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Acute endocarditis in drug addicts: surgical treatment for gram-negative sepsis
Abstract:
We studied 37 consecutive patients, all drug addicts, who underwent 48 valve operations from 1976 through 1981. GN bacteria were the major organisms in 25 patients (64%), compared with a previous reported incidence of 10%. Operative indications were uncontrolled sepsis in 49%, embolism in 27% and heart failure in 24% of the patients. Primary operations included nine tricuspid valvectomies and 14 aortic, 10 mitral and four aortic/mitral valve replacements. Early (30-day) mortality was 2.7% (one of 37 patients); five of nine patients who had 11 reoperations survived. Long-term follow-up revealed a late mortality of 39% (11 of 28) in patients with left-sided disease; eight of the 11 patients who died had GN infection with perivalvular abscess. Thus, the subgroup with GN sepsis and left-sided disease had a combined early and late mortality of 50%, with all deaths occurring within 8 months postoperatively. We conclude that valve replacement in the presence of active sepsis can be safely performed, but GN sepsis in addicts increases the risk of early reinfection and late mortality.
Insights
Drug addicts undergoing valve operations had a high incidence of Gram-negative (GN) bacterial infections. GN sepsis in these patients significantly increased the risk of reinfection and late mortality, especially with left-sided heart disease.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Drug addiction is associated with an increased risk of infective endocarditis.
- Gram-negative (GN) bacteria are an uncommon cause of infective endocarditis but may be more prevalent in certain patient populations.
Purpose of the Study:
- To investigate the incidence of GN bacterial infections in drug addicts undergoing valve operations.
- To evaluate the outcomes of valve operations in this patient group, particularly concerning sepsis and mortality.
Main Methods:
- Retrospective study of 37 consecutive drug addicts undergoing 48 valve operations between 1976 and 1981.
- Analysis of operative indications, types of procedures, causative organisms, and early/late mortality.
- Focus on outcomes in patients with Gram-negative sepsis and left-sided heart disease.
Main Results:
- Gram-negative bacteria were the major organisms in 64% of patients, a significant increase from previous reports.
- Operative indications included uncontrolled sepsis (49%), embolism (27%), and heart failure (24%).
- Long-term follow-up showed a 39% late mortality in left-sided disease, with GN infection and perivalvular abscess being common causes of death.
Conclusions:
- Valve replacement can be safely performed in the presence of active sepsis.
- Gram-negative sepsis in drug addicts undergoing valve surgery is associated with a higher risk of early reinfection and late mortality.
- Patients with GN sepsis and left-sided disease had a 50% combined early and late mortality, with deaths occurring within 8 months postoperatively.