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Aetiology and outcome in 53 cases of native valve staphylococcal endocarditis
Abstract:
Within the last 30 years the profile of infective endocarditis has altered considerably with regard to microbiological causation, clinical features, and natural history. A contributory factor has undoubtedly been the development of potent antibiotics and their sometimes indiscriminate use. The increase in intravenous drug abuse in urban centres, the use of immunosuppressive agents, and the use of prosthetic heart valves have also all contributed. Although cardiac surgery in the uninfected heart provides a perfect environment for infective endocarditis, the improved design of prosthetic valves and the enhanced long-term survival and decreased immediate operative risk, means that surgery is viewed as the best option in many cases. In a series of 53 cases of staphylococcal endocarditis from a national endocarditis survey, those risk factors which influenced outcome were analysed. Thirty out of 53 patients had predisposing heart disease. Mortality was 39.6%. Statistical analysis revealed that attributable mortality was significantly associated with skin infection, systemic embolisation, and inappropriate therapy. Interestingly, surgical treatment was associated with better outcome.
Insights
Infective endocarditis profiles have changed due to antibiotics and IV drug use. Staphylococcal endocarditis shows high mortality, with skin infection and embolisation worsening outcomes, while surgery improves them.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- The epidemiology of infective endocarditis has evolved over 30 years.
- Factors influencing changes include antibiotic use, intravenous drug abuse, immunosuppression, and prosthetic heart valves.
- Despite risks, cardiac surgery is increasingly considered for prosthetic valve endocarditis.
Purpose of the Study:
- To analyze risk factors influencing outcomes in staphylococcal endocarditis.
- To identify predictors of mortality in infective endocarditis patients.
Main Methods:
- Retrospective analysis of 53 staphylococcal endocarditis cases from a national survey.
- Statistical analysis to determine factors associated with mortality.
Main Results:
- 39.6% mortality rate observed in the cohort.
- Predisposing heart disease present in 30 out of 53 patients.
- Significant associations found between mortality and skin infection, systemic embolisation, and inappropriate therapy.
Conclusions:
- Staphylococcal endocarditis carries a significant mortality risk.
- Early identification and management of risk factors like skin infection and embolisation are crucial.
- Surgical intervention appears to be associated with improved outcomes in staphylococcal endocarditis.