[Bacterial endocarditis: clinical and bacteriological aspects and prognostic factors]

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Review of 71 bacterial endocarditis cases from 1970-1974 at Hôpital cantonal, Geneva.
• Analysis focused on microbiological, clinical, and therapeutic aspects.
• Identified a trend towards a higher prevalence of acute bacterial endocarditis.

Observation:

• Staphylococcus epidermidis demonstrated a pathogenic role, particularly in prosthetic valve endocarditis.
• Acute endocarditis cases showed rapid progression, significant valvular destruction (especially aortic valve), and poorer outcomes despite antibiotic therapy.
• Embolic phenomena were frequent, occurring in 70% of cured and 80% of fatal cases.

Findings:

• Mortality rate for acute endocarditis was 40% (10/25) compared to 21.7% (10/46) for subacute cases.
• Neurologic involvement, cardiac rhythm disturbances, and heart failure correlated with unfavorable evolution.
• Heart failure emerged as the primary cause of death and a major therapeutic challenge.

Implications:

• Acute bacterial endocarditis with aortic valve destruction and heart failure carries a poor prognosis, even with emergency valve replacement.
• A significant proportion of patients (22/30) with endocarditis post-procedure were aware of a heart murmur but lacked antibiotic prophylaxis.
• Urgent need for developing and disseminating effective antibiotic prophylaxis regimens to prevent bacterial endocarditis.