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Enterococcal endocarditis: a comparison of prosthetic and native valve disease.
L B Rice1, S B Calderwood, G M Eliopoulos
1Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02115.
Reviews of Infectious Diseases
|January 1, 1991
Summary
Enterococcal endocarditis, especially prosthetic valve endocarditis (PVE), can often be treated successfully with antibiotics alone. Combination therapy with gentamicin and cell wall-active agents is effective for susceptible enterococci.
Area of Science:
- Infectious Diseases
- Cardiology
- Internal Medicine
Background:
- Enterococcal endocarditis presents a significant clinical challenge, affecting both native and prosthetic heart valves.
- Mortality rates remain substantial, particularly in native valve endocarditis (NVE) cases involving the aortic valve.
Purpose of the Study:
- To analyze treatment outcomes and identify prognostic factors in patients with enterococcal endocarditis.
- To evaluate the efficacy of antibiotic therapy, including gentamicin combinations, and the role of surgery.
Main Methods:
- Retrospective analysis of 41 episodes of enterococcal endocarditis (22 NVE, 19 PVE) between 1973 and 1987.
- Assessment of mortality, complications, treatment strategies (antibiotics, surgery), and adverse events like renal dysfunction.
Main Results:
- Overall mortality was 15%; NVE had higher mortality (18%) than PVE (11%).
- Aortic valve involvement in NVE correlated with adverse outcomes.
- 69% of PVE patients were cured with antibiotics alone.
- Gentamicin combination therapy was common (mean 5 weeks); 44% experienced renal dysfunction.
Conclusions:
- Enterococcal prosthetic valve endocarditis (PVE) can frequently be cured with antibiotic therapy alone.
- Gentamicin in combination with cell wall-active agents is effective for enterococcal endocarditis lacking high-level gentamicin resistance.
- Aortic valve involvement is a critical factor in native valve endocarditis outcomes.