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Infective endocarditis, 1970-1979. A study of culture-positive cases in St. Thomas' Hospital
Abstract:
Ninety-three episodes of culture-positive endocarditis occurred in 88 patients in the years 1970 to 1979. Streptococci caused two-thirds of the cases, with Streptococcus mitior and Streptococcus sanguis most common. Among the Group D streptococci, Streptococcus bovis was much more common than Streptococcus faecalis. Staphylococci accounted for a quarter of the episodes. Streptococcal endocarditis was commonest in the elderly, whereas staphylococcal endocarditis occurred at all ages. Degenerative heart disease was the underlying cardiac factor in nearly half the streptococcal cases, but staphylococci most often affected normal heart valves. When prosthetic valves were infected endocarditis of early onset was staphylococcal but that of late onset was streptococcal. Narcotic abuse was a common cause of staphylococcal endocarditis, second only to surgical wound infection following valve replacement. Streptococci affected the mitral and aortic valves equally but the staphylococci more usually involved mitral or tricuspid valves. The overall mortality was 36 per cent but was much higher for staphylococcal than streptococcal endocarditis.
Insights
This study on culture-positive endocarditis found streptococci were the most common cause, particularly in the elderly. Staphylococcal endocarditis occurred across all ages and had a higher mortality rate.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Endocarditis remains a significant clinical challenge, with varying etiological agents and patient demographics.
- Understanding the epidemiology of culture-positive endocarditis is crucial for effective treatment strategies.
Purpose of the Study:
- To analyze the causative agents, clinical features, and outcomes of culture-positive endocarditis.
- To compare streptococcal and staphylococcal endocarditis in terms of patient characteristics, affected valves, and mortality.
Main Methods:
- Retrospective analysis of 93 episodes of culture-positive endocarditis in 88 patients from 1970-1979.
- Categorization of causative organisms (Streptococci, Staphylococci, etc.) and analysis of associated patient factors and cardiac conditions.
Main Results:
- Streptococci caused two-thirds of cases, predominantly Streptococcus mitior and Streptococcus sanguis, common in the elderly with degenerative heart disease.
- Staphylococci accounted for a quarter of cases, affecting all age groups and often normal valves; associated with narcotic abuse and surgical infections.
- Staphylococcal endocarditis had a higher mortality rate (36% overall) compared to streptococcal endocarditis.
Conclusions:
- Streptococcal and staphylococcal endocarditis exhibit distinct epidemiological patterns and clinical presentations.
- Prompt diagnosis and targeted therapy are essential, especially for staphylococcal endocarditis due to its higher mortality.