Carlos Falces

• MD, PhD
• Consultant at Hospital Clínic de Barcelona

Background Traditional treatment of methicillin-susceptible Staphylococcus aureus (MSSA) native valve endocarditis is based on cloxacillin/cefazolin monotherapy. Antibiotics with high activity against MSSA such as ceftaroline and daptomycin have been marketed last years, but there are no clinical trials evaluating them as monotherapy or combination...

The POET trial demonstrated that moving from intravenous to oral antibiotics in stable patients with left-sided infective endocarditis (IE) was noninferior to fully parenteral treatment. However, it did not compare outpatient strategies. The OraPAT-IE GAMES trial is a noninferiority, multicenter, randomized, open-label study aimed to compare partia...

(1) Background: Alternative antibiotics are needed to treat infective endocarditis (IE) caused by non-faecalis/non-faecium enterococci; we aimed to assess the in vitro activity of ampicillin plus ceftriaxone (AMP + CTR) against these enterococci and to describe its clinical efficacy in IE cases. (2) Methods: Time–kill curves with standard (ISI) and...

Introduction Phase II Cardiac rehabilitation programs (CRP) decrease morbidity and mortality after acute coronary syndromes (ACS). However, in a high percentage of patients, this beneficial effect is reduced if the intervention is stopped. Besides, presence-based programs are complex and expensive, and telematic approach could be equally effective...

Background and Aims It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk p...

Background Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied. Objectives To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods Prospective multicenter cohort incl...

Background: We aimed to describe infective endocarditis cases from noncardiac surgery centers, as current knowledge on infective endocarditis is derived mostly from cardiac surgery hospitals. Methods: An observational retrospective study (2009-2018) was conducted in 9 noncardiac surgery hospitals in Central Catalonia. All adult patients diagnose...

Introduction and objectives: The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/...

IntroductionInfective endocarditis (IE) has undergone important changes in its epidemiology worldwide.Methods The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century.ResultsIE cases from 13 European countries were included. Two pe...

BACKGROUND Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underutilized. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and women. OBJECTIVE To deve...

Background Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients. Objective T...

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients d...

Background Studies investigating cardiac implantable electronic device infective endocarditis (CIED-IE) epidemiological changes and prognosis over long periods of time are lacking. Methods Retrospective single cardiovascular surgery center cohort study of definite CIED-IE episodes between 1981–2020. A comparative analysis of two periods (1981–2000...

Background/Introduction Congestive heart failure (CHF) is a strong prognostic factor in infective endocarditis (IE), but data are lacking regarding its current management and outcome in Europe. Purpose To evaluate the current management and survival of patients with left-sided IE complicated by CHF. Methods We used data of the ESC-EORP EURO-ENDO...

In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological co...

Introduction Hyperglycemia is very common in hospitalized patients and is associated with worse clinical outcomes. Aims We implemented a clinical and educational program to improve the overall glycemic control during hospital admission, and, in patients with HbA1c > 8%, to improve their metabolic control after hospital admission. Methods Non-crit...

Background Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences...

Objectives: The role of colorectal neoplasms (CRN) as a common potential source of recurrent Streptococcus gallolyticus subsp. gallolyticus (SGG) and Enterococcus faecalis (EF) endocarditis remains unstudied. We aimed to investigate what proportion of episodes of recurrent endocarditis are caused by a succession of SGG and EF, or vice versa, and t...

Background Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multi-centre registry. Methods The EurObservation...

Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valv...

Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated...

Resumen Introducción La hiperglucemia es altamente prevalente en pacientes hospitalizados y se asocia con peores resultados clínicos. Objetivos Implementar un programa hospitalario de atención y educación terapéutica para mejorar el control glucémico medio y en pacientes ingresados con hemoglobina glucosilada (HbA1c) > 8% y mejorar su control met...

Abiotrophia and Granulicatella species are fastidious organisms, representing around 1%–3% of infective endocarditis (IE). Little is known about the optimal antibiotic treatment of these species, and daptomycin has been suggested as a therapeutic option. We describe the antimicrobial profile in Abiotrophia and Granulicatella IE isolates, investigat...

Objectives To investigate if the addition of cloxacillin to vancomycin enhances the activity of both monotherapies for treating MSSA and MRSA experimental endocarditis (EE) in rabbits. Methods Vancomycin plus cloxacillin was compared with the respective monotherapies and daptomycin. In vitro time–kill studies were performed using standard (105 cfu...

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity....

Background Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods Prospective cohort study (...

Background Little is known about the characteristics and impact of septic shock (SS) on the outcomes of infective endocarditis (IE). We aimed to investigate the characteristics and outcomes of patients with IE presenting with SS and to compare them to those of IE patients with sepsis (Se) and those with neither Se nor SS (no-Se-SS). Methods Prospe...

Mycobacterium wolinskyi is a rapid-growth non-tuberculous mycobacterium. Twenty-one cases of M. wolinskyi infection have been described so far, more than half as cardiovascular or postoperative cardiothoracic infections. We report the case of a patient with a cardiovascular implantable electronic device infected by M. wolinskyi, successfully treate...

Background: Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. We aimed to investigate the characteristics and outcomes of endocarditis patients presenting with acute heart failure (AHF), particularly of those developing CS. Methods: Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic...

Objective To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods Retrospective analysis of data from a prospective multicenter study in...

Background: In vitro and in vivo activity of daptomycin alone or plus either cloxacillin or fosfomycin compared with cloxacillin alone and cloxacillin plus gentamicin were evaluated in a rabbit model of MSSA experimental endocarditis (EE). Methods: Five MSSA strains were used in the in vitro time-kill studies at standard (105-106 cfu/mL) and hig...

Objectives Although the benefits of surgery in infective endocarditis (IE) are clear, an unneglectable proportion of patients do not undergo surgery despite clear operative indication. Outcomes of these patients are poorly reported. With this study, we aim to analyze patient profiles, indication for surgery, decision‐making, and outcomes of patient...

The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an...

Introduction: Higher vancomycin MICs have been associated with more complicated courses and higher mortality rates in S. aureus bacteremia and endocarditis (IE). The aim of this study was to investigate whether the strains belonging to the cohort of 93 patients from a previously published study in which strains with vancomycin-MIC≥1.5 μg/ml present...

BACKGROUND Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS This was a post hoc analysis of a prospectively collected cohort of pa...

Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-cen...

Introduction: Optimal treatment options remain unknown for infective endocarditis (IE) caused by penicillin (PEN)-resistant viridans group streptococcal (VGS) strains. The aims of this study were to report two cases of highly-PEN-resistant-VGS-IE, perform a literature review, and to evaluate various antibiotic combinations in vitro and in vivo . Ma...

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratifie...

The three human coronaviruses that emerged (E-CoVs) in the last two decades, i.e. severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pose a serious threat to global health. They share some characteristics, including the...

Introduction and objectives: The resting 12-lead electrocardiogram (ECG) has been used in the evaluation of young asymptomatic individuals to detect pre-existing heart disease, but systematic ECG use is controversial and there are no data on this population in our environment. We aimed to determine the prevalence and spectrum of electrocardiograph...

Objectives The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. Methods This is a cost-uti...

Background: Classification of left ventricular diastolic function (LVDF) by echocardiography is controversial. The aim of this study was to evaluate the impact of the last 2016 recommendations for LVDF evaluation on brain natriuretic peptide (BNP) levels, proportion of final heart failure (HF) diagnosis, and cardiovascular outcomes. Methods: Out...

Background: Pericardial effusion is a frequent finding in the setting of infective endocarditis. Limited data exists on clinical characteristics and outcomes in this group of patients. We aimed to determine the associated factors, clinical characteristics, and outcomes of patients who had pericardial effusion and native valve infective endocarditi...

Resumen Introducción y objetivos El electrocardiograma (ECG) se ha propuesto como prueba de cribado de cardiopatías para jóvenes asintomáticos, pero hay controversia sobre su uso sistemático y no se dispone de datos sobre esta población en nuestro medio. El objetivo del presente estudio es determinar la prevalencia y la variedad de hallazgos elect...

Objectives: The study aimed to describe the epidemiology, microbiological and clinical features of a population sample of 17 patients with HACEK-IE and to compare them with matched control patients with IE caused by Viridans group Streptococci (VGS-IE). Methods: Description of definite (14; 82.2%) and possible (3; 17.6%) HACEK-IE included in the...

The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) has a relatively low mortality rate, compared to the diseases caused by other coronaviruses. Notwithstanding this, a notable proportion of patients develop severe forms of the disease, and the prevalence of COVID-19 is high worldwide....

We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies using standard (10⁶) and high (10⁸) inocula. Combined therapy w...

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. Objectives: This study sought to describe the clinical and microbiological features of IE in patients with...

This study aims to investigate whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies at standard (105) and high (108) inocula. Combin...

[This corrects the article DOI: 10.1371/journal.pone.0192387.].

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-fou...

Background International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no available studies assessing its suitability f...

Dataset with demographic, microbiological, clinical, and therapeutic information on the 78 cases included in the study. (SAV)

Background: Heart failure with preserved ejection fraction (HFPEF) is the most frequent form of heart failure in ambulatory patients with new-onset symptoms. We previously showed that lung function abnormalities are highly prevalent in HFPEF patients. In this observational, longitudinal study, we tested the hypothesis that the presence of airflow...

Intravenous thrombolysis is contraindicated in acute ischemic stroke secondary to infective endocarditis. We report our initial experience of six cases with proximal vessel occlusion treated with mechanical thrombectomy. It was safe (no bleeding) and effective (significant, early neurological improvement) and might therefore be useful in this clini...

Background: Infective endocarditis (IE) caused by Abiotrophia (ABI) and Granulicatella (GRA) is poorly studied. This work aims to describe and compare the main features of ABI and GRA IE. Methods: We performed a retrospective study of 12 IE institutional cases of GRA or ABI and of 64 cases published in the literature (overall, 38 ABI and 38 GRA...

The aim of this in vivo study was to compare the efficacy of vancomycin at standard doses (VAN-SD) to that of VAN at adjusted doses (VAN-AD) in achieving a VAN AUC/MIC?400 against three MRSA strains with different microdilution VAN MICs in an experimental endocarditis model. The valve vegetation bacterial counts after 48hours of VAN therapy were co...

Purpose of the review: Infective endocarditis (IE) is a relatively infrequent infectious disease. It does, however, causes serious morbidity, and its mortality rate has remained unchanged at approximately 25%. Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very sca...

Resumen Introducción y objetivos Así como la asociación entre la endocarditis infecciosa por Streptococcus bovis y la neoplasia colorrectal (NCR) es bien conocida, no se han publicado hasta la fecha resultados de estudios que valoren dicha asociación con la endocarditis infecciosa por Enterococcus faecalis (EIEF). El objetivo de este estudio es de...

Background: Previous studies showed development of daptomycin non-susceptibility (DNS: MIC >4 mg/L) in Enterococcus faecalis infections. However, no studies have assessed the efficacy of the combination of daptomycin/ampicillin against E. faecalis strains developing DNS in the experimental endocarditis (EE) model. Objectives: To assess the in vi...

Objectives: A recent study showed a poorer prognosis in left-sided MSSA endocarditis treated with cloxacillin when the vancomycin MIC was ≥1.5 mg/L. We aimed to validate these results using the International Collaboration on Endocarditis cohort and to analyze whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5...

The incidence of atherosclerotic diseases has increased in Europe due in part to the population's sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact in the healthcare system of...

Introduction and objectives: The association between Streptococcus bovis group infective endocarditis and colorectal neoplasm (CRN) is well-known. However, no studies have assessed the association between Enterococcus faecalis infective endocarditis (EFIE) and CRN. We aimed to determine whether the prevalence of CRN is higher in patients with EFIE...

Background and objective: The incidence of atherosclerotic diseases has increased in Europe due in part to the population's sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact...

Background: Left atrial (LA) dysfunction has been related to symptom onset in patients with heart failure (HF). However, the potential prognostic role of LA function has been scarcely studied in outpatients with new-onset HF symptoms. Methods: Consecutive outpatients with suspected HF onset evaluated at a one-stop clinic were screened. HF diagno...

Methods: A prospective study with 80 consecutive patients with suspected IE and ICED infection (65 men and 15 women with a mean age of 68±13 years old) between June 2013 and May 2015 was performed in our hospital. The inclusion criteria was clinically suspected IE and ICED infection at the following locations: native valve (NV) (n = 21), PV (n = 2...

The urgent need of effective therapies for MRSA infective endocarditis (IE) is cause of concern. We aimed to ascertain the in vitro and in vivo activity of the old antibiotic fosfomycin combined with different beta-lactams against methicillin-resistant (MRSA) and glycopeptide-intermediate resistant (GISA) S. aureus strains. Time-kill tests with ten...

Amat-Santos et al1 assessed the incidence, clinical features, and outcomes of infective endocarditis (IE) during the first year after transcatheter aortic valve replacement (TAVR). The incidence of IE reported was lower than in the largest recent studies, including that of our group.2,3 Also significant was the lower rate of periannular complicati...

The role of high-intensity exercise and other emerging risk factors in lone atrial fibrillation (Ln-AF) epidemiology is still under debate. The aim of this study was to analyse the contribution of each of the emerging risk factors and the impact of physical activity dose in patients with Ln-AF. Patients with Ln-AF and age- and sex-matched healthy c...