Nuria Fernández-Hidalgo

Objectives: To evaluate whether clinical characteristics and outcomes of patients with Enterococcus faecalis bloodstream infection (EF-BSI) differ by biological sex. Methods: Quasi-experimental study conducted at two hospitals, comprising a retrospective phase (2017–2019) and a prospective intervention phase (2022–2024), including adults with a first episode of monomicrobial EF-BSI. Patients who died within 72 h or were receiving palliative care were excluded. A structured management bundle was implemented in the intervention phase. Clinical features, bundle adherence, and 90-day mortality were compared by sex. Cox regression was used to assess the association between sex and 90-day mortality. Results: Among 250 patients, 77 (31%) were females and 173 (69%) males. Females were younger than males (median 63 [50–76] vs. 73 [63–80] years; p < 0.001). Cardiovascular disease was more frequent in males (30 [39%] vs. 94 [54%]; p = 0.025), whereas immunosuppressive therapy (29 [38%] vs. 35 [20%]; p = 0.004) and connective tissue disease (9 [12%] vs. 2 [1%]; p < 0.001) were more frequent in females. Persistent bacteraemia (2/57 [4%] vs. 30/139 [22%]; p = 0.002) and infective endocarditis (14 [18%] vs. 59 [34%]; p = 0.011) were more frequent in males. Females received fewer bundle measures (5 [3–6] vs. 5 [4–6]; p = 0.028), largely because echocardiography and colonoscopy were less frequently indicated. Ninety-day mortality was 22% (17) in females and 14% (25) in males ( p = 0.136). Female sex was associated with higher 90-day mortality after adjustment (aHR 2.00, 95%CI 1.04–3.83). Conclusions: Further studies should explore the underlying causes of these differences and potential implications for individualized management.

Sutureless aortic bioprostheses have become an established alternative for surgical aortic valve replacement, particularly in elderly and high-risk patients. The Perceval (Livanova) valve, the most widely studied sutureless device, offers favorable hemodynamic performance and reduced operative times but introduces specific challenges when prosthetic valve endocarditis (PVE) occurs. Although the incidence of Perceval PVE is low and comparable to that of conventional bioprostheses, this complication is associated with substantial morbidity and mortality. Diagnosis is often complex due to acoustic shadowing on echocardiography, making multimodality imaging with transesophageal echocardiography, cardiac computed tomography, and [18F]-FDG PET/CT essential. Microbiological profiles resemble those of other biological prostheses, but perivalvular extension and early mechanical instability are frequent. Management follows general PVE principles but often requires early surgical intervention because of the valve’s reliance on radial fixation. This review summarizes current evidence on epidemiology, microbiology, diagnostic strategies, treatment, and prognosis of endocarditis involving the Perceval valve, and identifies areas for future research.

Aims: Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment, and outcome of patients presenting with IE-related EE. Methods and results: Cases recorded from 2014 to 2023 in nine centres in Europe and the United States were collected. Results were compared to a matched control group. Conclusion: Sixty-six patients with EE were reported, mean age of 65.2 ± 14.9 years, 71% (n = 47) male. Blood cultures were positive in 97% (64 cases) of patients, with a predominance of streptococci (46%, n = 30). As compared with the control group (n = 264), the EE group presented with more frequent diabetes (35% vs. 21%, P = 0.02), history of cirrhosis (9% vs. 3%, P = 0.04), glomerulonephritis (15% vs. 0.4%, P < 0.001), embolism before admission (92% vs. 55%, P < 0.001), and Janeway lesions (9% vs. 1%, P = 0.002). Streptococcal infection (46% vs. 26%, P = 0.001) was more frequent and Enterococcal infection (0% vs. 18%, P < 0.001) less frequent in the EE group. The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%), and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients. Conclusion: EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.

Infective endocarditis (IE) is a relatively rare but life-threatening systemic infection, which remains associated with high morbidity and mortality. The epidemiology of IE has shifted to involve an increasing numbers of older patients with both cardiovascular and other types of prosthetic devices, multiple comorbid conditions often requiring invasive procedures, increasingly virulent pathogens, in particular Staphylococcus aureus, or that can harbour anti-microbial resistance, and an escalation of injection drug use in many areas of the world. In parallel, advancements in diagnostic and therapeutic options have led to complex strategies in patients’ management. Despite these epidemiologic shifts, clinical trials have been rare and most of the evidence guiding IE management derives from expert consensus or analysis of large registries. Because of this, a multi-disciplinary IE team-based approach has been recommended as the standard of care. The aim of this review is to explore the rationale for a multi-disciplinary team-based approach to the management of IE. This approach has proved to be potentially beneficial based on multiple investigations that have evaluated patient outcomes. In addition, implementation strategies, feasibility and options of the team approach have also been highlighted.