Bacterial endocarditis at Blegdamshospitalet in Copenhagen 1944-1973

The clinical pattern of 34 cases ob subacute bacterial endocarditis (SBE) and 46 cases of acute bacterial endocarditis (ABE) is outlined. In the SBE group the mortality was 9% and the incidence of major complications during the treatment period was 15% for cerebrovascular accidents, 9% for other systemic or pulmonary emboli and 9% for congestive heart failure indicating valvular damage. In 31 bacteriologically proven cases growth was obtained in 68% of all blood cultures, and in 94% of the cases at least one positive culture was among the first 5 ones drawn. In the ABE group the overall mortality was 72% and mortality for cases occurring after 1960 was 58%. Major factors contributing to death were valvular incompetence, uncontrolled infection and embolisation. In order to reduce major complications and resulting disability in SBE it is suggested that treatment be started on clinical suspicion as soon as 5 blood cultures have been drawn over a period of 48 hours. Attempts to reduce mortality in ABE may include cardiac surgery in the acute phase.