Staphylococcal Endocarditis

Abstract

Infections due to Micrococcus pyogenes (Staphylococcus) are becoming increasingly difficult to manage because of the remarkable tendency of members of this genus to develop resistance to penicillin and other antibiotics. Although the individual strains vary considerably in this respect, the majority of staphylococci isolated from hospital patients and personnel in several clinics are currently being found to be penicillin-resistant.* During the past few years we have followed the course of several patients with staphylococcal endocarditis. Of interest is a comparison of the results of therapy in this group with a much larger series obtained by reviewing the records of all such cases at the Johns Hopkins Hospital for the past 20 years. This series was divided arbitrarily into three periods. The first was 1933-1943, a time in which no well-established antibiotic treatment was available, although penicillin was used in a few of the later cases in doses which we now realize were inadequate. The second period, extending from 1944 through 1948, was expected to represent the time during which effective doses of penicillin were used with most strains of staphylococci still sensitive to that agent.f The third period includes the five years from 1949 through 1953. Of 12 cases in this group, 42% of the organisms were penicillinresistant. One purpose of this study is to evaluate the special problems related to that complication. During the 20-year period 1933 through 1953, there were 104 instances of staphylococcal bacteremia, excluding cases in which the bacteremia represented a terminal epi¬ sode in patients who were near death from some unrelated disease. The present report is concerned with an analysis of the 38 pa¬ tients in this group who we felt fulfilled the criteria for the diagnosis of staphylococcal endocarditis. Here the question of definition becomes somewhat difficult, and so we have established two categories. The first category includes 25 cases of endocarditis proved by autopsy, and the second includes 13 cases in which the diagnosis was "clinically cer¬ tain." In the prepenicillin era nearly all patients with staphylococcal endocarditis died, but since then the infection has been cured often enough to bring up the question of whether or not the diagnosis is justified in patients who survive. The cases which qualified as clinically certain instances of acute endocarditis were those with repeatedly positive blood cultures in the presence of definite signs of some type of valvular dis¬ ease, which may or may not have been present with the onset of the infection. Sig¬ nificant changes in the character of the mur¬ murs while under observation or embolie phenomena of more than transient nature involving the skin, brain, lungs, kidneys, or other peripheral arteries were taken as further evidence in favor of endocarditis. Of these 38 cases, 22 fell into the 10 years of Period I, 3 in the 5 years of Period II, and 13 in the 5 years of Period III. The striking fall in incidence in the second period * References 1-4.t...

The Problem of Staphylococcal Infection

“…In several of the recent reports-for example, one by Barber and Burston (1955) from London a few months ago-the number and the form of staphylococcal disease seen in patients on admission to the hospital are listed, but no comment is made concerning how the material compares with the experience in years past. Fisher et al (1955) reported that in the twenty-year period.…”

Multiple Pulmonary Artery Aneurysms

“…Although the course of erythromycin was continued for 19 days after the temperature had returned to normal, the organism is notoriously resistant, and Fisher, Wagner, and Ross (1955) recommend that treatment should be continued for six to seven weeks. Possibly, however, a new infection of the blood occurred, as the patient had had further boils before the onset of symptoms of the second illness.…”

Bacterial Endocarditis

“…Temperature chart and relevant data in a patient with aortic incompetence in whom the infection was cured, but rupture of an aortic valve cusp led to death from congestive Temperature chart and relevant data in a patient with ventricular septal defect in whom the infection was cured without added cardiac damage.Acute bacterial endocarditis.-The mortality stfll remains extremely high Fisher et aL (1955). andShubin et al (1958), reporting on cases of staphylococcal endocarditis, quoted a mortality of from 50-75 %, while Morgan and Bland (I959) noted that 85 % of 53 patients with acute bacterial endocarditis died.…”