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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.
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 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 streptococci) 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 streptococci) and 62% (gram-positive bacteria other than streptococci and staphylococci); in relation to the underlying heart disease, the mortality was 16% in patients 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 different etiologic agents and in relation to the cardiac status before the IE.
Insights
Infective endocarditis (IE) remains a serious condition with high mortality, influenced by specific causative agents and pre-existing heart conditions. Treatment strategies, including surgery, impact survival rates in these complex patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Context:
- Infective endocarditis (IE) is a severe infection affecting the heart's inner lining, often the valves.
- Understanding the diverse etiologic agents and patient cardiac status is crucial for effective management.
- Despite advances in treatment, IE continues to pose significant mortality risks.
Purpose:
- To investigate the clinical features, causative agents, treatment modalities, and mortality rates of infective endocarditis.
- To analyze the relationship between specific etiologic agents, underlying cardiac conditions, and patient outcomes.
- To evaluate the impact of medical and surgical interventions on mortality in IE patients.
Summary:
- A study of 300 IE episodes revealed viridans group streptococci (31%) and Staphylococcus aureus (20%) as common etiologic agents.
- Valvular heart disease (40%) and prosthetic heart valves (23%) were the most frequent underlying cardiac conditions.
- Mortality was 26% overall, varying significantly with etiologic agents and cardiac status, notably higher in prosthetic valve endocarditis (43%).
Impact:
- This research highlights the persistent high mortality of infective endocarditis, emphasizing the need for tailored treatment approaches.
- Findings underscore the importance of considering specific microbial causes and patient cardiac health when managing IE.
- The study provides critical data for refining treatment protocols and improving survival rates for IE patients, particularly those with prosthetic valves or complex cardiac histories.