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[Infective endocarditis: analysis of 300 episodes]
A J Mansur1, M Grinberg, S D Gallucci
1Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo.
Purpose:
Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE).
Patients And Methods:
300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males.
Results:
a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococcus) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non group D streptococcus) and 62% (gram-positive bacteria other than streptococci ans staphylococci); in relation to the underlying with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves.
Conclusion:
The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the cardiac status before the IE.
Insights
Infective endocarditis (IE) has a high mortality rate despite modern treatments. Patient outcomes for IE are significantly influenced by pre-existing cardiac conditions and the specific causative agents.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Context:
- Infective endocarditis (IE) is a serious infection affecting the heart's inner lining.
- Understanding the clinical features, causative agents, and treatment outcomes is crucial for managing IE.
- This study analyzes a large cohort of IE episodes to provide comprehensive insights.
Purpose:
- To investigate the clinical characteristics of infective endocarditis (IE).
- To identify the primary etiologic agents responsible for IE.
- To evaluate treatment strategies and mortality rates in IE patients.
Summary:
- The study reviewed 300 IE episodes in 288 patients, with viridans group streptococci (31%) and Staphylococcus aureus (20%) being the most common etiologic agents.
- Valvular heart disease (40%) and prosthetic heart valves (23%) were the most frequent underlying cardiac conditions.
- Mortality was 26% overall, with higher rates observed in patients with prosthetic valves (43%) and certain bacterial infections.
Impact:
- The findings highlight the persistent high mortality of IE, emphasizing the need for improved diagnostic and therapeutic approaches.
- Mortality rates vary significantly based on the underlying cardiac status and the identified etiologic agent.
- This research provides valuable data for clinicians in optimizing IE management and patient care.