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1/122. Enterococcus avium endocarditis in an infant with tetralogy of fallot.

    We report a case of infective endocarditis secondary to Enterococcus avium in a 1-year-old infant with tetralogy of fallot and a Blalock-Taussig shunt. To our knowledge, this is the first case of E. avium endocarditis to be reported.
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2/122. endocarditis due to aerococcus urinae: diagnostic tests, fatty acid composition and killing kinetics.

    Two cases of aerococcus urinae endocarditis are reported. The organism is not included in any database of commercial identification systems at this time. Formation of tetrades and positive reactions for leucine arylamidase and beta-glucuronidase pointed strongly to A. urinae. The cellular fatty acid pattern was similar to that of aerococcus viridans, with predominantly C16:0, C18:1 omega 9c and C18:0; the presence of C18:1 omega 7t differentiated our isolates from A. viridans and can support the diagnosis of A. urinae. Furthermore, susceptibility to penicillin but resistance to cotrimoxazole represents a pattern opposite to that of A. viridans. Minimal inhibition concentrations of gentamicin and netilmicin were < or = 64 mg/l but those of tobramycin were > or = 256 mg/l. Penicillin combined with either gentamicin or netilmicin showed distinct synergy in killing kinetics. These combinations seem to be the appropriate regimen to treat A. urinae endocarditis.
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3/122. Septicaemia and endomyocarditis caused by aerococcus urinae.

    aerococcus urinae, an uncommon urinary tract pathogen, was recently shown to cause septicaemia and endocarditis in a few patients in denmark and the netherlands. In austria this is the first report of a fatal course of endomyocarditis by aerococcus urinae, associated with multiple septic infarcts.
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4/122. Three cases of serious infection caused by aerococcus urinae.

    Three cases of serious infection caused by aerococcus urinae are presented: a patient with endocarditis and two patients with soft-tissue infection (phlegmon and balanitis respectively). The literature on aerococcus urinae infections is reviewed and the antibiotic therapy discussed. aerococcus urinae is a pathogen isolated primarily from urine specimens of elderly patients with local or systemic predisposing conditions. Most infections are mild, but serious infections such as endocarditis and septicemia/urosepsis have been described. Penicillin or ampicillin in combination with an aminoglycoside and close monitoring of the patient's clinical status and laboratory results would seem to be the best strategy for management of cases of serious infection.
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5/122. endocarditis caused by abiotrophia species.

    Two cases of endocarditis with nutritionally variant streptococci are presented. Such strains have recently been included in the new genus abiotrophia. A total of 12 additional abiotrophia strains, including the type strains of abiotrophia defectiva and abiotrophia adiacens, were characterized in order to comment on their microbiological characteristics.
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6/122. Bivalve polymicrobial infective endocarditis.

    Polymicrobial infective endocarditis is uncommon, particularly vancomycin-resistant endocarditis and fugal endocarditis. The incidence of these infections is likely to. increase with advances in mediCAl technology and widespread use of central venous catheters. We report a case of bivalve endocarditis in which four organisms were identified, including vancomycin-resistant Enteroocausfaecium and Torulopsis glabrata.
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7/122. osteomyelitis and possible endocarditis secondary to lactococcus garvieae: a first case report.

    Although osteomyelitis is commonly caused by staphylococcal infection, the first case of a lumbar osteomyelitis secondary to lactococcus garvieae is reported. The case was complicated by possible endocarditis of an aortic valve prosthesis.
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8/122. Once-daily aminoglycoside in the treatment of enterococcus faecalis endocarditis: case report and review.

    Once-daily administration of aminoglycosides (ODA) is effective and safe for many indications. By optimizing pharmacodynamic principles, it enhances bactericidal activity and minimizes toxicity. Its use for the treatment of enterococcal infection is controversial, however, and results of in vitro studies and animal models of endocarditis are conflicting. To date, no case reports or clinical trials have examined its utility in human enterococcal endocarditis. A patient with right-sided endocarditis caused by enterococcus faecalis was managed by once-daily gentamicin. Clinical and bacteriologic cures of this patient raise questions as to whether enterococcal endocarditis should be regarded as contraindication to ODA. The clinical utility of ODA in this disease deserves further investigation.
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9/122. Prosthetic biologic valve endocarditis caused by a vancomycin-resistant (vanA) enterococcus faecalis: case report.

    We recently observed (February 1999) a 68-year old patient with endocarditis on a prosthetic biologic valve caused by a vancomycin-resistant enterococcus faecalis. Broth dilution tests showed susceptibility to ampicillin (MIC=0.5 microg/ml), no high resistance to aminoglycosides (MIC for gentamicin <500 microg/ml) and resistance to vancomycin (MIC >256 microg/ml) and teicoplanin (MIC >16 microg/ml). A PCR assay detected vanA gene in this strain. A transthoracic echocardiogram did not show valvular vegetations. A possible endocarditis was diagnosed and the patient received ampicillin for 8 weeks and gentamicin for 6 weeks. The patient remained afebrile after a 4-month follow-up when he underwent surgical replacement of the dysfunctional bioprosthetic valve. mitral valve was sterile on culture, but histology confirmed the diagnosis of previous endocarditis. This is the third case of endocarditis caused by vancomycin-resistant E. faecalis reported to date.
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10/122. Infective endocarditis as a cause of fever in hemodialysis patients.

    Vascular access infections are common in maintenance hemodialysis patients especially with dual lumen cuffed catheter. Persistent infections may lead to valvular seeding and the development of infective endocarditis. Though antibiotic therapy may often suffice, many patients may require surgical correction which carries a high risk of mortality. However appropriate preoperative therapy may considerably reduce the risk of surgery in maintenance hemodialysis patients.
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