts; Stomatitis; Streptococcal Infections; Tetracycline; Thrombophlebitis; Urinary Tract Infections; Whipple Disease

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

Topics: Bacteriological Techniques; Diagnosis; Embolism; Endocarditis, Bacterial; Erythromycin; Fever; Heart Defects, Congenital; Heart Valves; Humans; Lung Diseases; Penicillin Resistance; Penicillins; Pneumococcal Infections; Postoperative Complications; Prognosis; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

In a recent landmark trial of bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) isolates, vancomycin MICs were >or=1 microg/ml for only 16% of the isolates, and accessory gene regulator (agr) function as measured by delta-hemolysin activity was absent or reduced in only 28.1% of the isolates. This clinical study did not capture a population of MRSA isolates predictive of vancomycin treatment failure.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Daptomycin; Endocarditis, Bacterial; Genotype; Hemolysin Proteins; Humans; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Clinical Trials as Topic; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Tetracycline

Enterococcus hirae infections are reported to cause growth depression, encephalomalacia, endocarditis, and septicemia in chickens. This report describes osteomyelitis in the proximal femur of a 3-week-old broiler chicken that also suffered from valvular endocarditis and liver necrosis. Histologically, clusters of gram-positive coccoid bacteria were found in many organs, including bone lesions. In tissues from 5 of 6 examined chickens from the same flock, E hirae was isolated in large numbers. To the authors' knowledge, this is the first report of spontaneous bacterial osteomyelitis where E hirae was cultured from bone and where coccoid bacteria consistent with Enterococcus spp were simultaneously demonstrated within bone lesions.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Chickens; DNA, Bacterial; DNA, Ribosomal; Endocarditis, Bacterial; Enterococcus; Gram-Positive Bacterial Infections; Norway; Osteomyelitis; Poultry Diseases; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Tetracycline

Streptococcus gallolyticus subsp. gallolyticus is an important causative agent of infectious endocarditis, while the pathogenicity of this species is widely unclear. To gain insight into the pathomechanisms and the underlying genetic elements for lateral gene transfer, we sequenced the entire genome of this pathogen.. We sequenced the whole genome of S. gallolyticus subsp. gallolyticus strain ATCC BAA-2069, consisting of a 2,356,444 bp circular DNA molecule with a G+C-content of 37.65% and a novel 20,765 bp plasmid designated as pSGG1. Bioinformatic analysis predicted 2,309 ORFs and the presence of 80 tRNAs and 21 rRNAs in the chromosome. Furthermore, 21 ORFs were detected on the plasmid pSGG1, including tetracycline resistance genes telL and tet(O/W/32/O). Screening of 41 S. gallolyticus subsp. gallolyticus isolates revealed one plasmid (pSGG2) homologous to pSGG1. We further predicted 21 surface proteins containing the cell wall-sorting motif LPxTG, which were shown to play a functional role in the adhesion of bacteria to host cells. In addition, we performed a whole genome comparison to the recently sequenced S. gallolyticus subsp. gallolyticus strain UCN34, revealing significant differences.. The analysis of the whole genome sequence of S. gallolyticus subsp. gallolyticus promotes understanding of genetic factors concerning the pathogenesis and adhesion to ECM of this pathogen. For the first time we detected the presence of the mobilizable pSGG1 plasmid, which may play a functional role in lateral gene transfer and promote a selective advantage due to a tetracycline resistance.

Topics: Bacterial Proteins; Chromosomes, Bacterial; Drug Resistance, Bacterial; Endocarditis, Bacterial; Gene Transfer, Horizontal; Genome, Bacterial; Genomics; Humans; Plasmids; Streptococcus; Tetracycline; Virulence Factors

Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis.. Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160.. There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%.. Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.

Topics: Adult; Aged; Brucella melitensis; Brucellosis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Streptomycin; Survival Rate; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

We have described a 28-year-old male sheepfarmer who had fever, headache, chills, malaise, and aortic insufficiency. Echocardiography revealed a tricuspid aortic valve with a large vegetation on the right cusp, an enlarged left ventricle, and diastolic flutter of the mitral valve. Repeated blood cultures were negative. Seroconversion of IgG and IgM to Rickettsia typhi was found on the 13th day of hospitalization. The patient was treated with tetracycline for 1 year and remained afebrile and free of symptoms for 9 months, when he was lost to follow-up. IgM and IgG fluorescent antibodies to R typhi remained positive during 8 months of the follow-up period. We believe this to be the second reported case of endocarditis due to R typhi and the first not treated surgically.

Topics: Adult; Endocarditis, Bacterial; Humans; Male; Tetracycline; Typhus, Endemic Flea-Borne

Six cases of well-documented Brucella endocarditis are reported. All the patients gave a history of ingestion of raw milk and/or being in contact with sheep and/or camels during herding. The diagnosis was based in each case on a history of ingestion of raw milk, high titres of Brucella antibodies, a positive blood culture and echocardiography. A combination of tetracycline, rifampicin and streptomycin was found to be effective in eradicating the Brucella organism. Two cases required aortic valve replacement, and another two required replacement of both aortic and mitral valves. One case died before any surgical intervention could be performed and one patient did not require surgery. Although it was noted that the Brucella organism attacks mainly valves which are already damaged, it may also attack and infect normal valves.

Topics: Adolescent; Adult; Aortic Valve; Brucellosis; Endocarditis, Bacterial; Female; Humans; Male; Prognosis; Rifampin; Saudi Arabia; Tetracycline

The bacterium Actinobacillus actinomycetemcomitans is found in large numbers in subgingival plaque and gingival tissues of patients with LJP and PLS. This bacterium too has been found to cause infective bacterial endocarditis in patients at risk. Antibiotic prophylaxis is necessary for at risk patients with LJP and PLS because significant bacteraemia is produced during extensive periodontal instrumentation, extractions and surgery which are required in managing these cases. The current antibiotic regimens recommended by the American Heart Association/Council on Dental Therapeutics are not effective against this bacterium. A two-stage prophylactic approach is advocated, first with tetracycline for two weeks to eliminate the Actinobacillus actinomycetemcomitans, followed by the regimens recommended by the American Heart Association on the day of the dental procedure itself. Tetracycline should not be used concurrently or as a substitute for the recommended regimens by the American Heart Association/Council on Dental Therapeutics.

Topics: Actinobacillus Infections; Aggressive Periodontitis; Endocarditis, Bacterial; Humans; Keratoderma, Palmoplantar; Papillon-Lefevre Disease; Periodontal Diseases; Tetracycline

Five cases of Brucella infective endocarditis are described involving a native aortic valve, two native mitral valves, a mitral valve bioprosthesis, and a ventricular septal defect patch. The diagnosis of Brucella infective endocarditis was established from the clinical features, with a high Brucella serologic titer in each case. Blood and tissue cultures were positive in four of five patients. Two-dimensional echocardiograms demonstrated moderately large vegetations on the three affected native valves and the patch and also revealed the development of vegetation on the mitral bioprosthesis as the disease progressed. All the patients were successfully treated by combined surgical and medical therapy, the latter consisting of co-trimoxazole, tetracycline, and streptomycin/gentamicin for 6 weeks; the affected valves and the ventricular septal defect patch were all replaced. There were no operative deaths and there has been no recurrence of infection to date. One patient died suddenly of an unknown cause 1 year after the operation.

Topics: Adult; Aortic Valve; Brucellosis; Combined Modality Therapy; Drug Combinations; Echocardiography; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Optimal treatment of prosthetic valve endocarditis due to Brucella melitensis is unknown. The presence of ring abscess makes extensive surgical débridement and valve replacement essential steps of management. Antimicrobial therapy with tetracycline hydrochloride plus streptomycin sulfate or sulfamethoxazole and trimethoprim can achieve the sterilization of infected cardiac tissue. Late bland periprosthetic leaks occur frequently. Reoperation can be safely performed after a period of antimicrobial therapy. Prolonged treatment with doxycycline hyclate seems advisable.

Topics: Adult; Aortic Valve; Brucella; Brucellosis; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Reoperation; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim

In 1985 dentists in the Lothian Region of Scotland were questioned about their use of prophylactic antibiotics for patients at risk of developing infective endocarditis. Replies were compared with those obtained from a similar survey in 1981. The results showed a marked change in practice with widespread adoption of the single-dose oral amoxycillin regimen; this was the regimen of choice for 63% of general dental practitioners. For patients allergic to penicillin 76% of practitioners used erythromycin and there was a decline in the use of tetracycline and clindamycin. The adoption of amoxycillin reflects the ease of compliance with a simple single-dose regimen. This change has produced a striking improvement in the timing of prophylactic antibiotic therapy.

Topics: Amoxicillin; Anti-Bacterial Agents; Clindamycin; Dentistry; Drug Administration Schedule; Drug Hypersensitivity; Endocarditis, Bacterial; Erythromycin; Heart Diseases; Humans; Penicillins; Risk Factors; Surveys and Questionnaires; Tetracycline

Echocardiographic diagnosis of a case of endocarditis, subsequently proven to be due to a chlamydial organism, is described. Early echocardiographic diagnosis guided initial medical management and directed urgent surgical intervention when the patient deteriorated. Reported cases of chlamydial endocarditis are reviewed.

Topics: Antigens, Bacterial; Aortic Valve Insufficiency; Chlamydophila psittaci; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Psittacosis; Tetracycline

Brucellosis, being eradicated among domestic animals in some countries, is still prevalent in some others where it poses a potential threat to the consumers of milk and cheese and those working with animals and meat. The patient presented below had contracted a severe and long-standing Brucella abortus infection by ingesting raw camel milk. She had signs of endocarditis and disseminated intravascular coagulation, but recovered when treated with tetracyclin and streptomycin.

Topics: Adult; Brucellosis; Disseminated Intravascular Coagulation; Endocarditis, Bacterial; Female; Humans; Streptomycin; Tetracycline

Actinobacillus actinomycetemcomitans is an oral bacterium which is being encountered with increasing frequency in infective endocarditis. This organism occurs in high numbers in periodontitis lesions of patients with localized juvenile periodontitis (periodontosis). It is present infrequently, and only in low numbers in most other individuals. Its common resistance to penicillin, erythromycin and vancomycin represents a clinical problem in patients at risk of developing endocarditis after dental treatment. However, the high activity of tetracyclines against A. actinomycetemcomitans may be useful in prophylactic endocarditis considerations by allowing a suppression of the organism prior to the institution of recommended prophylactic protocols. In this study, we determined the effect of systemic tetracycline-HCl therapy (1 gm/day) on the oral A. actinomycetemcomitans population in five localized juvenile periodontitis patients who were heavily infected with the organism. A. actinomycetemcomitans could not be detected in samples of subgingival and supragingival dental plaque and cheek mucosal surfaces following 14 days of administration of systemic tetracycline. The organism was still undetectable 3 weeks after therapy but it reappeared at a few oral sites at week 8 post-treatment. On the basis of this data, it is proposed that the prophylactic endocarditis therapy of patients with high numbers of penicillin-resistant A. actinomycetemcomitans include a two-stage approach: first, the systemic administration of tetracycline for 14 days, and second, institution of a conventional prophylactic protocol during the time of dental treatment.

Topics: Actinobacillus; Actinobacillus Infections; Adolescent; Dental Plaque; Endocarditis, Bacterial; Female; Humans; Male; Mouth Diseases; Periodontitis; Tetracycline

Topics: Bioprosthesis; Brucellosis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Middle Aged; Streptomycin; Tetracycline

A four-year retrospective review of 55 patients with disseminated infections from Neisseria gonorrhoeae revealed that this complication occurs in young adults, with a predominance in women (80%). The most common manifestation of disseminated gonococcal infection was arthritis, which occurred in 47 patients (85.5%). The second most common manifestation of disseminated gonococcal infection was dermatitis, which occurred in 33 patients (60%). A thorough history, a careful physical examination, and a high index of suspicion are essential for the diagnosis. Disseminated gonococcal infection can be confirmed by isolation of gonococci from potential sites, including urethra, cervix, rectum, oropharynx, and blood. Early diagnosis and adequate therapy are necessary to prevent serious complications. The role of the gynecologist in preventing, diagnosing, and/or treating this disorder is emphasized.

Topics: Adolescent; Adult; Ampicillin; Arthritis, Infectious; Endocarditis, Bacterial; Female; Gonorrhea; Humans; Male; Menstruation; Middle Aged; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Skin Diseases, Infectious; Tetracycline

Pseudomonas alcaligenes is a common soil and water inhabitant that has rarely been proven a human pathogen. We describe a fatal case of Pseudomonas alcaligenes endocarditis. The need for accurate identification of unusual organisms isolated in a clinical setting are discussed.

Topics: Endocarditis, Bacterial; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pseudomonas; Pseudomonas Infections; Tetracycline

Despite a worldwide distribution of Coxiella burnetii, only single cases of Q fever endocarditis have been reported outside Great Britain and Australia. We present 10 patients; five were female, only four had a history of environmental exposure, and the mitral valve was involved as commonly as the aortic stenosis, and three patients had a prosthetic valve. We confirm the importance of hepatic involvement, thrombocytopenia and hypergammaglobulinemia as diagnostic features. Diagnosis was established by finding and elevated complement-fixing antibody to Phase I C. burnetii antigen. Tetracycline, with or without lincomycin or cotrimoxazole, was used in nine patients, and one patient received cotrimoxazole as as the sole antibiotic agent. Optimal duration of therapy is unknown. In one patient, relapse followed when treatment was stopped after 18 months. Valve replacement was necessary in five patients, because of hemodynamic problems. Five patients died, and the means survival is 36 months with a range of five to 66 months. We suggest that Q fever endocarditis is frequently missed, and we recommend clinicians to consider the diagnosis in all cases of culture-negative endocarditis.

Topics: Adult; Antibodies, Bacterial; Coxiella; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Ireland; Lincomycin; Male; Middle Aged; Q Fever; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Chlamydia Infections; Echocardiography; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Tetracycline

Eight patients with chronic Q fever endocarditis were treated with tetracycline for up to 40 months. In addition, five of these patients received co-trimoxazole. Six patients had prosthetic valves. Two patients who had Q fever endocarditis on their native valves required valve replacement because of haemodynamic difficulties: in only one did the Q fever endocarditis contribute to the haemodynamic difficulty. One patient died. It is suggested that medical treatment is continued until clinically and haematologically there is no evidence of endocarditis and the Q fever phase 1 antibody titre is less than 200. No recurrence of Q fever endocarditis has been detected in three of our patients who have now stopped treatment.

Topics: Adult; Aged; Antibodies, Bacterial; Chronic Disease; Coxiella; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Q Fever; Sulfamethoxazole; Tetracycline; Trimethoprim

Topics: Acute Disease; Adolescent; Adult; Brucellosis; Endocarditis, Bacterial; Female; Fever of Unknown Origin; Humans; Lung Diseases; Male; Middle Aged; Spinal Diseases; Streptomycin; Tetracycline

These recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Drug Administration Schedule; Endocarditis, Bacterial; Endophthalmitis; Epididymitis; Female; Gonorrhea; Hospitalization; Humans; Infant, Newborn; Male; Meningitis; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillinase; Pregnancy; Pregnancy Complications, Infectious; Salpingitis; Spectinomycin; Tetracycline

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.

Topics: Adult; Aortic Valve Insufficiency; Brucellosis; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Rifampin; Streptomycin; Tetracycline

Two patients with Q fever endocarditis are described. Both patients demonstrated some of the characteristic features of Q fever endocarditis, i.e. the long course of the disease before diagnosis, persistently negative blood cultures, resistance to conventional antibiotic therapy and a dramatic response to tetracycline therapy. Complications included arteriovenous thrombo-embolism and hepatic enlargement, and 1 patient developed an immune complex form of glomerulonephritis. The possibility of Q fever endocarditis should be considered in all patients with infective endocarditis in whom blood cultures are negative and who fail to respond to conventional antibiotic therapy.

Topics: Adult; Endocarditis, Bacterial; Female; Glomerulonephritis; Humans; Liver Diseases; Male; Q Fever; Tetracycline

Two cases of bacterial endocarditis caused by Haemophilus parainfluenzae are reported with a review of 33 other cases of H. parainfluenzae endocarditis and 5 cases of H. influenzae endocarditis. Although H. parainfluenzae is usually considered a non-pathogenic microorganism, this review firmly establishes its role as a causative agent in endocarditis. Furthermore, several clinical features were noted which were atypical when compared to findings usually present in patients with bacterial endocarditis. The mean age of the patients was only 27 years. Over 60% of the patients had no identifiable predisposing illness, an unexpected finding in view of the low degree of pathogenicity associated with this microorganism. Polymicrobial bacteremia, usually with viridans streptococci, was found in 11% of patients. Major arterial emboli were documented in 57% of patients, an incidence unchanged from the pre-antibiotic era. Diagnosis of the disease is dependent upon an awareness of the fastidious cultural requirements necessary for isolation of Haemophilus species. Culture media must contain a source of X and V factors. Mortality from H. parainfluenzae endocarditis has been reduced from 100 per cent prior to 1940 to about 12 per cent by use of appropriate antimicrobial agents. Awareness that Haemophilus species can cause bacterial endocarditis is important because the diagnosis is dependent upon utilization of special culture methods and the patient may not respond to some of the empiric regimens used for treating bacterial endocarditis. It should be especially considered as a possible cause of "culture-negative" or "abacteremic" endocarditis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteriological Techniques; Cephalothin; Child; Drug Therapy, Combination; Embolism; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Haemophilus influenzae; Heart Valve Diseases; Humans; Male; Middle Aged; Streptococcal Infections; Streptomycin; Tetracycline

Although the serum bactericidal test is commonly used in the management of infective endocarditis, little has been written about its validity or limitations. We report three cases of gram-negative bacillary endocarditis (Pseudomonas aeruginosa, Vibrio fetus and Serratia marcescens) encountered in 1 year at a Veterans Administration hospital. Serum bactericidal titers were considered necessary to identify inadequate antibiotic regimens or to avoid unnecessary drug toxicity. The limitations of the test, particularly those pertaining to gram-negative infections, are reviewed. Misleading results during treatment with aminoglycoside antibiotics could be due to the tendency of serum to become alkaline on standing. A detailed study of the interaction of the complement-dependent bactericidal system of serum with eight antibiotics is presented. In the context of the serum bactericidal test, the interaction was additive or synergistic in 15 of 16 determinations, indicating the need to include a control study of serum sensitivity of the infecting microorganism in each case.

Topics: Adult; Anti-Bacterial Agents; Bacteria; Blood Bactericidal Activity; Campylobacter fetus; Carbenicillin; Colistin; Endocarditis, Bacterial; Gentamicins; Humans; Hydrogen-Ion Concentration; Male; Microbial Sensitivity Tests; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Serratia marcescens; Tetracycline; Vibrio Infections

A simple model has been developed for the production of bacterial endocarditis in rabbits. The principle depends on the insertion of a polyethylene catheter into the venous or arterial system so that the tip rests in the heart cavity in which endocarditis is to be established. After catheter placement, intravenous injection of any one of a variety of microorganisms regularly produces infective endocarditis. The characteristics of the infection in rabbits are similar to those observed in infective endocarditis in man. The production of streptococcus viridans infections in previously immunized animals leads to the development of diffuse glomerulonephritis. Translating antibiotic doses on a weight basis, prophylactic antibiotic treatment programs recommended in man have been shown to be ineffective in rabbits. If the activity of antibiotics in this model infection in rabbits can be assumed to be comparable to that in man, it is necessary that we reconsider the currently accepted recommendation for prophylaxis and treatment of infective endocarditis in man.

Topics: Animals; Cardiac Catheterization; Drug Administration Schedule; Endocarditis, Bacterial; Escherichia coli; Penicillin G Procaine; Rabbits; Sepsis; Staphylococcus; Streptococcus; Tetracycline; Tooth Extraction

A survey of Oxfordshire dentists showed that most practise prophlaxis of bacterial endocarditis, but that few follow currently recommended regimens. for example, prophylactic antibiotics are started one or more days before the procedure by 72 per cent of dentists, and two or more days before by 25 per cent. Eight-seven per cent administer antibiotics for a total of four or more days. Penicillin is most often given, but tetracyline remains the commonest second choice. Only 12 per cent use intramuscular drugs as first choice, and procaine penicillin is seldom used. These practices are contrasted with current medical recommendations and discussed with reference to fresh experimental evidence on prevention of bacterial endocarditis.

Topics: Administration, Oral; Anti-Bacterial Agents; Cephalosporins; Clindamycin; Dentistry, Operative; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Heart Valve Diseases; Humans; Penicillin G; Penicillin V; Penicillins; Surgery, Oral; Surveys and Questionnaires; Tetracycline

A retrospective study was done on patients admitted to the University of Michigan Hospital from 1962 to 1972 with a diagnosis of bacterial endocarditis. The findings in the group studied indicate that Streptococcus viridans was the predominant causative organism, males were affected three times as often as females, erythromycin was effective against organisms of oral origin, dental procedures were not definitely established as responsible for the onset of the disease in any of the cases, and rheumatic heart disease and congenital heart disease were the predominant, but not the only, predisposing factors.

Topics: Age Factors; Dental Care; Endocarditis, Bacterial; Erythromycin; Heart Defects, Congenital; Heroin Dependence; Humans; Microbial Sensitivity Tests; Mouth; Penicillins; Retrospective Studies; Rheumatic Heart Disease; Sex Factors; Streptococcus; Streptomycin; Tetracycline; Tooth

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cat Diseases; Cats; Dog Diseases; Dogs; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Kanamycin; Microbial Sensitivity Tests; Pneumonia; Streptomycin; Tetracycline; Time Factors; Wounds and Injuries

Topics: Adult; Drug Combinations; Endocarditis, Bacterial; Humans; Middle Aged; Oleandomycin; Staphylococcal Infections; Tetracycline

Topics: Adult; Aged; Ampicillin; Cephalosporins; Child; Chloramphenicol; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Female; Gastrointestinal Diseases; Gentamicins; Humans; Kanamycin; Lincomycin; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Oxacillin; Penicillin G; Streptococcal Infections; Streptococcus; Streptomycin; Tetracycline; Urologic Diseases; Vancomycin

Bacterial endocarditis was produced by intravenous injection of Streptococcus viridans into rabbits with preexisting sterile endocardial vegetations. After 6 h had elapsed, bacteria in the vegetations could not be eradicated by brief treatment with antimicrobials to which the streptococci were sensitive. However, when treatment with penicillin was continued for 4 days, the animals were cured. The 6-h infection therefore offered a model in which treatments could be conveniently compared over a short period. Synergism was demonstrated between penicillin and streptomycin in endocarditis due to a fully penicillin-sensitive streptococcus, a point which had not been previously proved in vivo. The clinical implications are discussed.

Topics: Animals; Anti-Bacterial Agents; Cephaloridine; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Penicillins; Rabbits; Streptococcal Infections; Streptococcus; Streptomycin; Swine; Tetracycline; Vancomycin

Topics: Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Oral; Endocarditis, Bacterial; Erythromycin; General Practice, Dental; Humans; Immunosuppression Therapy; Injections, Intramuscular; Jaw Fractures; Mouth Diseases; Osteomyelitis; Penicillins; Periapical Abscess; Pericoronitis; Radiotherapy; Tetracycline

Bacteriostatic agents are frequently recommended as alternatives to penicillin for prophylaxis of bacterial endocarditis. To test the efficacy of this group of antimicrobials, prophylaxis of experimental streptococcal endocarditis was attempted with tetracycline. The number of streptococci colonizing the aortic valves of rabbits was not affected by inhibitory levels of tetracycline, but multiplication was checked. Streptococcis urvived in vegetations for seven days despite the continuous presence of tetracycline, and multiplied when the drug was withdrawn. It is therefore suggested that bacteriostatic agents may be valueless for prophylaxis of bacterial endocarditis.

Topics: Animals; Aortic Valve; Bacteriological Techniques; Catheterization; Drug Resistance, Microbial; Endocarditis, Bacterial; Female; Injections, Intramuscular; Male; Rabbits; Streptococcal Infections; Streptococcus; Tetracycline; Time Factors

Topics: Anti-Bacterial Agents; Bacillus; Blood; Cells, Cultured; Culture Media; Endocarditis, Bacterial; Escherichia coli Infections; Humans; Klebsiella Infections; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pseudomonas Infections; Salmonella Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Adult; Anti-Bacterial Agents; Endocarditis, Bacterial; Gentamicins; Heroin Dependence; Humans; Male; Methicillin; Microbial Sensitivity Tests; Penicillins; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Tetracycline

Topics: Adult; Body Temperature; Carbenicillin; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Heart Valve Prosthesis; Humans; Lincomycin; Male; Middle Aged; Serratia marcescens; Tetracycline; Time Factors

The effectiveness of various antibiotics commonly recommended for the prophylaxis of bacterial endocarditis has been evaluated in experimental streptococcal endocarditis in rabbits. High doses of penicillin G did not prevent the development of this infection. The only consistently successful prophylactic regimens using penicillin alone were those which provided for both an early high serum level and more than 9 h of effective antimicrobial action. Vancomycin was the only other drug which proved uniformly successful when given alone, even though the duration of its antimicrobial action in the blood was only 3 h. However, combined therapy using penicillin G or ampicillin with streptomycin was always effective in prophylaxis. Treatment with single injections of ampicillin, cephaloridine, cephalexin, clindamycin, cotrimoxazole, rifampicin, streptomycin, erythromycin, and tetracycline failed to prevent infection. The findings provide information on the effect of antimicrobials in vivo and may be applicable to the chemoprophylaxis of infective endocarditis in clinical practice.

Topics: Ampicillin; Animals; Cephaloridine; Clindamycin; Endocarditis, Bacterial; Erythromycin; Female; Male; Penicillin G; Rabbits; Rifampin; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Bacteria; Bacteroides; Bacteroides Infections; Chloramphenicol; Embolism; Endocarditis, Bacterial; Erythromycin; Humans; Lincomycin; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Rifampin; Tetracycline; Vancomycin

Topics: Antibodies, Bacterial; Chloramphenicol; Endocarditis, Bacterial; Humans; Male; Q Fever; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Blood Bactericidal Activity; Cephalothin; Clindamycin; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Erythromycin; Gentamicins; Humans; New York City; Oxacillin; Penicillins; Sepsis; Streptococcal Infections; Streptococcus; Streptomycin; Tetracycline; Vancomycin

Topics: Acidosis; Clostridium Infections; Clostridium perfringens; Endocarditis, Bacterial; Enterococcus faecalis; Heart Failure; Humans; Male; Middle Aged; Penicillin Resistance; Penicillins; Streptococcal Infections; Streptomycin; Tetracycline

Topics: Animals; Cephalothin; Dog Diseases; Dogs; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Tetracycline; Zoonoses

Topics: Bacteriological Techniques; Endocarditis, Bacterial; Female; Humans; Middle Aged; Penicillin G; Salmonella; Salmonella Infections; Sepsis; Species Specificity; Tetracycline; Ulcer

Topics: Adolescent; Adult; Ampicillin; Anemia; Arthritis, Infectious; Arthritis, Reactive; Endocarditis, Bacterial; Female; Gonorrhea; Hepatitis; Humans; Male; Meningitis; Menstruation; Myocarditis; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin V; Pericarditis; Pregnancy; Pregnancy Complications, Infectious; Pyuria; Sepsis; Skin Diseases; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Cephalothin; Chloramphenicol; Drug Synergism; Endocarditis, Bacterial; Erythromycin; Leucomycins; Lincomycin; Microbial Sensitivity Tests; Neomycin; Novobiocin; Penicillin G; Streptococcus; Streptomycin; Tetracycline; Vancomycin

Topics: Ampicillin; Anti-Bacterial Agents; Drug Synergism; Endocarditis, Bacterial; Humans; Penicillin G; Penicillins; Sepsis; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Blood; Corynebacterium; Endocarditis, Bacterial; Erythromycin; Humans; Mouth; Penicillins; Postoperative Complications; Streptococcus; Tetracycline; Tooth Extraction

Topics: Administration, Oral; Bacteriological Techniques; Endocarditis, Bacterial; Erythromycin; Gingiva; Humans; Injections, Intramuscular; Lincomycin; Long-Term Care; Microbial Sensitivity Tests; Penicillin G; Penicillin G Benzathine; Penicillin Resistance; Rheumatic Fever; Rheumatic Heart Disease; Staphylococcus; Streptococcus; Sulfadiazine; Tetracycline

Topics: Aortic Valve Insufficiency; Coxiella; Endocarditis, Bacterial; Humans; Male; Middle Aged; Tetracycline

Topics: Adult; Aneurysm, Infected; Animals; Antacids; Aortic Valve; Brucella; Brucellosis; Brucellosis, Bovine; Cattle; Chloramphenicol; Digitalis Glycosides; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Oral Manifestations; Postoperative Complications; Prednisone; Streptomycin; Tetracycline

Topics: Adult; Cephaloridine; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Lincomycin; Methicillin; Oxacillin; Staphylococcal Infections; Staphylococcus; Tetracycline; Time Factors

Topics: Ampicillin; Anti-Bacterial Agents; Cephalosporins; Child; Cloxacillin; Colistin; Drug Synergism; Dysentery, Bacillary; Endocarditis, Bacterial; Humans; Infections; Lincomycin; Meningitis; Nafcillin; Neomycin; Oxacillin; Penicillin Resistance; Penicillins; Pneumococcal Infections; Polymyxins; Shigella; Streptococcal Infections; Sulfamethoxazole; Tetracycline; Urinary Tract Infections

Topics: Ampicillin; Animals; Animals, Laboratory; Cattle; Cephalothin; Chloramphenicol; Endocarditis, Bacterial; Enterobacteriaceae; Erythromycin; Escherichia coli; Heart Atria; Heart Valve Prosthesis; Jugular Veins; Kanamycin; Methicillin; Neomycin; Penicillin G; Penicillin Resistance; Polymyxins; Portal Vein; Sepsis; Staphylococcus; Streptomycin; Tetracycline; Vena Cava, Inferior

Topics: Adrenocorticotropic Hormone; Cardiomegaly; Convalescence; Digitalis Glycosides; Diuretics; Endocarditis, Bacterial; Erythromycin; Glucocorticoids; Heart Failure; Humans; Injections, Intramuscular; Penicillins; Pericarditis; Rheumatic Heart Disease; Socioeconomic Factors; Streptococcal Infections; Tetracycline

Topics: Ampicillin; Cephalothin; Chloramphenicol; Corynebacterium diphtheriae; Cross Infection; Endocarditis, Bacterial; Extracorporeal Circulation; Heart Valve Prosthesis; Humans; Male; Methicillin; Middle Aged; Penicillin G; Streptomycin; Tetracycline; Vancomycin

Topics: Aged; Cephaloridine; Endocarditis, Bacterial; Eubacterium; Humans; Male; Tetracycline

Topics: Adult; Chloramphenicol; Endocarditis, Bacterial; England; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Q Fever; Scotland; Tetracycline

Topics: Aortic Valve; Endocarditis, Bacterial; Humans; Male; Rickettsia Infections; Tetracycline

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Streptococcus; Tetracycline; Tooth Extraction

Topics: Animals; Dihydrostreptomycin Sulfate; Dog Diseases; Dogs; Endocarditis, Bacterial; Erythrocyte Count; Hematocrit; Hemoglobinometry; Leukocyte Count; Novobiocin; Penicillin G Procaine; Prednisolone; Tetracycline

Topics: Actinobacillus; Adult; Aortic Valve Stenosis; Chloramphenicol; Drug Synergism; Endocarditis, Bacterial; Fermentation; Haemophilus; Humans; Kanamycin; Male; Neomycin; Penicillins; Polymyxins; Streptomycin; Tetracycline

Topics: Adrenal Cortex Hormones; Anaphylaxis; Drug Hypersensitivity; Endocarditis, Bacterial; Erythromycin; Histamine H1 Antagonists; Humans; Penicillins; Skin Tests; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Administration, Oral; Ampicillin; Cephaloridine; Cephalothin; Chloramphenicol; Endocarditis, Bacterial; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Microbial Sensitivity Tests; Penicillin G; Probenecid; Streptococcus; Streptomycin; Tetracycline; Time Factors

Topics: Aged; Chloramphenicol; Endocarditis, Bacterial; Humans; Male; Middle Aged; Tetracycline; Vibrio

Pre- and post-extraction blood cultures were taken from 242 patients. The post-extraction ones were taken from 100 unpremedicated patients, from 42 with an erythromycin estolate cover, and from 100 patients after protection with pyrrolidino methyl tetracycline. The 100 post-extraction blood cultures from unpremedicated patients gave 64 positive results which yielded 155 strains, 88 of which were not aerobes. One hundred and fifteen representative strains were tested for sensitivity to 22 antibiotics. Of the 42 patients who received the erythromycin orally, 16 yielded positive blood cultures of mixtures of aerobes and anaerobes and of the 100 given one intravenous injection of the tetracycline three only developed a bacteraemia of a single type of aerobe. The serum concentrations obtained with the tetracycline given intravenously were 15 to 20 times higher than the serum levels obtained with the erythromycin given orally. There is a strong indication for using this kind of efficient antibiotic cover for dental extractions and other operative procedures known to be followed by a bacteraemia.

Topics: Endocarditis, Bacterial; Erythromycin; Humans; Postoperative Complications; Sepsis; Tetracycline; Tooth Extraction

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Drug Therapy; Endocarditis; Endocarditis, Bacterial; Hexachlorophene; Humans; Leukocyte Count; Oxacillin; Penicillins; Postoperative Care; Preoperative Care; Staphylococcal Infections; Streptomycin; Surgical Wound Infection; Tetracycline; Thoracic Surgery

Topics: Acinetobacter; Anti-Bacterial Agents; Chlortetracycline; Colistin; Dihydrostreptomycin Sulfate; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Neomycin; Nitrofurantoin; Oxytetracycline; Pathology; Penicillins; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Bacteriological Techniques; Child; Chloramphenicol; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Erythromycin; Fever; Infant; Infant, Newborn; Leukocyte Count; Meningitis; Methicillin; Middle Aged; Mortality; Osteomyelitis; Penicillins; Sepsis; Staphylococcal Infections; Streptomycin; Tetracycline

Clinical and pathological features of two fatal cases of bacterial endocarditis with Candida albicans superinfection are described. One patient presented with combined Streptococcus viridans and Candida endocarditis of the aortic valve. The second patient, an addict to paregoric injected intravenously, developed Staphylococcus aureus of the tricuspid valve with eventual Candida endocarditis. The responsible organisms were identified from blood cultures during the hospital course, and by culture or tissue section of postmortem material. Candida endocarditis has emerged as a disease entity in the past 20 years. The incidence is increasing and patients with bacterial endocarditis are among those at risk. Antibiotic therapy appeared to facilitate the development of Candida endocarditis in these two cases.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Candida albicans; Candidiasis; Dermatologic Agents; Endocarditis; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Middle Aged; Pathology; Penicillins; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Superinfection; Tetracycline; Tricuspid Valve; Viridans Streptococci

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: Bacteroides; Cardiac Surgical Procedures; Chloramphenicol; Drug Therapy; Endocarditis; Endocarditis, Bacterial; Erythromycin; Escherichia coli Infections; Klebsiella; Norway; Penicillins; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Sulfonamides; Surgical Wound Infection; Tetracycline; Thoracic Surgery

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

Topics: Animals; Anti-Bacterial Agents; Bronchitis; Bronchopneumonia; Endocarditis; Endocarditis, Bacterial; Furunculosis; Humans; Lung Abscess; Plants, Medicinal; Pneumonia; Pyelitis; Pyelocystitis; Sepsis; Tetracycline

Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Humans; Oleandomycin; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Anti-Bacterial Agents; Bronchiectasis; Cholangitis; Coombs Test; Drug Hypersensitivity; Empyema; Endocarditis; Endocarditis, Bacterial; Hemagglutination; Humans; Osteomyelitis; Penicillins; Precipitin Tests; Pyelonephritis; Sepsis; Streptomycin; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Dogs; Endocarditis, Bacterial; Staphylococcal Infections; Staphylococcus; Tetracycline; Tetracycline Resistance

Topics: Anti-Bacterial Agents; Endocarditis; Endocarditis, Bacterial; Micrococcus; Oleandomycin; Staphylococcus; Tetracycline