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Prosthetic valve endocarditis
Abstract:
The diagnosis, therapy, and complications of prosthetic valve endocarditis (PVE) in 48 patients seen between 1962 and 1978 are reviewed. Staphylococcus epidermidis and diphtheroids were the most common causes of both early and late PVE. These microorganisms were frequently resistant to the penicillins and cephalosporins but were uniformly sensitive to vancomycin. The mortality rate in this series was 69%, with 20% of the deaths attributed to central nervous system emboli and the remainder to cardiac causes. The mortality rate exceeded 75% in patients with any of the following findings: aortic valve infection, nonstreptococcal infecting microorganism, new or increased regurgitant murmurs, or significant congestive heart failure (CHF). The mortality rate was lowest in streptococcal PVE (29%) and in mitral valve PVE (49%). The unacceptably high mortality rate suggests that early replacement of infected prostheses should be considered in all patients except those with uncomplicated streptoccal or mitral valve PVE.
Insights
Prosthetic valve endocarditis (PVE) is deadly, often caused by resistant bacteria. Vancomycin shows sensitivity, but high mortality suggests early valve replacement is crucial for most patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Prosthetic valve endocarditis (PVE) poses significant diagnostic and therapeutic challenges.
- Understanding causative agents and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To review the diagnosis, therapy, and complications of PVE.
- To identify factors associated with mortality in PVE patients.
Main Methods:
- Retrospective review of 48 PVE cases diagnosed between 1962 and 1978.
- Analysis of causative microorganisms, treatment responses, and clinical outcomes.
Main Results:
- Staphylococcus epidermidis and diphtheroids were common PVE pathogens, often resistant to penicillins/cephalosporins but sensitive to vancomycin.
- Overall mortality was 69%, with CNS emboli and cardiac causes predominating.
- High mortality (>75%) linked to aortic valve infection, non-streptococcal agents, regurgitant murmurs, or CHF.
- Lower mortality in streptococcal PVE (29%) and mitral valve PVE (49%).
Conclusions:
- PVE carries a high mortality rate, necessitating aggressive management strategies.
- Early prosthetic valve replacement should be strongly considered for most PVE cases, except select uncomplicated streptococcal or mitral valve infections.