Bacterial endocarditis 1956-1965: analysis of clinical features and treatment in relation to prognosis and mortality.

Shinebourne, E A; Cripps, C.; Hayward, Graham; Shooter, R. A.

doi:10.1136/hrt.31.5.536

Cited by 55 publications

(5 citation statements)

References 16 publications

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“…The changing microbial aetiology of the disease has been noted by many workers (Rabinovich et al, 1965;Lerner and Weinstein, 1966;Shinebourne et al, 1969;Finland and Barnes, 1970) but streptococci remain the largest single group of organisms associated with bacterial, endocarditis. The mouth has been considered to be the principal portal of entry of streptococci into the bloodstream (Horder, 1909;Okell and Elliott, 1935;Bender and Pressman, 1945;McEntegart and Porterfield, 1949), and Korn and Schaffer (1962) have suggested that the gingival crevice is the most likely source.…”

Section: Introductionmentioning

confidence: 99%

Streptococci isolated from the bloodstream and gingival crevice of man

Crawford

Russell

1983

Journal of Medical Microbiology

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SUMMARY. One hundred and twenty six strains of streptococci isolated from the bloodstreams of 123 hospital in-patients-55 with endocarditis-and 255 strains isolated from the gingival crevices of 66 volunteers were characterised. Species isolated were Streptococcus mitior, S. sanguis, undifferentiated viridans streptococci, S. salivarius, S. milleri, S. mutans, S. bovis and S. faecalis. There was no significant difference between the distribution of species in blood and in the gingival crevice. S. mitior and S . sanguis were found less frequently in blood than their presence in the gingival crevice would have suggested, whereas S. milleri was found more frequently. This may indicate that S. milleri is more invasive or that it enters the bloodstream from sources other than the gingival crevice.

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Section: Introductionmentioning

confidence: 99%

Streptococci isolated from the bloodstream and gingival crevice of man

Crawford

Russell

1983

Journal of Medical Microbiology

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“…The fracture may have been unrelated or the infective endocarditis may have been caused in some way by the anaesthetic, but endocarditis has been reported after closed fractures. 4 In two patients the endocarditis occurred during pregnancy and in another it followed parturition. This association has been noted by others.…”

mentioning

confidence: 98%

The microbiology and pathogenesis of infective endocarditis.

Bayliss¹,

Clarke²,

Oakley³

et al. 1983

Heart

254

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suMMARY Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported. The mean age of patients was 51*6 years and there was a greater proportion of males (2:1). Of the 544 episodes 347 (63%) were due to streptococci, 19%o to staphylococci, and 14%o to bowel organisms. A wide variety of other organisms were responsible for a few cases, and 10% were culture negative. In 60(% the portal of entry of the infection could not be ascertained: 19% were probably of dental origin: 16% arose from the alimentary, genitourinary, or respiratory tracts or from the skin or in association with drug addiction, fractures, or pregnancy; the remaining 5% were related to cardiac or other vascular surgery, cardiac catheterisation, haemodialysis, or other procedures involving the blood stream. Seventy-four (14%) of the 541 patients (mean age 59*0 years) died; the mortality was 30% in staphylococcal cases, 14%o in infections due to bowel organisms, and 6% in other streptococcal infections. One hundred and seventy-one (32%) of the patients appeared to have had normal hearts before the onset of illness and another 59 (1Y1%) had cardiac lesions not previously recognised. The aortic valve was the most common site of infection. Ninety (17%) of the patients had prosthetic valves or had undergone other cardiac surgery while 34 (6%) had had a previous episode of infective endocarditis. Nine (1-6%) episodes were not diagnosed until necropsy or operation and 34 (6.3%) required urgent valve replacement.Since Horder's classic description of infective endocarditis nearly three quarters of a century ago' antibiotics and valve replacement have transformed the then hopeless prognosis. Studies have shown a changing pattern of the disease,2-9 but despite the enormous advances in microbiology, particularly the speciation of the streptococci, the source of the infection is often not known and the proportion of cases related to dental procedures or sepsis is probably smaller than previously believed. A recent study of 541 patients with infective endocarditis with particular reference to dental prophylaxis has confirmed this.10 The number of patients studied was so large compared with previous reports that we considered it appropriate to present some of the other findings in respect of microbiology and pathogenesis.

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“…Since the introduction of antibacterial therapy the mortality from bacterial endocarditis has declined significantly, although still in the order of 2 0 4 0 % (8, 15, 16,18,19). In recent years septicaemia has been replaced by intractable congestive heart failure as the major cause of death (15-17).…”

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confidence: 99%

Surgical Treatment of Bacterial Endocarditis

Anker¹,

Thaulow²,

Forfang³

et al. 1981

Journal of Internal Medicine

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ABSTRACT. Prosthetic valve implantation was performed in 36 patients with bacterial endocarditis. Thirty‐two of them were in functional class III or IV (NYHA). The early mortality rate was 16.7%. In six patients perivalvular fistulas occurred and were of haemodynamic significance in three of them. At follow‐up after 44 months on average, the clinical condition was excellent (functional class I or II) in 20 of the 26 survivors. The results encourage an active attitude towards surgical intervention in patients with valvular insufficiency due to bacterial endocarditis.

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Bacterial endocarditis 1956-1965: analysis of clinical features and treatment in relation to prognosis and mortality.

Cited by 55 publications

References 16 publications

Streptococci isolated from the bloodstream and gingival crevice of man

Streptococci isolated from the bloodstream and gingival crevice of man

The microbiology and pathogenesis of infective endocarditis.

Surgical Treatment of Bacterial Endocarditis

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