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[Prognostic factors of prosthetic valve endocarditis. Apropos of 122 cases]
S Witchitz1, M Wolff, C Chastang
1Service de réanimation des maladies infectieuses, hôpital Bichat-Claude-Bernard, Paris.
Abstract:
The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and multivariate analysis. The principal causative organisms were Staphylococcus aureus (33%), streptococci (20%), coagular-negative staphylococci (12%), enterococci (10%) and gram-negative bacilli (9%). The 4 month survival rate was 66% (42 deaths). The main predictive factor for death was infection with S. aureus (75% vs 15% with other organisms). In S. aureus infection, multivariate analysis identified the following predictive factors for death: a prothrombin ratio less than 30% (RR = 8.3), mediastinitis (RR = 4.9), cardiac failure (RR = 4.4) and septic shock (RR = 2.6). In cases of infection with other organisms, the following factors were predictive of death: a prothrombin ratio of less than 30% (RR = 32.26), renal failure (RR = 7.31) and cardiac failure (RR = 6.07). In patients with S. aureus infection, survival was better after than without surgery: 9/20 (45%) versus 0/20 (p < 0.001). In infection with other organisms, there was no difference in a survival after surgical (89%) or medical therapy (81%). Chronic endocarditis relapses over 1 to 5 years was observed in 9 cases. All patients were reoperated a total number of 18 times with 5 deaths. Very prolonged antibiotic therapy is recommended in these patients. The authors conclude that endocarditis not due to S. aureus and without complications may be treated medically. Rapid reoperation is necessary in all other cases.
Insights
Prosthetic valve endocarditis (PVE) outcomes depend on the causative organism. Staphylococcus aureus PVE requires surgery for better survival, while other PVE cases without complications can be treated medically.
Area of Science:
- Infectious Diseases
- Cardiology
- Surgical Outcomes
Context:
- Prosthetic valve endocarditis (PVE) poses significant mortality risks.
- Understanding prognostic factors is crucial for effective PVE management.
- This study analyzes PVE cases from 1978-1992.
Purpose:
- To identify prognostic factors for mortality in patients with PVE.
- To compare outcomes based on causative organisms and treatment modalities.
- To guide clinical decision-making in PVE management.
Summary:
- A study of 122 PVE patients revealed Staphylococcus aureus as a primary cause of mortality.
- Predictive factors for death in S. aureus PVE include low prothrombin ratio, mediastinitis, cardiac failure, and septic shock.
- For non-S. aureus PVE, predictive factors for death include low prothrombin ratio, renal failure, and cardiac failure.
- Surgical intervention improved survival in S. aureus PVE, while medical therapy was comparable to surgery for other organisms.
- Relapses occurred in 9 cases, necessitating reoperation.
Impact:
- Findings highlight the critical role of causative organism in PVE prognosis.
- Differentiates treatment strategies for S. aureus versus other PVE infections.
- Emphasizes the need for prompt surgical intervention in complicated PVE cases.
- Suggests prolonged antibiotic therapy for chronic relapsing cases.