Treatment of infective endocarditis: a 10-year comparative analysis.

Abstract

The results of surgical and non-surgical treatment of active infective endocarditis in 182 patients over a 10-year period were analyzed. Heart failure, annular and myocardial abscesses, heart block, and coronary embolism, seen most frequently with staphylococcal and fungal endocarditis, were the primary causes of death in both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). In NVE, surgery significantly improved the survival in patients with moderate or severe heart failure (P less than 0.05) and in all patients with staphylococcal endocarditis (P less than 0.03). In PVE, surgery significantly influenced survival in patients with moderate or severe heart failure (P less than 0.05) and in the entire group with late PVE (P less than 0.01). Early surgery is recommended for patients with native valve endocarditis and moderate or severe heart failure; those patients with staphylococcal NVE, regardless of hemodynamic state, should undergo early valve replacement. Early surgery is recommended for PVE patients with moderate or severe heart failure. We also recommend early valve replacement for early and late staphylococcal PVE.

Surgery for Infective Endocarditis

“…14,15 Studies from the 1970s and 1980s compared medical and surgical treatment of congestive heart failure complicating IE and demonstrated a consistent reduction in mortality after surgery, from a range of 56% to 86% to a range of 11% to 35%. 41,42 Although no correction was made for underlying comorbidity, similar results were reported in 2 more recent Scandinavian studies, 26,43 in which the best results were obtained with early intervention within 1 week of presentation. Early valve surgery in patients with congestive heart failure is associated with a substantial reduction in mortality compared with medical therapy alone, 5,15,21,22,44 and this scenario is now the most common and clearest indication for surgery, being present in 72% of patients who underwent early intervention in a recent European series.…”

Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography

“…The following clinical and biological parameters were prospectively collected at diagnosis and during hospitalization: age, sex, fever (temperature Ͼ38°C), previous heart disease, intravenous drug abuse, HIV infection, diabetes, history of cancer, comorbidity, 24 moderate or severe congestive heart failure (CHF) diagnosed as previously described, 25 and serum creatinine Ͼ2 mg/dL. Early surgery was defined as valve replacement or repair performed during the course of antibiotic therapy.…”

Update on clinical significance of coagulase-negative staphylococci

“…By the 1980s, the range of infections believed to be caused by CNS, and especially by S. epidermidis, was quite wide and included bacteremia (24,207); native valve endocarditis (NVE) and prosthetic valve endocarditis (7,11,260); osteomyelitis (204,233); pyoarthritis (204); peritonitis during continuous ambulatory dialysis (182,267); mediastinitis (34); prostatitis (45,310); infections of permanent pacemakers (48), vascular grafts and intravascular catheters (242,243), cerebrospinal fluid shunts (100), and prosthetic joints and a variety of orthopedic devices (38,54,218); and UTIs (148,156,192). The CNS species S. saprophyticus was often regarded as a more important opportunistic pathogen than S. epidermidis in human UTIs, especially in young, sexually active females (3,206,307).…”