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[Staphylococcal endocarditis on a heart valve prosthesis. Apropos of 28 cases]
G de Gevigney1, M C Grimard, J P Gare
1Service de cardiologie, Hôpital cardio-vasculaire et pneumologique Louis-Pradel, Lyon.
Abstract:
The purpose of this retrospective study of 28 cases of staphylococcal endocarditis on cardiac valve prosthesis was to evaluate the prognosis of that disease and the possible causes of its recent improvement. Between March 1977 and May 1987, 69 patients were treated for bacterial endocarditis on cardiac valve prosthesis. Among these, 28 patients (19 men, 9 women, mean age 53.2 +/- 14.3 years) had staphylococcal endocarditis (Staph. epidermidis in 18 cases, Staph. aureus in 10 cases) of early (10 cases) or late (18 cases) onset. Complications were present in no less than 27 out of 28 patients, the most frequent being heart failure, embolism or neurological disorders. The mortality rate was high (61 p. 100). Among the clinical variables studied, only a state of shock seemed to be predictive of death. Mortality was higher in the group treated medically (100 p. 100) than in the group treated surgically (50 p. 100). Since 1984, however, a significant decrease of mortality was noted; it coincided with the systematic use of vancomycin but also with surgical treatment in all cases. As a result of this study, we suggest that all patients with staphylococcal endocarditis on cardiac valve prosthesis should be operated upon and that this should be done as soon as possible, before the end of the classical antibiotic therapy period.
Insights
Staphylococcal endocarditis on prosthetic valves has a high mortality rate. Early surgical intervention, alongside vancomycin, significantly improves patient survival, suggesting prompt surgery is crucial.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Context:
- Bacterial endocarditis on prosthetic cardiac valves presents a significant clinical challenge.
- Staphylococcal species are a common cause of prosthetic valve endocarditis.
- This study examines outcomes over a decade (1977-1987).
Purpose:
- To evaluate the prognosis of staphylococcal endocarditis on cardiac valve prostheses.
- To identify factors contributing to recent improvements in patient outcomes.
- To inform optimal treatment strategies for this severe condition.
Summary:
- This retrospective study analyzed 28 cases of staphylococcal endocarditis in patients with prosthetic heart valves.
- High complication rates (96%) and mortality (61%) were observed.
- Mortality decreased significantly after 1984, coinciding with vancomycin use and universal surgical intervention.
Impact:
- The findings strongly advocate for early surgical intervention in staphylococcal prosthetic valve endocarditis.
- Suggests that surgical treatment should precede or coincide with the completion of antibiotic therapy.
- Highlights the critical role of surgical management in reducing mortality for this complex infection.