Systematic Search for Present and Potential Portals of Entry for Infective Endocarditis

• Published in: Journal of the American College of Cardiology 2016-01, Vol.67 (2), p.151-158
• Main Authors: Delahaye, François, MD, PhD, M’Hammedi, Ali, MD, Guerpillon, Brice, MD, de Gevigney, Guy, MD, Boibieux, André, MD, Dauwalder, Olivier, PharmD, PhD, Bouchiat, Coralie, PharmD, PhD, Vandenesch, François, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; Bacteria - classification; Bacteria - isolation & purification; Cardiology; Cardiovascular; colonic abnormalities; Colonoscopy - methods; cutaneous infections; Dental Care - methods; dental infections; Disease; Endocarditis - diagnosis; Endocarditis - epidemiology; Endocarditis - etiology; Endocarditis - microbiology; Female; France - epidemiology; Gastrointestinal Diseases - complications; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - epidemiology; Health Status Indicators; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Internal Medicine; Male; Microorganisms; Middle Aged; Mortality; Ostomy; Preventive Health Services - methods; Preventive Health Services - organization & administration; Risk Assessment - methods; Skin Diseases, Bacterial - complications; Skin Diseases, Bacterial - diagnosis; Skin Diseases, Bacterial - epidemiology; Stomatognathic Diseases - complications; Stomatognathic Diseases - diagnosis; Stomatognathic Diseases - epidemiology; Streptococcus infections; Ulcers
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.10.065

Abstract Background Looking for and treating the portal of entry (POE) of infective endocarditis (IE) is important, but published research on this topic is nonexistent. Objectives The goal of this study was to systematically search for the POEs of present and potentially new episodes of IEs. Methods Patients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥50 years of age and in those with familial histories of colonic polyposis. Treatment of the POE was systematically considered. Results The POEs of the present IE episodes were identified in 74% of the 318 included patients. The most frequent POE was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively. Conclusions Our search for the POEs of present IEs was often successful, as was searching for an oral or dental or a gastrointestinal POE of a new IE episode. We advise the systematic performance of stomatologic examinations in patients with IE and performance of colonoscopy in patients ≥50 years of age or at high risk for colorectal cancer.