J. of Cardiovasc. Trans. Res. DOI 10.1007/s12265-014-9550-z
Is There a Need for Bacterial Endocarditis Prophylaxis in Patients Undergoing Urological Procedures? Salvatore Patanè
Received: 29 January 2014 / Accepted: 12 February 2014 # Springer Science+Business Media New York 2014
Abstract Heart valve repair or replacement is a serious problem.The focused update on infective endocarditis of American College of Cardiology/American Heart Association 2008 (ACC/AHA guidelines) and Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) of the European Society of Cardiology (ESC guidelines) describe prophylaxis against infective endocarditis as not recommended for urinary tract procedures in the absence of active infection. A statistical association has been recently shown between urological procedures and the development of infective endocarditis. New evidences concerning infective endocarditis due to Actinobaculum schaalii, Neisseria gonorrhoeae, Streptococcus agalactiae, Enterococcus faecalis, Pseudomonas aeruginosa, Aerococci and Staphylococcus aureus, and new findings indicate there is a need for bacterial endocarditis prophylaxis in patients undergoing urological procedures especially in elderly patients and in cancer and immunocompromised patients, to avoid serious consequences. Keywords Antibiotic prophylaxis . Cardio-oncology . Infective endocarditis . Urological procedures
Text Heart valve repair or replacement is a serious problem [1–7]. The focused update on infective endocarditis of American College of Cardiology/American Heart Association 2008 (ACC/AHA guidelines) [8–10] and Guidelines on the Editor-in-Chief Jennifer L. Hall oversaw the review of this article S. Patanè (*) Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina, Messina, Italy e-mail: [email protected]
prevention, diagnosis, and treatment of infective endocarditis (new version 2009) of the European Society of Cardiology (ESC guidelines) [11] describe prophylaxis against infective endocarditis (IE) as not recommended for urinary tract procedures in the absence of active infection (class III recommendation) with a level of evidence: B on ACC/AHA guidelines and a level of evidence: C on ESC guidelines. ESC guidelines indicate an antibiotic regimen in the case of an infection or to prevent wound infection or sepsis in highest-risk patients against Enterococci [11], and ACC/AHA guidelines indicate that enterococcal urinary tract infection or colonization eradication is reasonable before elective cystoscopy or other urinary tract manipulation [8–10]. The American Urological Association cites the ACC/AHA guidelines [8–10] and also remembers that the potential benefit of the antimicrobial prophylaxis is determined by patient factors, procedure factors, and the potential morbidity of infection [12]. A statistical association has been recently shown between urological procedures and the development of IE [13, 14]. IE by urinary tract commensals Actinobaculum schaalii has also been reported in elderly [15, 16] and immunocompromised patients [16]. Neisseria gonorrhoeae IE has been reported in asymptomatic urinary tract patients without previous heart disease [17]. Even Streptococcus agalactiae (Group B Streptococci (GBS)) can colonize the genitourinary tract [18] or the blood of healthy asymptomatic individuals [19, 20] and it has been increasingly associated with invasive disease, including IE [18], mainly in the elderly, in immunocompromised, diabetic, and cancer patients [18, 19]. Enterococcus faecalis IE [21], especially hospital-acquired IE, has also been reported [22, 23] as well as Pseudomonas aeruginosa IE [24]. Aerococci can be found in an asymptomatic carriage state and they can cause invasive infections including IE with many reported fatalities especially in elderly patients [25]. Staphylococcus aureus asymptomatic bacteriuria, which is reportedly associated with IE [26] and transrectal prostate biopsy, may be accompanied by IE [14]. Furthermore, IE occurs in more than 50 % of cases in
J. of Cardiovasc. Trans. Res.
patients with no previously known valve disease [27] and increasing evidence suggests that the role of IE antibiotic prophylaxis remains a dark side of the cardio-oncology prevention [28]. IE, in elderly cancer patients, complicating chemotherapy is not uncommon and it is strongly associated with agranulocytosis, immunosuppression, and increase in the incidence of Gram-negative bacteria responsible for most cases of urinary tract infections [29]. Urological cancer patients receiving chemotherapy are also more susceptible to infectious complications due to bone marrow suppression leading to neutropenia [30]. Research suggests an increase in infectious complications after prostate biopsy [31] in elderly patients [32], leading to the occurrence of bacteremia for nosocomial factors while performing urological manipulations [33, 34] especially in immunosuppressed patients [35]. This evidence indicates there is a need for bacterial endocarditis prophylaxis in patients undergoing urological procedures especially in elderly and cancer and immunocompromised patients, to avoid serious consequences.
9.
10.
11.
Conflict of Interest None declared 12.
References 1. Denti P, Maisano F, Alfieri O. (2014) Devices for mitral valve repair. J Cardiovasc Transl Res. doi:10.1007/s12265-014-9543-y. 2. Lim, D. S. (2013). Using imaging to guide patient selection and performance of catheter-based mitral valve repair for mitral regurgitation. Journal of Cardiovascular Translational Research, 6(5), 675– 680. doi:10.1007/s12265-013-9492-x. 3. Chi, N. H., Huang, C. H., Huang, S. C., Yu, H. Y., Chen, Y. S., Wang, S. S., et al. (2014). Robotic mitral valve repair in infective endocarditis. Journal of Thoracic Disease, 6(1), 56–60. doi:10.3978/j.issn. 2072-1439.2014.01.05. 4. Bateman, M. G., Quill, J. L., Hill, A. J., & Iaizzo, P. A. (2013). The clinical anatomy and pathology of the human atrioventricular valves: implications for repair or replacement. Journal of Cardiovascular Translational Research, 6(2), 155–165. doi:10.1007/s12265-0129437-9. 5. Bateman, M. G., Hill, A. J., Quill, J. L., & Iaizzo, P. A. (2013). The clinical anatomy and pathology of the human arterial valves: implications for repair or replacement. Journal of Cardiovascular Translational Research, 6(2), 166–175. doi:10.1007/s12265-012-9438-8. 6. Ragosta, M. (2013). Multi-modality imaging of the aortic valve in the era of transcatheter aortic valve replacement: a guide for patient selection, valve selection, and valve delivery. Journal of Cardiovascular Translational Research, 6(5), 665–674. doi:10. 1007/s12265-013-9490-z. 7. Gallo, M., Bianco, R., Bottio, T., Naso, F., Franci, P., Zanella, F., et al. (2013). Tissue-engineered heart valves: intra-operative protocol. Journal of Cardiovascular Translational Research, 6(4), 660–661. doi:10.1007/s12265-013-9480-1. 8. Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O’Gara, P. T., et al. (2008). ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the
13.
14.
15.
16.
17.
18.
19.
Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 52(8), 676–685. Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., et al. (2008). ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 118(8), 887–896. Epub 2008 Jul 28. Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., et al. (2008). ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Catheter Cardiovasc Interv. 2008 Sep 1;72(3):E1–12. Habib, G., Hoen, B., Tornos, P., Thuny, F., Prendergast, B., Vilacosta, I., et al. (2009). ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. European Heart Journal, 30(19), 2369–2413. Wolf, J. S., Jr., Bennett, C. J., Dmochowski, R. R., Hollenbeck, B. K., Pearle, M. S., & Schaeffer, A. J. (2008). Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on Urologic surgery antimicrobial prophylaxis. Journal of Urology, 179(4), 1379–1390. doi:10.1016/j.juro.2008. 01.068. Erratum in: J Urol. 2008Nov; 180(5):2262-3. Mohee, A., West, R., Baig, W., Eardley, I., & Sandoe, J. A. (2013). A case-control study: are urological procedures risk factors for the development of infective endocarditis? BJU International. doi:10. 1111/bju.12550. Ansari, J., Garcha, G. S., Huang, H., Bakaeen, F. G., Virani, S. S., & Jneid, H. (2013). Acute aortic valve rupture from infective endocarditis after transrectal prostate biopsy: a call to revise the AHA guidelines for prevention of infective endocarditis. Clinical Medicine Insights: Case Reports, 6, 29–33. doi:10.4137/CCRep. S10503. Erratum in: Clin Med Insights Case Rep. 2013;6:99. Olsen, A. B., Andersen, P. K., Bank, S., Søby, K. M., Lund, L., & Prag, J. (2013). Actinobaculum schaalii, a commensal of the urogenital area. BJU International, 112(3), 394–397. doi:10.1111/j.1464410X.2012.11739.x. Ghadian, A. (2012). Actinobaculum schaalii as a uropathogen in immunocompromised hosts. Iranian Journal of Kidney Diseases, 6(5), 332–333. Ramos A, García-Pavía P, Orden B, Cobo M, Sánchez-Castilla M, Sánchez-Romero I, Múñez E, Marín M, García-Montero C. (2013) Gonococcal endocarditis: a case report and review of the literature.Infection. [Epub ahead of print] Otaguiri, E. S., Morguette, A. E., Tavares, E. R., Dos Santos, P. M., Morey, A. T., Cardoso, J. D., et al. (2013). Commensal Streptococcus agalactiae isolated from patients seen at University Hospital of Londrina, Paraná, Brazil: capsular types, genotyping, antimicrobial susceptibility and virulence determinants. BMC Microbiology, 13, 297. doi:10.1186/1471-2180-13-297. Stevens, W. T., Bolan, C. D., Oblitas, J. M., Stroncek, D. F., Bennett, J. E., & Leitman, S. F. (2006). Streptococcus agalactiae sepsis after transfusion of a plateletpheresis concentrate: benefit of donor evaluation. Transfusion, 46(4), 649–651.
J. of Cardiovasc. Trans. Res. 20. Ivanova Georgieva, R., García López, M. V., Ruiz-Morales, J., Martínez-Marcos, F. J., Lomas, J. M., Plata, A., et al. (2010). J Infect. Streptococcus agalactiae left-sided infective endocarditis. Analysis of 27 cases from a multicentric cohort. Journal of Infection, 61(1), 54–59. 21. Sillanpää, J., Chang, C., Singh, K. V., Montealegre, M. C., Nallapareddy, S. R., Harvey, B. R., et al. (2013). Contribution of individual Ebp Pilus subunits of Enterococcus faecalis OG1RF to pilus biogenesis, biofilm formation and urinary tract infection. PLoS One, 8(7), e68813. doi:10.1371/journal.pone.0068813. 22. Kafil, H. S., Mobarez, A. M., & Moghadam, M. F. (2013). Adhesion and virulence factor properties of Enterococci isolated from clinical samples in Iran. Indian Journal of Pathology and Microbiology, 56(3), 238–242. doi:10.4103/0377-4929.120375. 23. Pinholt, M., Ostergaard, C., Arpi, M., Bruun, N. E., Schønheyder, H. C., Gradel, K. O., et al. (2014). Danish Collaborative Bacteraemia Network (DACOBAN). Incidence, clinical characteristics and 30day mortality of enterococcal bacteraemia in Denmark 2006-2009: a population-based cohort study. Clinical Microbiology and Infection, 20(2), 145–151. 24. Galle, M., Carpentier, I., & Beyaert, R. (2012). Structure and function of the Type III secretion system of Pseudomonas aeruginosa. Current Protein and Peptide Science, 13(8), 831–842. 25. Rasmussen, M. (2013). Aerococci and aerococcal infections. Journal of Infection, 66(6), 467–474. doi:10.1016/j.jinf.2012.12.006. 26. Al Mohajer, M., & Darouiche, R. O. (2012). Staphylococcus aureus bacteriuria: source, clinical relevance, and management. Current Infectious Disease Reports, 14(6), 601–606. doi:10.1007/s11908012-0290-4. 27. Tornos, P., Gonzalez-Alujas, T., Thuny, F., & Habib, G. (2011). Infective endocarditis: the European viewpoint. Current Problems in Cardiology, 36(5), 175–222. doi:10.1016/j.cpcardiol.2011.03.004.
28. Patanè, S. (2012). A dark side of the cardio-oncology: the bacterial endocarditis prophylaxis. International Journal of Cardiology, 157(3), 448–449. doi:10.1016/j.ijcard.2012.04.023. 29. Todaro, J., Bollmann, P. W., Nussbacher, A., Camargo, L. F., Santos, B. F., Alvarenga, D., et al. (2012). Multiple myeloma complicated with Pseudomonas endocarditis. Einstein (Sao Paulo), 10(4), 498– 501. English, Portuguese. 30. Yasufuku, T., Shigemura, K., Tanaka, K., Arakawa, S., Miyake, H., & Fujisawa, M. (2013). Risk factors for refractory febrile neutropenia in urological chemotherapy. Journal of Infection and Chemotherapy, 19(2), 211–216. doi:10.1007/s10156-012-0478-4. 31. Womble, P. R., Dixon, M. W., Linsell, S. M., Ye, Z., Montie, J. E., Lane, B. R., et al. (2013). Infection-related hospitalizations after prostate biopsy in a state-wide quality improvement collaborative. Journal of Urology. doi:10.1016/j.juro.2013.12.026. 32. Arain, F. A., Williams, B. D., Lick, S. D., Boroumand, N., & Ahmad, M. (2013). Echocardiographic, histopathologic, and surgical findings in Staphylococcus lugdunensis mitral valve endocarditis after prostate biopsy. Circulation, 128(14), e204–e206. doi:10.1161/ CIRCULATIONAHA. 113. 002928. 33. Krikunov AA, Kharchenko NL, Fed'ko VV, Rusnak AO. (2013) [Risk factors for infective endocarditis in cardiac valve prosthesis patients] .Klin Khir. (2):25-7. Russian. 34. Siegman-Igra, Y. (2010). Infective endocarditis following gastrointestinal and genitourinary procedures: an argument in favour of prophylaxis. Scandinavian Journal of Infectious Diseases, 42(3), 208–214. doi:10.3109/00365540903443140. 35. Unic, D., Starcevic, B., Sicaja, M., Baric, D., Rudez, I., Biocic, S., et al. (2013). Aortic valve endocarditis in a transplanted heart after urethral instrumentation. Annals of Thoracic Surgery, 96(3), e61– e62. doi:10.1016/j.athoracsur.2013.03.113.
Is There a Need for Bacterial Endocarditis Prophylaxis in Patients Undergoing Urological Procedures? Salvatore Patanè
Received: 29 January 2014 / Accepted: 12 February 2014 # Springer Science+Business Media New York 2014
Abstract Heart valve repair or replacement is a serious problem.The focused update on infective endocarditis of American College of Cardiology/American Heart Association 2008 (ACC/AHA guidelines) and Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) of the European Society of Cardiology (ESC guidelines) describe prophylaxis against infective endocarditis as not recommended for urinary tract procedures in the absence of active infection. A statistical association has been recently shown between urological procedures and the development of infective endocarditis. New evidences concerning infective endocarditis due to Actinobaculum schaalii, Neisseria gonorrhoeae, Streptococcus agalactiae, Enterococcus faecalis, Pseudomonas aeruginosa, Aerococci and Staphylococcus aureus, and new findings indicate there is a need for bacterial endocarditis prophylaxis in patients undergoing urological procedures especially in elderly patients and in cancer and immunocompromised patients, to avoid serious consequences. Keywords Antibiotic prophylaxis . Cardio-oncology . Infective endocarditis . Urological procedures
Text Heart valve repair or replacement is a serious problem [1–7]. The focused update on infective endocarditis of American College of Cardiology/American Heart Association 2008 (ACC/AHA guidelines) [8–10] and Guidelines on the Editor-in-Chief Jennifer L. Hall oversaw the review of this article S. Patanè (*) Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina, Messina, Italy e-mail: [email protected]
prevention, diagnosis, and treatment of infective endocarditis (new version 2009) of the European Society of Cardiology (ESC guidelines) [11] describe prophylaxis against infective endocarditis (IE) as not recommended for urinary tract procedures in the absence of active infection (class III recommendation) with a level of evidence: B on ACC/AHA guidelines and a level of evidence: C on ESC guidelines. ESC guidelines indicate an antibiotic regimen in the case of an infection or to prevent wound infection or sepsis in highest-risk patients against Enterococci [11], and ACC/AHA guidelines indicate that enterococcal urinary tract infection or colonization eradication is reasonable before elective cystoscopy or other urinary tract manipulation [8–10]. The American Urological Association cites the ACC/AHA guidelines [8–10] and also remembers that the potential benefit of the antimicrobial prophylaxis is determined by patient factors, procedure factors, and the potential morbidity of infection [12]. A statistical association has been recently shown between urological procedures and the development of IE [13, 14]. IE by urinary tract commensals Actinobaculum schaalii has also been reported in elderly [15, 16] and immunocompromised patients [16]. Neisseria gonorrhoeae IE has been reported in asymptomatic urinary tract patients without previous heart disease [17]. Even Streptococcus agalactiae (Group B Streptococci (GBS)) can colonize the genitourinary tract [18] or the blood of healthy asymptomatic individuals [19, 20] and it has been increasingly associated with invasive disease, including IE [18], mainly in the elderly, in immunocompromised, diabetic, and cancer patients [18, 19]. Enterococcus faecalis IE [21], especially hospital-acquired IE, has also been reported [22, 23] as well as Pseudomonas aeruginosa IE [24]. Aerococci can be found in an asymptomatic carriage state and they can cause invasive infections including IE with many reported fatalities especially in elderly patients [25]. Staphylococcus aureus asymptomatic bacteriuria, which is reportedly associated with IE [26] and transrectal prostate biopsy, may be accompanied by IE [14]. Furthermore, IE occurs in more than 50 % of cases in
J. of Cardiovasc. Trans. Res.
patients with no previously known valve disease [27] and increasing evidence suggests that the role of IE antibiotic prophylaxis remains a dark side of the cardio-oncology prevention [28]. IE, in elderly cancer patients, complicating chemotherapy is not uncommon and it is strongly associated with agranulocytosis, immunosuppression, and increase in the incidence of Gram-negative bacteria responsible for most cases of urinary tract infections [29]. Urological cancer patients receiving chemotherapy are also more susceptible to infectious complications due to bone marrow suppression leading to neutropenia [30]. Research suggests an increase in infectious complications after prostate biopsy [31] in elderly patients [32], leading to the occurrence of bacteremia for nosocomial factors while performing urological manipulations [33, 34] especially in immunosuppressed patients [35]. This evidence indicates there is a need for bacterial endocarditis prophylaxis in patients undergoing urological procedures especially in elderly and cancer and immunocompromised patients, to avoid serious consequences.
9.
10.
11.
Conflict of Interest None declared 12.
References 1. Denti P, Maisano F, Alfieri O. (2014) Devices for mitral valve repair. J Cardiovasc Transl Res. doi:10.1007/s12265-014-9543-y. 2. Lim, D. S. (2013). Using imaging to guide patient selection and performance of catheter-based mitral valve repair for mitral regurgitation. Journal of Cardiovascular Translational Research, 6(5), 675– 680. doi:10.1007/s12265-013-9492-x. 3. Chi, N. H., Huang, C. H., Huang, S. C., Yu, H. Y., Chen, Y. S., Wang, S. S., et al. (2014). Robotic mitral valve repair in infective endocarditis. Journal of Thoracic Disease, 6(1), 56–60. doi:10.3978/j.issn. 2072-1439.2014.01.05. 4. Bateman, M. G., Quill, J. L., Hill, A. J., & Iaizzo, P. A. (2013). The clinical anatomy and pathology of the human atrioventricular valves: implications for repair or replacement. Journal of Cardiovascular Translational Research, 6(2), 155–165. doi:10.1007/s12265-0129437-9. 5. Bateman, M. G., Hill, A. J., Quill, J. L., & Iaizzo, P. A. (2013). The clinical anatomy and pathology of the human arterial valves: implications for repair or replacement. Journal of Cardiovascular Translational Research, 6(2), 166–175. doi:10.1007/s12265-012-9438-8. 6. Ragosta, M. (2013). Multi-modality imaging of the aortic valve in the era of transcatheter aortic valve replacement: a guide for patient selection, valve selection, and valve delivery. Journal of Cardiovascular Translational Research, 6(5), 665–674. doi:10. 1007/s12265-013-9490-z. 7. Gallo, M., Bianco, R., Bottio, T., Naso, F., Franci, P., Zanella, F., et al. (2013). Tissue-engineered heart valves: intra-operative protocol. Journal of Cardiovascular Translational Research, 6(4), 660–661. doi:10.1007/s12265-013-9480-1. 8. Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O’Gara, P. T., et al. (2008). ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the
13.
14.
15.
16.
17.
18.
19.
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