Related Experiment Videos
[An increased incidence of bacterial endocarditis in chronic inflammatory bowel diseases]
G Kreuzpaintner1, D Horstkotte, B Lösse
1Medizinische Klinik und Poliklinik, Abteilungen für Gastroenterologie und Kardiologie, Heinrich-Heine-Universität Düsseldorf.
Abstract:
Of 92 consecutive patients treated for proven native valve endocarditis three had ulcerative colitis and 2 Crohn's disease. All 5 patients developed severe complications; three had to undergo emergency valve replacement. With a prevalence of 64.1/10(5) cases of inflammatory bowel disease the calculated incidence (5/92) revealed a significant over-representation of inflammatory bowel disease among patients with proven endocarditis (p less than 5.08 x 10(-9)). Possible explanations may be the suppression of cellular immune defense by therapeutic interventions, high frequency of bacteremia caused by increased permeability of the damaged mucosa for bacteria and a higher incidence of diagnostic and therapeutic interventions in this patient population. Therefore, prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.
Insights
Patients with inflammatory bowel disease (IBD) have a significantly higher risk of developing infective endocarditis. Prophylaxis is recommended for IBD patients undergoing procedures that may cause bacteremia.
Area of Science:
- Cardiology
- Gastroenterology
- Infectious Diseases
Background:
- Native valve endocarditis is a serious infection requiring prompt treatment.
- Inflammatory bowel disease (IBD) encompasses chronic conditions like ulcerative colitis and Crohn's disease.
- The relationship between IBD and infective endocarditis is not well-established.
Observation:
- Five patients with inflammatory bowel disease (IBD) were identified among 92 patients with native valve endocarditis.
- These five IBD patients experienced severe complications, including three requiring emergency valve replacement.
- The incidence of IBD in endocarditis patients was significantly higher than expected based on IBD prevalence.
Findings:
- A significant over-representation of inflammatory bowel disease (IBD) was observed in patients with proven endocarditis.
- The calculated incidence of IBD among endocarditis patients was significantly higher than the general population prevalence (p < 5.08 x 10(-9)).
- Potential contributing factors include immune suppression, increased bacterial translocation from damaged mucosa, and frequent interventions in IBD patients.
Implications:
- Patients with active inflammatory bowel disease (IBD) may require careful consideration for bacterial endocarditis prophylaxis.
- Prophylaxis should be considered before procedures causing bacteremia, even in the absence of traditional cardiac risk factors.
- Further research is warranted to elucidate the mechanisms linking IBD and infective endocarditis.