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Polymicrobial infective endocarditis in the 1980s
L M Baddour1, J Meyer, B Henry
1Department of Medicine, University of Missouri-Columbia 65212.
Abstract:
Clinical experience over the past decade suggests that the number of cases of polymicrobial infective endocarditis has greatly increased. We found 101 reports of cases of polymicrobial endocardial infection in a review of the English-language literature published in the 1980s. The mean patient age, 36.5 years, reflected a relatively young population, with men outnumbering women almost 2:1. Seventy-one patients were intravenous drug users; only three described recent invasive medical procedures. More than one-half of the patients had infections of the tricuspid valve, and 31 patients developed septic pulmonary emboli. The mean age of patients who died was significantly (P = .004) greater than that of those who survived. In comparison with patients who were infected with three or more organisms, those who were infected with two pathogens were almost twice (38.3% vs. 20.8%) as likely to die of their infections. These differences in mortality reflected the relative paucity of endocardial infections involving the left heart in patients with polymicrobial infections caused by three or more organisms (compared with those infected with two pathogens, P = .0032) and the variability in virulence among infecting agents.
Insights
Polymicrobial infective endocarditis cases increased, predominantly affecting young intravenous drug users. Infections with two pathogens were more lethal than those with three or more, linked to left-heart involvement and pathogen virulence.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Clinical observations indicate a rising incidence of polymicrobial infective endocarditis.
- A literature review identified 101 cases of polymicrobial endocardial infection from the 1980s.
Observation:
- The average patient age was 36.5 years, with a male predominance (2:1 ratio).
- Intravenous drug use was a significant risk factor (71 patients), while recent invasive procedures were rare (3 patients).
- Tricuspid valve infections were most common (over 50%), leading to septic pulmonary emboli in 31 patients.
Findings:
- Older age correlated with increased mortality (P = .004).
- Patients with two pathogens had a higher mortality rate (38.3%) compared to those with three or more pathogens (20.8%).
- Polymicrobial infections with three or more organisms showed less left-heart involvement (P = .0032) and varied pathogen virulence.
Implications:
- Understanding risk factors like intravenous drug use is crucial for early diagnosis and prevention.
- The number of causative pathogens influences disease severity and mortality in infective endocarditis.
- Further research into pathogen virulence is needed to refine treatment strategies for polymicrobial endocarditis.