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[Endocarditis after extracorporeal circulation surgery]
Abstract:
Between January, 1976 and April 1988, 1279 patients underwent open-heart operation in Ren Ji Hospital. Thirty three patients were complicated by infective endocarditis postoperatively, an incidence of 2.58%. Medical treatment was carried out in 29 cases and thirteen were cured. In another three patients of valve prosthetic endocarditis, replacement of prosthetic valve was necessary for their cure. In our series, Gram negative bacilli had been proved by blood culture, autopsy and arterial thrombi in thirteen patients and candida in four, mixed infection in five and staphylococcus aureus in only one case. One should not rely on positive blood culture for the diagnosis. Echocardiographic studies are helpful to early diagnosis and proper treatment. The presence of vegetation or signs of prosthetic valve failure are strong indication for reoperation. In prevention, in addition to strict aseptic technic in the operating room, special emphasis should be focused on the preventive administration of sensitive antibiotics against hospital borne pathogens. All indwelling catheters in arteries and veins, tracheal tubes and urethral catheters should be removed after 72 hours. Efforts to prevent infection after reoperation are important measures for the prevention of infective endocarditis after open-heart operation.
Insights
Postoperative infective endocarditis occurred in 2.58% of open-heart surgery patients. Early diagnosis via echocardiography and preventive antibiotics are crucial for managing this serious complication.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Microbiology
Context:
- Open-heart surgery poses risks, including postoperative infective endocarditis (IE).
- This study analyzes IE incidence, causative agents, and outcomes in a large cohort of cardiac surgery patients.
- Understanding IE epidemiology is vital for improving patient care and prevention strategies.
Purpose:
- To determine the incidence and risk factors of infective endocarditis following open-heart operations.
- To evaluate the effectiveness of medical and surgical treatments for postoperative IE.
- To highlight diagnostic and preventive measures for IE in cardiac surgery patients.
Summary:
- A 2.58% incidence of infective endocarditis was observed in 1279 open-heart surgery patients.
- Gram-negative bacilli, Candida, and mixed infections were common pathogens; Staphylococcus aureus was rare.
- Echocardiography aids early diagnosis, while prosthetic valve replacement is critical for some cases. Positive blood cultures alone are insufficient for diagnosis.
- Preventive strategies include strict aseptic techniques, targeted antibiotic prophylaxis, prompt removal of indwelling devices, and infection control post-reoperation.
Impact:
- Findings underscore the importance of vigilant diagnosis and tailored treatment for postoperative IE.
- Recommendations for antibiotic prophylaxis and device management can reduce IE incidence.
- This research informs clinical practice for preventing and managing infective endocarditis in cardiac surgery settings.