Infective Endocarditis

Abstract

The mean age was 50.5 years. Nine (10.5%) of these patients had Prosthetic Valve Endocarditis, the remaining 76 (89.5%) had Native Valve Endocarditis. Twenty-nine percent of patients were NYHA 4 pre-operatively, 15% of patients were haemodynamically unstable requiring inotropic support, 34% were persistently febrile despite antibiotic therapy, and 48% had suffered any embolic event, 20% suffered cerebral emboli. The commonest causative organism in our series was Staphylococcus Aureus (54.1%) with 2.3% of cases being due to MRSA. The second commonest organism isolated was Streptococcus spp. at 21.1%. Operative mortality was 12.9%, of which on-table mortality was 2.2%. Mean follow-up was 56 months (range 1-151). Early recurrence rates (<3 months) were 2.3%. Late recurrence was 7.0%. The pre-operative factors associated with increased mortality were age over 65, inotropic requirement, uncontrolled sepsis and cerebral emboli. We summarise our experience and recommendations for a team approach to the management of infective endocarditis.

Infective endocarditis: a Hunter New England perspective

“…In particular, Dunne et al found a perioperative mortality of 12.9% in a series of 85 surgical patients in Perth, primarily due to ongoing sepsis. 7 In 108 patients undergoing surgical management of IE at the Princess Alexandria Hospital in Brisbane, Nayak et al, found a 30-day mortality of 6.5% in a cohort, where the majority of patients underwent surgery on an emergency basis. 6 More liberal surgical intervention in our cohort might have resulted in better results for the whole cohort at the expense of exemplary surgical results.…”

“…2, 3 Although the large International Collaboration on Endocarditis (ICE) includes Australian data, few articles have reviewed the geographical and associated demographic features of IE within the Australian population. [4][5][6][7] The Hunter New England Local Health District (HNELHD) is a large health district comprising much of the northern and eastern aspect of New South Wales, Australia. It provides care for a population of 840 000 within an area of 132 845 km 2 , with a large tertiary teaching hospital in Newcastle, John Hunter Hospital, at the centre of specialist treatment.…”

Surgical Aspects of Infective Endocarditis with Focus on the Aortic Root

“…If the infection is restricted to the valve tissue, mortality ranges between 10 and 16% (17) . Age over 65 years, preoperative inotropic requirement, uncontrolled sepsis, left side endocarditis and cerebral embolization have been found to be significantly associated with increased mortality (14) . Yankah et al reported a survival rate of 70.4±3.6% in a 17-year follow-up which stabilizes during the follow-up after the fourth year (46) .…”

“…IE is an uncommon disease that, as stated, carries significant morbidity and mortality and has a wide range of presentations (12) . Aortic valve IE frequency ranges between 36% to 50% (13)(14)(15) and IE of the mitral valve is observed between 34% to 42% (14)(15)(16)(17) according to several studies.…”

Twenty-Year Experience in the Diagnosis and Treatment of Infective Endocarditis

“…Average 5-year survival after cured NVA fluctuates among researchers between 75% and 88% [ 10 , 12 , 41 ]. In PVE 5-year survival is 59% to 82% [ 12 , 41 , 43 , 49 ].…”