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Endocarditis caused by coagulase-negative staphylococci
Abstract:
Sixteen patients with coagulase-negative staphylococcal endocarditis were treated at the University of Minnesota Hospitals between January 1970 and September 1977. In six patients, endocarditis developed after prosthetic valve surgery; among the other ten patients (the medical group), eight had known antecedent valvular disease. The skin was thought to be the source of infection in eight patients, suggesting that prompt treatment of skin infections and avoidance of injections in patients with valvular disease are important measures in the prevention of this disease. Patients with prosthetic valve endocarditis were infected with antibiotic-resistant organisms and had a higher mortality than those in the medical group (83% versus 20%). Bacterial isolates from three patients with prosthetic valve endocarditis were resistant to methicillin, and two of these three isolates also were resistant to cephalothin by quantitative susceptibility testing. The only patient with prosthetic valve endocarditis to survive was operated upon early in the course of his illness. These observation, coupled with the high mortality in this series and in others, has prompted us to advocate early surgery in prosthetic valve endocarditis.
Insights
Coagulase-negative staphylococcal endocarditis, especially in prosthetic valve patients, has high mortality. Early surgery is recommended for prosthetic valve endocarditis to improve survival rates.
Area of Science:
- Infectious Diseases
- Cardiology
- Surgical Innovation
Background:
- Coagulase-negative staphylococcal endocarditis (CNSE) poses a significant clinical challenge.
- CNSE frequently affects patients with prosthetic heart valves or pre-existing valvular disease.
- Identifying infection sources, such as skin, is crucial for prevention.
Purpose of the Study:
- To analyze treatment outcomes for patients with CNSE.
- To compare mortality rates between prosthetic valve endocarditis (PVE) and medical endocarditis groups.
- To evaluate the role of early surgical intervention in PVE.
Main Methods:
- Retrospective analysis of 16 CNSE patients treated between 1970 and 1977.
- Categorization of patients into prosthetic valve surgery and medical groups.
- Assessment of bacterial resistance patterns and patient outcomes.
Main Results:
- Prosthetic valve endocarditis (PVE) patients exhibited higher mortality (83%) compared to the medical group (20%).
- Antibiotic-resistant organisms, including methicillin-resistant strains, were prevalent in PVE cases.
- Early surgical intervention was associated with survival in the sole PVE survivor.
Conclusions:
- Prosthetic valve endocarditis (PVE) carries a substantially higher mortality risk than other forms of CNSE.
- Antibiotic resistance is a significant concern in PVE.
- Early surgical intervention should be strongly considered for patients with prosthetic valve endocarditis.