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Prosthetic valve endocarditis
Abstract:
Prosthetic valve endocarditis is an infrequent but serious complication of cardiac valve replacement. The overall frequency of prosthetic valve endocarditis is approximately 2%. The frequency of early-onset and late-onset infections is 0.78% and 1.1%, respectively. Staphylococci are the most common isolate from patients with early-onset infection, accounting for 47.5% of the total number of isolates. Staphylococcus epidermidis causes 27% of these staphylococcal infections. Among patients with late-onset infection, streptococci are the predominant microorganism, constituting 42% of the total number of isolates from patients in this group. The overall mortality among patients with prosthetic valve endocarditis is high--59%; the mortality among patients with early- or late-onset infections is 77% and 46%, respectively. Most patients with staphylococcal prosthetic valve endocarditis should undergo cardiac valve replacement in addition to antimicrobial therapy. Closely monitored anticoagulant therapy should be cautiously continued in patients with prosthetic valve endocarditis.
Insights
Prosthetic valve endocarditis (PVE) affects about 2% of patients after cardiac valve replacement, with early infections often caused by staphylococci and late infections by streptococci. PVE carries a high mortality rate, necessitating valve replacement for staphylococcal cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Prosthetic valve endocarditis (PVE) is a rare but severe complication following cardiac valve replacement surgery.
- The overall incidence of PVE is approximately 2%, with variations in early-onset (0.78%) and late-onset (1.1%) infections.
Purpose of the Study:
- To analyze the frequency, causative microorganisms, and mortality rates associated with prosthetic valve endocarditis.
- To provide insights into appropriate management strategies for PVE.
Main Methods:
- Retrospective analysis of patient data concerning prosthetic valve endocarditis.
- Identification and categorization of microbial isolates from infected prosthetic valves.
- Assessment of mortality rates based on infection onset and causative agents.
Main Results:
- Staphylococci are the primary pathogens in early-onset PVE (47.5%), with Staphylococcus epidermidis being a significant contributor (27%).
- Streptococci are predominant in late-onset PVE (42%).
- Overall mortality for PVE is high at 59%, with significantly higher rates for early-onset (77%) compared to late-onset (46%) infections.
Conclusions:
- Prosthetic valve endocarditis presents a substantial mortality risk, influenced by the timing of onset and specific pathogens.
- Surgical valve replacement is recommended for staphylococcal PVE, alongside antimicrobial therapy.
- Anticoagulant therapy requires careful monitoring in PVE patients.