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Clinical characteristics and outcomes in pseudomonas endocarditis: a systematic review of individual cases

Systematic review of pseudomonas endocarditis

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Abstract

Background

The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This systematic review aimed to evaluate the emerging risk factors and outcomes in Pseudomonas IE.

Methods

A literature search was performed in major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords and combinations till November 2023. We recorded data for risk factors, diagnostic and treatment modalities. This study is registered with PROSPERO, CRD42023442807.

Results

A total of 218 cases (131 articles) were included. Intravenous drug use (IDUs) and prosthetic valve endocarditis (PVE) were major risk factors for IE (37.6% and 22%). However, the prosthetic valve was the predominant risk factor in the last two decades (23.5%). Paravalvular complications (paravalvular leak, abscess, or pseudoaneurysm) were described in 40 cases (18%), and the vast majority belonged to the aortic valve (70%). The mean time from symptom onset to presentation was 14 days. The incidence of difficult-to-treat resistant (DTR) pseudomonas was 7.4%. Valve replacement was performed in 57.3% of cases. Combination antibiotics were used in most cases (77%), with the aminoglycosides-based combination being the most frequently used (66%). The overall mortality rate was 26.1%. The recurrence rate was 11.2%. Almost half of these patients were IDUs (47%), and most had aortic valve endocarditis (76%).

Conclusions

This review highlights the changing epidemiology of Pseudomonas endocarditis with the emergence of prosthetic valve infections. Acute presentation and associated high mortality are characteristic of Pseudomonas IE and require aggressive diagnostic and therapeutic approach.

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Data availability

The data analysed in the current study will be available from the corresponding author on reasonable request.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India

    Durga Shankar Meena, Deepak Kumar, Bhuvanesh Kumar, Gopal Krishana Bohra, Naresh Midha & Mahendra Kumar Garg

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Contributions

Author DSM, DK and BK conceived the study; DSM, DK, BK and MKG designed the study protocol and methodology; DSM, GKB, DK, NM, MKG and BK analysed the data and drafted the manuscript; all authors critically revised the manuscript for critical content. All authors read and approved the final manuscript.

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Correspondence to Durga Shankar Meena.

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Meena, D.S., Kumar, D., Kumar, B. et al. Clinical characteristics and outcomes in pseudomonas endocarditis: a systematic review of individual cases. Infection (2024). https://doi.org/10.1007/s15010-024-02311-z

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