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PET/CT vs TEE: diagnostic value for infective endocarditis (IE) Single-centre, prospective study (2012-2014): N=45 adult pts (median age: 65 yr) with suspected.

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Presentation on theme: "PET/CT vs TEE: diagnostic value for infective endocarditis (IE) Single-centre, prospective study (2012-2014): N=45 adult pts (median age: 65 yr) with suspected."— Presentation transcript:

1 PET/CT vs TEE: diagnostic value for infective endocarditis (IE) Single-centre, prospective study (2012-2014): N=45 adult pts (median age: 65 yr) with suspected prosthetic or intracardiac-device-associated IE, undergoing PET/CT + transoesophageal echocardiography (TEE) Concordant findings between PET/CT and TEE: N=25 episodes: IE present (+): N=15; IE absent (-): N=10 Definite IE with PET/CT + and TEE – (N=14; 31%) –N=1: pulmonary septic embolism detected on PET/CT → definite diagnosis of IE, despite TEE - and PET/CT - Fernández-Hidalgo N. ECCMID 2014 abs. eP127 1 of 2 Data from poster

2 PET/CT vs TEE: diagnostic value for infective endocarditis (IE) PET/CT - with equivocal findings on TEE: N=4 –No signs of infection after removing antimicrobials Other advantages of PET/CT: –Identification of site of infection in pts with prosthetic valves + devices → avoid unnecessary removal of uninfected valves –Alternative diagnosis: N=2 (pneumonia, spondylodiscitis) –Diagnosis of tumours: N=5 (colon: N=3; lung: N=2) (4 of them in early, potentially curable stage) PET/CT might be useful for early diagnosis of IE of cardiac prostheses, for precise identification of the location of infection if >1 device is in place and for early diagnosis of tumours in elderly pts Fernández-Hidalgo N. ECCMID 2014 abs. eP127 2 of 2 Data from poster

3 Antistaphylococcal β-lactams vs vancomycin for IE due to methicillin-susceptible CoNS: mortality risk Multi-centre, observational cohort study: –International Collaboration on Endocarditis (ICE) Prospective Cohort Study database: N=5,568 pts with infective endocarditis (IE) (2000-2006) –ICE-Plus database: N=2,019 patients with IE (2008-2010) N=280 adult pts with monomicrobial IE caused by methicillin-susceptible coagulase-negative staphylococci (CoNS) (Non-lugdunensis CoNS: methicillin MIC ≤0.25 µg/ml; S.lugdunensis: MIC ≤2 µg/ml) : –Antistaphylococcal β-lactams: N=88: Penicillinase-resistant penicillin: N=81 / Cefazolin: N=7 –Vancomycin: N=36 (4 pts with S. lugdunensis) Baseline parameters: no sign. ≠ between β-lactam and vancomycin group for age, gender, prosthetic valve IE, left-sided IE, diabetes mellitus, previous IE episodes, embolisation other than stroke, new or worsening heart failure, paravalvular abscess/fistula, valvular perforation, persistent bacteraemia, cardiovascular surgery, etc. Carugati M. ECCMID 2014 abs. O252 1 of 2 Data from oral presentation

4 Cox regression analysis: Use of β-lactams is NOT a significant predictor of survival time after discharge: HR=1.74; P=0.22 Antistaphylococcal β-lactams vs vancomycin for IE due to methicillin-susceptible CoNS: mortality risk No sign. differences in mortality were found between antistaphylococcal β-lactam and vancomycin for methicillin-susceptible CoNS IE Carugati M. ECCMID 2014 abs. O252 2 of 2 Data from oral presentation

5 Ampicillin plus ceftriaxone (AC) for enterococcal infective endocarditis (IE): impact of length of Tx on efficacy Single-centre, retrospective analysis (Spain; 1997-2013): N=78 pts with enterococcal IE treated with AC or ampicillin + gentamicin (AG): –For 4 weeks: native, non-complicated IE –For 6 weeks: prosthetic or complicated IE or symptoms since >3 mo Pericas JM. ECCMID 2014 abs. eP123 1 of 2 Data from poster

6 Ampicillin plus ceftriaxone (AC) for enterococcal infective endocarditis (IE): impact of length of Tx on efficacy AEs due to antibiotic Tx: no sign. ≠ between AG and AC groups: –AG: skin rash (N=1), ototoxicity (N=2), vestibular toxicity (N=1) –AC: myelotoxicity (N=1), skin rash (N=2), C. difficile diarrhoea (N=2), superinfections due to β-lactam resistant agents (N=2) Pericas JM. ECCMID 2014 abs. eP123 2 of 2 Data from poster As 4 weeks Tx with AC for enterococcal IE showed a trend towards higher incidence of relapses, AC should be prolonged for ≥6 weeks


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