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

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

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

• 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

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

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