Blood Infection

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Redone

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I wasn't sure where to post this because it appears I have a very unusual case. I had a Bucuspid valve replacement with a St. Jude 21mm Mechanical, received a descending Aortic Graph for an Aneurysm at 4.5mm and had two Coronary Arteries moved November 29, 2021. I had an amazing recovery, no sternum pain and was back to activity in 6 weeks. In April my partner and I took a two week trip to Utah to hike the 5 National Parks. After landing at the airport on May 13th I ended up with a fever of 102.5 on Saturday May 14th. I did an androgen test, which was negative so I thought it might be the Flu. I ended up at the emergency room on May 17th still with fevers getting as high as 104 briefly. They determined I somehow had a blood infection. I had cut myself in Sedona on a hike, but this is still a mystery as to how I got the blood infection. 9 days in the hospital, first on broad spectrum antibiotic then once they figured out the Bacteria I was growing Strep B they put me on Ceftriaxone and discharged me on May 24. I ended up back at the ER on June 11 still with fevers. My PET Scan showed possible signs of bacteria on the aortic graft and valve. A Transesophogial Ultrasound was just done on June 13, which reveal outpouchings (possibly abcesses) on the graft and maybe even the valve. It appears like I may have to endure another Open Heart Surgery to remove the bacteria because the Ceftriaxone can't penetrate the abcesses or outpouchings as they call them. Has anyone else ever had a blood infection? I would love to hear your experience.
 

tom in MO

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My commiserations. I don't know anything personally, but from acquaintances have found that blood infections can happen to anyone, anytime and are complicated to control. You need a good infectious disease doctor. One person got a serious infection from falling down on the gym floor and getting an abrasion.

Good luck.
 

Redone

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Thank you for your response Tom! I have a team of Infectious Disease Drs, Cardiologists and Cardiac Surgery working on this. I spent May 17 - 24 (9 days) in the hospital and am now back in the hospital while they try to figure out whether to replace my Aortic Graft and Mechanical Valve. It's awful to think a small papercut even can wreak such havoc! Praying I'm not undergoing heart surgery #2.
 

Redone

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My surgeon recommends I do the surgery sooner than later. He said, the blood infection caused quite a bit of damage to the valve and Aortic Graft unfortunately and there are outpouchings/abcesses. I'm still getting fevers and night sweats regardless of being on Ceftriaxone since May 21. I'm not growing any new bacteria since May 24, but it definitely caused a lot of damage. Just a heads up don't keep your razors for months and months, throw them out after maybe 6 - 10 uses. I'm not saying that's how this happened because they will never know, but bacteria on razors is a thing.
 

Chuck C

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Just a heads up don't keep your razors for months and months, throw them out after maybe 6 - 10 uses. I'm not saying that's how this happened because they will never know, but bacteria on razors is a thing.

Good tip. I am thinking that I might start storing mine in a glass of alcohol between uses.
 

Redone

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My step-dad is an Orthopedic Surgeon and said, soaking them in alcohol is a good idea. Good thinking on your part!

On anorher note do you know anything about Homograft valves? My surgeon is saying he might have no choice during reoperation to place a Homograft instead of mechanical and I would rather have another mechanical. Problem is he had to make my last one fit, which involved cutting a bit of tissue.
 

mecretired

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I experienced this twice. Strep infection proceeded to endocarditis. Initial oral antibiotics only worked short term. I was hospitalized and put on IV antibiotics—then a PIC line for self administered antibiotics for 4 more weeks. (Both times).Fortunately they treated my infection correctly and TEE showed no damage to valve. I have a St Jude grafted aortic valve. After the second time they kept me on oral antibiotics. I have been on twice a day Cephalexin for 2 years now. Was your infection strep, staph?
 

Chuck C

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On anorher note do you know anything about Homograft valves?

From what I know, if I was going to go tissue and a homograft was available, I would probably choose the homograft, although I would want to do a lot more due diligence on it. In our age range tissue valves generally last about 10 years. The new Resilia tissue could do a little better, but it is still unknown. On the other hand, homografts will often last 20 years or more. @pellicle had a homograft and it lasted about 18 years. I believe his valve was still ok at the time, but they had to operate due to an aneurysm, so they replaced the valve at the time as well.

On the infection issue, one thing that I do is always keep a bottle of amoxycillin available. I use it before any dental cleaning, which is standard for those with prosthetic valves, but also in the event that I should get a significant cut or step on a nail, I'll take 2000mg, as a precaution, as I would before any dental appointment. This is something for which the effectiveness is unknown, and likely never will be known, but I see no harm in the practice and it could help mitigate the risk of infection.
 

Redone

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I experienced this twice. Strep infection proceeded to endocarditis. Initial oral antibiotics only worked short term. I was hospitalized and put on IV antibiotics—then a PIC line for self administered antibiotics for 4 more weeks. (Both times).Fortunately they treated my infection correctly and TEE showed no damage to valve. I have a St Jude grafted aortic valve. After the second time they kept me on oral antibiotics. I have been on twice a day Cephalexin for 2 years now. Was your infection strep, staph?
I'm so sorry to hear you dealt with that. I am on IV antibiotics (Ceftriaxone) since approximately May 20, but a lot of damage has occurred unfortunately. My infection is Strep B. I also have outpouchings/abscesses along the Aortic Graft. The valve is also damaged 😔
 

pellicle

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Hi Chuck and good morning from Australia

to extend what you've answered to @Redone

On the other hand, homografts will often last 20 years or more. @pellicle had a homograft and it lasted about 18 years. I believe his valve was still ok at the time, but they had to operate due to an aneurysm, so they replaced the valve at the time as well.

yes, that's right, my first surgery (at 10) was a fix, my second at 28 was a homograft. I was fortunate that in Queensland our primary cardiac hospital had a great interest in homografts which (if I understood correctly) was sufficiently world class as to have done surgeries on US heart surgeons.

From my collected notes on the literature reading I did on that:



The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements.

RESULTS:

The 30-day/hospital mortality was 3% overall, falling to 1.13 +/- 1.0% for the 352 homograft root replacements.
Actuarial late survival at 25 years of the total cohort was 19 +/- 7%.
Early endocarditis occurred in two of the 1,022 patient cohort, and freedom from late infection (34 patients) actuarially at 20 years was 89%. One-third of these patients were medically cured of their endocarditis.
Preservation methods (4 degrees C or cryopreservation) and implantation techniques displayed no difference in the overall actuarial 20-year incidence of late survival endocarditis, thromboembolism or structural degeneration requiring operation.
Thromboembolism occurred in 55 patients (35 permanent, 20 transient) with an actuarial 15-year freedom in the 861 patients having aortic valve replacement +/- CABG surgery of 92% and in the 105 patients having additional mitral valve surgery of 75% (p = 0.000).
Freedom from reoperation from all causes was 50% at 20 years and was independent of valve preservation.
Freedom from reoperation for structural deterioration was very patient age-dependent. For all cryopreserved valves, at 15 years, the freedom was
⦁ 47% (0-20-year-old patients at operation),
⦁ 85% (21-40 years), {I was in this group as I was 28 at surgery}
⦁ 81% (41-60 years) and
⦁ 94% (>60 years). Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).

CONCLUSION:
This largest, longest and most complete follow up demonstrates the excellent advantages of the homograft aortic valve for the treatment of acute endocarditis and for use in the 20+ year-old patient. However, young patients (< or = 20 years) experienced only a 47% freedom from reoperation from structural degeneration at 10 years such that alternative valve devices are indicated in this age group.
The overall position of the homograft in relationship to other devices is presented.

to this date I've never seen any study as lengthy or as complete emerging from the USA or anywhere actually. The (once well known ) Edinburgh study of mechanical was of lower count of patients (533 ) and of a shorter duration of follow-up.


The Edinburgh heart valve study of 533 patients, who had their valve implant(s) between 1975 and 1979, now reports comparative clinical outcome for mechanical versus bioprosthetic valves at 20 years.1 The present report supplements a 12 year follow up, published in 1991.2 The original study was prospective and randomised. The study design was modified in January 1977 in those patients randomised to receive a porcine bioprosthesis. Initially, the porcine valve used was the Hancock prosthesis, but, after January 1977, the Carpentier-Edwards valve was used because of its “substantial cost advantage”.
 

mecretired

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I'm so sorry to hear you dealt with that. I am on IV antibiotics (Ceftriaxone) since approximately May 20, but a lot of damage has occurred unfortunately. My infection is Strep B. I also have outpouchings/abscesses along the Aortic Graft. The valve is also damaged 😔
I am so sorry. Your cardiologist should have caught your infection sooner and put you in the hospital for iv antibiotics (just my opinion). Did anyone check your CRP? (C reactive protein) I am so blessed that mine was caught early both times and treated. My aortic valve and graft both survived. My infectious disease doctor said almost all strep infections come from the mouth. I don’t floss anymore—use a water pic instead. Also started using antibacterial mouthwash before brushing.
 

Redone

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From what I know, if I was going to go tissue and a homograft was available, I would probably choose the homograft, although I would want to do a lot more due diligence on it. In our age range tissue valves generally last about 10 years. The new Resilia tissue could do a little better, but it is still unknown. On the other hand, homografts will often last 20 years or more. @pellicle had a homograft and it lasted about 18 years. I believe his valve was still ok at the time, but they had to operate due to an aneurysm, so they replaced the valve at the time as well.

On the infection issue, one thing that I do is always keep a bottle of amoxycillin available. I use it before any dental cleaning, which is standard for those with prosthetic valves, but also in the event that I should get a significant cut or step on a nail, I'll take 2000mg, as a precaution, as I would before any dental appointment. This is something for which the effectiveness is unknown, and likely never will be known, but I see no harm in the practice and it could help mitigate the risk of infection.
This is a great recommendation regarding the Amoxycillian. I just saw a Periodontist and realized the premedication protocol, but I will now take the Amoxycillian when we go away or travel anywhere.

Thank you so much for involving @pellicle in the conversation. I did see he had a Homograft. 18 years is good. I guess I was hoping the mechanical would last me a lifetime, but it appears the risk of infection is greater in mechanical valves. My family and I remember my surgeon saying, it's good you chose a mechanical valve because you're not a candidate for a TAVR. I need to clarify this with him while I consider what is best. I'm still getting fevers, night sweats and don't feel myself.
 

Redone

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I am so sorry. Your cardiologist should have caught your infection sooner and put you in the hospital for iv antibiotics (just my opinion). Did anyone check your CRP? (C reactive protein) I am so blessed that mine was caught early both times and treated. My aortic valve and graft both survived. My infectious disease doctor said almost all strep infections come from the mouth. I don’t floss anymore—use a water pic instead. Also started using antibacterial mouthwash before brushing.
My Cardiologist didn't have anything to do with my situation. I called her as soon as I was getting fevers with huge concerns, asked her to call me back and her secretary called back and she will no longer be my cardiologist.

I got sick on May 14 and was in the hospital on May 17 so this didn't go long. Fevers began on the 14th. I immediately received Broad Spectrum Antibiotics and when they did my cultures I was in pointed antibiotics immediately. I live in Boston so some of the best hospitals in the country. On May 19th I had a TEE done and had absolutely no damage, however by May 24 this ripped through me and caused major damage. There wasn't a delay in my care.
 

Redone

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My Cardiologist didn't have anything to do with my situation. I called her as soon as I was getting fevers with huge concerns, asked her to call me back and her secretary called back and she will no longer be my cardiologist.

I got sick on May 14 and was in the hospital on May 17 so this didn't go long. Fevers began on the 14th. I immediately received Broad Spectrum Antibiotics and when they did my cultures I was in pointed antibiotics immediately. I live in Boston so some of the best hospitals in the country. On May 19th I had a TEE done and had absolutely no damage, however by May 24 this ripped through me and caused major damage. There wasn't a delay in my care.
I was told a waterpik flosser can also do this if bacteria dislodges, however I was told by my Infectious Disease Drs this is not an infection involving teeth, but much more likely a cut. It's a skin thing is what I was told.
 

pellicle

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.... It's a skin thing is what I was told.
well I'd first ask what the bacteria (exact name) was because statistically the oral route is the most common by far, but that of course does not mean only.

I'd seek alternative opinions before getting a redo because one of the fellas I assist in management of his INR with had a blood infection which caused an aneurysm in his liver. I know that on some occasions valve replacement is required if the valve itself is infected, but I understood that such is a lower risk with a mechanical valve. If the abscesses you describe are on the graft they may just be in the endothelium lining that your body has put down over the graft. I would also exactly raise that point (with that wording).

I would enquire if they are looking into a PICC administered treatment for the bacteria and what antibiotics they are using. Both in hospital for a week, and further at home for another two (among other treatments).

1655503169284.png


You may read of my treatment 10 years back here. Of course my infection was different but I was treated with alternating doses of vancomycin and penicillin. I remain now (yes still) on oral antibiotics for suppression ... this seems to be working because I've had no recurrence. I've had this procedure to attempt to determine if its still there or not (because procurement of antibiotics like this is slightly onerous in Australia).

Best Wishes
 
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Chuck C

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Bacteremia From Toothbrushing May Cause Endocarditis


Thanks for that. I note the following from your link:


"Is There Anything Else I Can Do to Lower My Risk for Bacterial Endocarditis?


  • Practice good oral hygiene. Brush your teeth at least twice a day; floss at least once daily; rinse with an antiseptic mouthwash at least once a day. Good oral and dental health is very important for patients at risk for endocarditis."
 

Redone

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well I'd first ask what the bacteria (exact name) was because statistically the oral route is the most common by far, but that of course does not mean only.

I'd seek alternative opinions before getting a redo because one of the fellas I assist in management of his INR with had a blood infection which caused an aneurysm in his liver. I know that on some occasions valve replacement is required if the valve itself is infected, but I understood that such is a lower risk with a mechanical valve. If the abscesses you describe are on the graft they may just be in the endothelium lining that your body has put down over the graft. I would also exactly raise that point (with that wording).

I would enquire if they are looking into a PICC administered treatment for the bacteria and what antibiotics they are using. Both in hospital for a week, and further at home for another two (among other treatments).

View attachment 888601

You may read of my treatment 10 years back here. Of course my infection was different but I was treated with alternating doses of vancomycin and penicillin. I remain now (yes still) on oral antibiotics for suppression ... this seems to be working because I've had no recurrence. I've had this procedure to attempt to determine if its still there or not (because procurement of antibiotics like this is slightly onerous in Australia).

Best Wishes
Hi @pellicle,
I have been on Ceftriaxone IV since May 20. I no longer have a blood infection. Strep B Bactremia, but they tell me the Aortic Graft has outpouchings/abcesses and the Mechanical is very damaged. I am definitely waiting this out even though I still get fevers, night sweats and feel fatigued. I also have an increased heart rate. On May 19 I had a TEE and everything looked good they said. Then I had another one on June 13 and they told me what I mentioned. My Surgeon is Head of Cardiac Surgery at Brigham and Women's Hospital in Boston and he is not pushing me to have surgery and he has consulted with the top Cardiac Surgeon's at Mass General Hospital as well as Echocardiography experts and pretty much everyone he knew with experience in this area. He does believe the valve has enough damage that I will eventually feel severe shortness of breath. The abcesses cannot be penetrated by the Ceftriaxone because they are abcesses. I think I responded to your questions and thank you so much for sharing the experience of the people you've worked with.
 

pellicle

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Hi

I have been on Ceftriaxone IV since May 20. I no longer have a blood infection.

while you are on antibiotics it is impossible to tell if you have a blood infection because the bacteria can not be reliably cultured


Strep B Bactremia

is a classic oral infection, it lives in the GI tract (from mouth to anus) and so unless you were shaving in a strange place a skin entrance is unlikely.

have you had:
  • dental hygiene
  • bleeding gums
  • a sore throat
  • a colonoscopy
prior to the infection?

, but they tell me the Aortic Graft has outpouchings/abcesses and the Mechanical is very damaged.

I suspect some "simplification" has occured in the communication, while the graft may have some (seems pretty unlikely given what its made of) it may exist around the placed where it was attached (to the heart or the artery). The valve itself is pyrolytic carbon, I would be frankly amazed if it has had any damage and I would expect a paper on that be appearing soon. Perhaps I'm wrong (and @nobog can set me straight) but pyrolytic carbon was made for missile tips

... It is used in high temperature applications such as missile nose cones, rocket motors, heat shields, laboratory furnaces, in graphite-reinforced plastic, coating nuclear fuel particles, and in biomedical prostheses.​

I am definitely waiting this out even though I still get fevers, night sweats and feel fatigued. I also have an increased heart rate.

good, and all of this suggests its still present. Have you had a CRP done? what was the number?

On May 19 I had a TEE and everything looked good they said. Then I had another one on June 13 and they told me what I mentioned. My Surgeon is Head of Cardiac Surgery at Brigham and Women's Hospital in Boston and he is not pushing me to have surgery and he has consulted with the top Cardiac Surgeon's at Mass General Hospital as well as Echocardiography experts and pretty much everyone he knew with experience in this area.

good ...

The abcesses cannot be penetrated by the Ceftriaxone because they are abcesses.

this is likely exactly right, however I'd specifically ask about the co-administration of rifampicin and penicillin ... that will be a rough ride for your INR and you may need to bridge with heparin. Mention that combo to them, its worth a shot.


This paper is not on a secure server so Chrome whinges like a 5yo at the supermarket, tell it "yes" and download it. Print or send the PDF to your team.

I won't kid you, it will be a journey ...

some reading



Best Wishes
 
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