Infective endocarditis in the 1980s: Experience at a heart hospital

Abstract

Summary: Three hundred episodes of infective endocarditis (IE) in 287 patients were studied from October 1978 to August 1986. The patients were in the age range of 0.2-78 (mean 30.76k 16.06) years; 185 (68%) occurred in male patients. The etiologic agents were: Streptococci viriduns group (93), enterococci (2 l), streptococci D group, nonenterococci (19), other streptococci (14), Staphylococcus aureus (59), Staphylococcus epidermidis (14), gram-negative bacteria (16), other gram-positive bacteria (16), fungi (4). Etiologic agents were not isolated in 52 (negative cultures). Valvular heart diseases occurred in 23 1 episodes, congenital heart diseases in 37, other heart diseases in 6. Sixty-nine occurred in patients with prosthetic heart valves. In 69 there was no previous heart disease. Surgical treatment was performed in 102 episodes (37 with prosthetic valve IE and 65 with native valve IE); 22 patients (21 %) died, 12 with prosthetic valve and 10 with native valve IE. The in-hospital mortality (medical and surgical patients) was 26 % (78 patients). Long-term follow-up of 206 patients up to 7.1 (mean 2.13 k 1.68) years revealed that 26 patients died. Thus, IE remains a disease with high mortality and is fatal to a third of the patients, in spite of the progress in therapeutic methods. Its morbidity and mortality continues beyond the microbiological cure.

A study of infectious endocarditis in Ribeirão Preto, SP - Brazil. Analysis of cases occurring between 1992 and 1997

“…Gramnegative rods caused 5.9% of the IE cases, while fungal endocarditis caused by Histoplasma capsulatum occurred in one case. These results differ from those of others 14 in which S. viridans predominated in about 31% of the episodes, S. aureus staying in second place with about 20%. IE by gram-negative rods and fungi was of low frequency 6 , similar to that observed in our study.…”

“…Its most frequent cause was septicemia (38.3%) accompanied by heart failure in 6.8% or embolism in 13.6% (Table VI). This mortality rate was higher than that observed in the São Paulo study 11 (27.1%) and much higher than that reported in recent studies from other countries (19-23%) 2,3,14 . Septicemia was the predominant cause of death, corroborating other observations 11 , but differing from those 3 in which the major cause of death was heart failure.…”

“…The site of the endocarditic attack in our patients was predominantly the mitral valve (30.5%), followed by the tricuspid and the aortic valves in 16.6% and 15.5% of the cases, respectively. Our results show an increased effect on the tricuspid valve compared with those of others 14 , who observed the mitral valve to be affected in 40% of the cases, aortic in 18% and tricuspid in 10.7%. The increased attack of the tricuspid valve is due to acute IE by S. aureus in patients using intravenous drugs, corresponding to 19.8% of all individuals studied.…”

“…Surgical treatment was more frequently used by us than by the Swedish workers (15%) 2 . It was however less frequent than in the Brazilian study of the 1980s (34%) 14 and the Canadian study 12 with 33% of the patients, respectively. In both the Brazilian and Canadian studies, the predominant indication for surgery was serious heart failure.…”

“…The analysis of the 180 episodes of IE of this study showed differences in the cause and site of cardiac attack, compared with results of studies performed in the 1980s 11,14 in Brazil. Such differences also appeared in results published in recent years in other countries, especially regarding intravenous drug users 3,11 .…”