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[Infectious endocarditis. A study of 50 patients in a non-university hospital]
G Cellarier1, P Laurent, Ch Jégo
1Service de cardiologie, HIA Sainte-Anne, boulevard Sainte-Anne, 83800 Toulon Naval. gcellarier@wanadoo.fr
Insights
Infectious endocarditis (IE) in 50 patients revealed streptococcus and staphylococcus as common causes. Early diagnosis and multidisciplinary care are crucial for managing IE complications and improving survival rates.
Area of Science:
- Cardiology
- Infectious Diseases
- Internal Medicine
Context:
- Presents findings from a single-center study of 50 consecutive patients admitted for infective endocarditis (IE) between 1992 and 2001.
- Highlights a median diagnostic interval of 57 days and common underlying valvular heart disease in 52% of cases.
Purpose:
- To analyze the clinical characteristics, causative organisms, management, and outcomes of infective endocarditis in a peripheral hospital setting.
- To identify prognostic factors influencing mortality and emphasize the need for effective management strategies.
Summary:
- The study involved 50 patients (average age 66 years, 36 men) with IE, predominantly caused by streptococci (60%) and staphylococci (22%).
- Commonly affected valves included mitral (21 cases) and aortic (19 cases). Surgery was indicated in 50% of patients.
- Mortality was 34%, with 24% attributed to IE, often due to infectious or hemodynamic complications. Key prognostic factors included age >70, delayed antibiotic therapy, large vegetations, embolism, and renal failure.
Impact:
- Findings underscore the significant mortality associated with IE and the importance of early diagnosis and intervention.
- Emphasizes the critical role of a multidisciplinary approach and strict prophylaxis in managing infective endocarditis.
- Data comparable to larger series suggest the generalizability of these findings for IE patient care.
Abstract:
The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.