Background
Methods
Search strategy
Eligibility criteria
Selection of studies
Data extraction, synthesis and analyses
Results
Reference | Cases | Design | Case definition | Microbiology | Assessment of antibiotic susceptibility | Therapy | Cure |
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Colli et al, Italy [9] | 12 NVIE and 2 PVIE requiring acute valve replacement(all left-sided) | Retrospective. Mean follow-up was 20.8 ± 7 months | By Duke criteria | MRSA (60%) | Yes | IV vancomycin for 5.3 ± 3.4 days followed by oral linezolid for 3 weeks | 100% |
S. viridans (30%) | |||||||
Enterococcus sp. (10%) | |||||||
Dworkin et al, USA [10] | 13 IVDUs with NVIE (all right-sided with no systemic metastasis) | Prospective. 4-week follow-up | ≥2 positive blood cultures AND any of the following: Vegetations on echocardiogram (definite – 3 cases) OR pulmonary infiltrates/effusion or tricuspid insufficiency murmur (probable – 6 cases) OR no other identifiable source for the infection (possible – 1 case) |
S. aureus (100%) | Yes | IV ciprofloxacin and oral rifampin for 1 week followed by oral ciprofloxacin and oral rifampin for 3 weeks | 77% |
Chetty et al, South Africa [11] | 15 NVIE (right-sided vs. left-sided not specified, all cases were considered uncomplicated) | Prospective. 3-year follow-up | Characteristics clinical features AND any of the following: Positive blood cultures OR vegetations on echocardiogram |
Streptococcus sp. (60%) | Yes | High dose oral amoxycillin for 6 weeks (47% also received probenecid) | 87% |
Culture negative (40%) | |||||||
Pinchas et al, Israel [12] | 11 NVIE (all left-sided, considered uncomplicated) | Prospective. Follow-up varied from 3 months to 12 years | Fever AND pre-existing valvular heart disease AND multiple positive blood cultures |
S. viridans (100%) | Yes | High dose oral ampicillin for 6 weeks with probenecid for the first 4 weeks. IM streptomycin for the first 2 weeks | 90% |
Phillips et al, UK [13] | 13 NVIE (right-sided vs. left-sided not specified) – all children | Retrospective. Follow-up varied from 1-15 years | Pre-existing valvular disease AND characteristic clinical features AND positive blood cultures |
S, viridans (62%) Staphylococcus sp. (23%) | Yes | IV therapy for < 2 weeks (92% ≤3 days) followed by oral penicillin V, ampicillin, cloxacillin, flucloxacillin or erythromycin for 6-8 weeks | 100% |
Other streptococci or Enterococcus sp. (15%) | |||||||
Gray et al, UK [14] | 13 NVIE (right-sided vs. left-sided not specified) | Retrospective. 3-month follow-up | Not specified |
S. viridans.(62%) | Yes | Oral ampicillin or propicillin (with or without probenecid) for 6 weeks | 92% |
E. faecalis (1%) | |||||||
Culture negative (37%) | |||||||
Campeau et al, Canada [15] | 10 NVIE (right-sided vs. left-sided not specified) | Retrospective. Follow-up varied from 6-30 months | Pre-existing valvular disease AND Characteristic clinical features AND ≥2 positive blood cultures |
S. viridans (60%) | Yes | Oral phenithicillin for 4-6 weeks (IM streptomycin for the first 2 weeks in 6 cases, concomitant probenecid in 2 cases) | 80% |
E. faecalis (30%) | |||||||
Anaerobic bacteria (10%) | |||||||
Friedberg et al, USA [16] | 11 NVIE (right-sided vs. left-sided not specified) | Retrospective. Follow-up not specified | Pre-existing rheumatic valvular disease AND Unexplained fever for ≥2½ weeks |
S. viridans (55%) | Yes | Oral Aureomycin for 5-8 weeks | 36% |
E. faecalis (18%) | |||||||
Culture negative (27%) | |||||||
Schein et al, USA [17] | 81 NVIE (right-side vs. left-sided not specified) | Retrospective. Follow-up varied from 2-8 years | Not specified |
Streptococcus sp. (94%) | Not specified | Oral sulfonamides (sulfanilamide, sulfapyridine, sulfathiazole or sulfadiazine) for 10 days-14 weeks | 10% |
S. aureus (1%) | |||||||
Enterococcus sp. (1%) | |||||||
H. influenza (4%) |
Reference | Cases | Design | Case definition | Microbiology | Therapy | Results |
---|---|---|---|---|---|---|
Heldman et al, USA [18] | 85 IVDUs with NVIE (all right-sided with no systemic metastases), 40 in the oral therapy arm and 45 in the IV therapy arm | Prospective, randomized, open label. 1-month follow-up | - ≥2 positive blood cultures AND any of the following: Valvular vegetations on echocardiogram (definite – 15 cases) OR evidence of pulmonary emboli on chest X-ray or tricuspid insufficiency murmur (probable – 26 cases) OR no other identifiable source for the infection (possible – 44 cases) | MRSA (5%) MSSA (89%) CoNS (6%) | Oral ciprofloxacin and rifampin for 4 weeks vs. IV oxacillin or vancomycin (IV gentamicin for the first 5 days) for 4 weeks | Cure rate: 90% (oral therapy) vs. 91% (IV therapy), p = 0.9 |
Treatment toxicity: 3% (oral therapy) vs. 62% (IV therapy), p < 0.001 | ||||||
Stamboulian et al, Argentine [19] | 30 NVIE (all left-sided), 15 in each arm | Prospective, randomized, open label. 3 to 6-motnh follow-up | - ≥2 positive blood cultures AND any of the following: New or changing regurgitant murmur OR predisposing heart disease OR vascular phenomena OR valvular vegetation on echocardiogram | S. viridans (50%) | IV or IM ceftriaxone for 2 weeks followed by high dose oral amoxicillin for 2 weeks vs. IV or IM ceftriaxone for 4 weeks | Cure rate: 100% in both arms. Treatment toxicity not reported |
S. bovis (50%) |
Observational studies
Quality assessment
Establishes uniform process for patient enrolment | Provides r case-definition for infective endocarditis | Provides criteria for inclusion and exclusion | Provides comparative information for eligible patients ultimately not enrolled | Provides Comparative analysis with a control group | All enrolled patients accounted for in the results? | It is possible to determine whether the study institutions were referral centers | |
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Colli et al[9] |
√
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√
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√
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X
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X
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√
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√
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Dworkin et al[10] |
√
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√
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√
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X
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X
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√
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√
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Chetty et al[11] |
X
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√
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√
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X
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X
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√
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√
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Pinchas et al[12] |
X
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√
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X
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X
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X
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√
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√
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Phillips et al[13] |
X
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√
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X
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X
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X
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√
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Gray et al[14] |
X
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X
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X
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X
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X
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√
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√
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Campeau et al[15] |
X
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√
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X
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X
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X
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√
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√
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Friedberg et al[16] |
X
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√
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X
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X
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X
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√
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√
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Schein et al[17] |
X
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X
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X
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X
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X
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√
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√
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Therapy and outcomes
Clinical trials
Quality assessment
Provides case definition for infective endocarditis | Defines eligibility criteria | Provides details of the setting and location of the study | Provides detailed description of the intervention | Details processes for ascertainment and measurement of outcomes | Provides justification for sample size | Establishes an adequate sequence generation | Allocation concealment | Blinding (study drug) | Blinding (outcomes) | Analysis of safety of the intervention | Describes participants’ flow | Addresses incompleted outcome data | Addresses risk of selective reporting | Provides information on accessibility to the study protocol, trial registration and funding for the study | |
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Heldman et al[18] |
√
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√
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√
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√
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√
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√
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√
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X
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X
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X
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√
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√
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√
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√
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√
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Stamboulian et al[19] |
√
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√
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√
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√
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X
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X
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X
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X
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X
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X
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X
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N.A.
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N.A.
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N.A.
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X
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