Hospital acquired native valve endocarditis: analysis of 22 cases presenting over 11 years

Abstract

Objective-To analyse hospital acquired infective endocarditis cases with respect to age, sex, clinical, laboratory, and echocardiographic features, predisposition, complications, surgery, mortality, and diagnostic criteria. Design-Prospective cohort study. Setting-Teaching hospital. Patients-A series of 200 patients with infective endocarditis presenting over 11 years, 168 with native valve infective endocarditis, of whom 22 acquired this infection in hospital. Results-22 (14%) of the 168 cases of native valve infection were hospital acquired. The most common pathogens were staphylococci (77%). Two thirds of patients had no cardiac predisposition; one third had end stage renal disease. The most common source of infection was vascular access sites (73%). Eleven patients died. In 11 cases, infective endocarditis was proven pathologically (six at necropsy, five during surgery) and analysis of these showed that 45% were classed as probable by the Beth Israel criteria, 73% as definite by the Duke criteria, and 91% as definite by our suggested modifications of the Duke criteria. Figures for the 11 cases not proven pathologically were 27%, 73%, and 91%, respectively. Five of the 22 cases (22%) were rejected by the Beth Israel criteria but none were rejected by the Duke criteria with or without our modifications. Conclusions-Hospital acquired infective endocarditis is diYcult to diagnose. The Duke criteria have improved diagnostic sensitivity and our modifications have improved it further. Mortality is high but has been reduced by surgery. This serious infection could, in many cases, be prevented by improved care of intravascular lines and prompt removal when obviously infected. (Heart 1998;79:442-447)

Infective endocarditis in drug addicts: role of HIV infection and the diagnostic accuracy of Duke criteria

“…At present, no data are available on the validation of Duke criteria in IVDUs with or without HIV infection. As previously reported in non IVDU patients [18][19][20][21][22][23][24][25][26], Duke criteria have a good sensitivity, specificity and diagnostic accuracy in both patients with or without HIV infection in our study, although 23% and 17%, respectively, cases are classified as possible infective endocarditis cases. Moreover, only in HIV infected patients were two cases classified as definite infective endocarditis in patients without infective endocarditis.…”

“…The results of these classifications were matched against the final diagnosis. The final diagnosis was obtained from medical records at discharge and confirmed by 3-month follow-up or anatomo-pathological findings following surgery, autopsy or bacteriologic analysis of a peripheral embolus [18][19][20][21][22][23][24][25][26]. Clinical data were obtained from history, physical examination and medical records at the time of the echocardiography and from clinical records at discharge.…”

Isolated Pulmonary Valve Endocarditis

“…Likely explanations include the low pressure gradient within the right heart, lower prevalence of right-sided congenital malformations, lower oxygen content of venous blood, and differences in the covering and vascularization of the right heart endothelium [1]. Risk factors for the development of PVE include intravenous drug abuse (28%), sepsis (19%), alcoholism (13%), S. aureus infection (44%) [4] and central venous and Swan-Ganz catheters [5,6]. On the contrary, 28% of PVE has no predisposing factors [7].…”

Echocardiography for the diagnosis of Staphylococcus aureus infective endocarditis

“…This schema, known as the Duke criteria, has been found to be more sensitive than the Beth Israel criteria in identifying patients with IE. For example, of the 479 histopathologically confirmed cases reported in 13 studies to date, the Beth Israel criteria correctly identified 53.7% as having probable endocarditis ( [59][60][61][62]. Interestingly, the Beth Israel criteria would have rejected 20.7% of these histopathologically confirmed cases of endocarditis, while the Duke criteria would have rejected <1%.…”