Hyperbaric Oxygen Treatment in Humans With Gram Positive Cocci Endocarditis
Status:
Recruiting
Trial end date:
2021-12-31
Target enrollment:
Participant gender:
Summary
Infectious endocarditis (IE) is defined as an infection anywhere on the endocardium, most
often localised to the cardiac valves. It is an infection with an increasing incidence and in
Denmark with 6-700 new cases annually. Approximately 45% of the patients must undergo cardiac
surgery with replacement of infected cardiac valves by prosthetic valves.
Recently, the formation of biofilms infections has drawn attention with respect to the
effects of hyperbaric re-oxygenation of stricken tissues as anaerobic bacterial metabolism
with low levels of activity within the biofilm environment, may be responsible for the
development of antimicrobial resistance. Polymorphonuclear leukocytes (PMNs) consume
available oxygen in the conversion of oxygen to ROS and in the formation of reactive nitrogen
species (RNS) by inducible nitric oxide (iNOS) as PMN's are activated by bacteria.
In pre-clinical context the effect of hyperbaric oxygen treatment (HBOT) in re-oxygenating
biofilm related infections have been demonstrated in infected lungs with Pseudomonas
aeruginosa and staphylococcus aureus endocarditis.
Adjunctive HBOT has never been offered to patients with IE. However, HBOT may be associated
with reduced compliance and side effects, such as equalisation problems of ears and sinuses
and confinement anxiety, and the treatment is organizational challenging. On this basis the
investigators suggest an initial feasibility study as the basis for a later and larger scaled
randomized controlled trial of HBOT in patients with IE.