 |
|
CLINICIAN'S CORNER
Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis
Andrew Wang, MD;
Eugene Athan, MD;
Paul A. Pappas, MS;
Vance G. Fowler, Jr, MD, MHS;
Lars Olaison, MD;
Carlos Paré, MD;
Benito Almirante, MD;
Patricia Muñoz, MD;
Marco Rizzi, MD;
Christoph Naber, MD;
Mateja Logar, MD;
Pierre Tattevin, MD;
Diana L. Iarussi, MD;
Christine Selton-Suty, MD;
Sandra Braun Jones, MD;
José Casabé, PhD;
Arthur Morris, MD;
G. Ralph Corey, MD;
Christopher H. Cabell, MD, MHS; for the International Collaboration on Endocarditis-Prospective Cohort Study Investigators
JAMA. 2007;297:1354-1361.
Context Prosthetic valve endocarditis (PVE) is associated with significant mortality and morbidity. The contemporary clinical profile and outcome of PVE are not well defined.
Objectives To describe the prevalence, clinical characteristics, and outcome of PVE, with attention to health care–associated infection, and to determine prognostic factors associated with in-hospital mortality.
Design, Setting, and Participants Prospective, observational cohort study conducted at 61 medical centers in 28 countries, including 556 patients with definite PVE as defined by Duke University diagnostic criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to August 2005.
Main Outcome Measure In-hospital mortality.
Results Definite PVE was present in 556 (20.1%) of 2670 patients with infective endocarditis. Staphylococcus aureus was the most common causative organism (128 patients [23.0%]), followed by coagulase-negative staphylococci (94 patients [16.9%]). Health care–associated PVE was present in 203 (36.5%) of the overall cohort. Seventy-one percent of health care–associated PVE occurred within the first year of valve implantation, and the majority of cases were diagnosed after the early (60-day) period. Surgery was performed in 272 (48.9%) patients during the index hospitalization. In-hospital death occurred in 127 (22.8%) patients and was predicted by older age, health care–associated infection (62/203 [30.5%]; adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.08-2.44; P = .02), S aureus infection (44/128 [34.4%]; adjusted OR, 1.73; 95% CI, 1.01-2.95; P = .05), and complications of PVE, including heart failure (60/183 [32.8%]; adjusted OR, 2.33; 95% CI, 1.62-3.34; P<.001), stroke (34/101 [33.7%]; adjusted OR, 2.25; 95% CI, 1.25-4.03; P = .007), intracardiac abscess (47/144 [32.6%]; adjusted OR, 1.86; 95% CI, 1.10-3.15; P = .02), and persistent bacteremia (27/49 [55.1%]; adjusted OR, 4.29; 95% CI, 1.99-9.22; P<.001).
Conclusions Prosthetic valve endocarditis accounts for a high percentage of all cases of infective endocarditis in many regions of the world. Staphylococcus aureus is now the leading cause of PVE. Health care–associated infection significantly influences the clinical characteristics and outcome of PVE. Complications of PVE strongly predict in-hospital mortality, which remains high despite prompt diagnosis and the frequent use of surgical intervention.
Author Affiliations: Department of Medicine, Duke University Medical Center, Durham, NC (Drs Wang, Fowler, Corey, and Cabell); Department of Infectious Disease, The Geelong Hospital at the University of Melbourne, Melbourne, Australia (Dr Athan); Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (Mr Pappas); Department of Infectious Disease, Sahlgrenska Universitetssjukhuset/Ostra, Göteborg, Sweden (Dr Olaison); Department of Cardiology, University of Barcelona, Barcelona, Spain (Dr Paré); Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain (Dr Almirante); Department of Infectious Disease, Hospital General Universitario Gregorio Maranon, Barcelona, Spain (Dr Muñoz); Department of Infectious Disease, Ospedali Riuniti, Bergamo, Italy (Dr Rizzi); Cardiology Clinic, University Essen, Essen, Germany (Dr Naber); Department of Infectious Disease, Medical Center Ljublijana, Ljublijana, Slovenia (Dr Logar); Department of Infectious Disease, Pontchaillou University, Rennes, France (Dr Tattevin); Department of Cardiology, II Universita di Napoli, Naples, Italy (Dr Iarussi); Cardiology Service, CHU Nancy-Brabois, Nancy, France (Dr Selton-Suty); Laboratorio de Técnicas No Invasivas, Hospital Clinico Pont Universidad Catolica de Chile, Santiago, Chile (Dr Jones); Department of Cardiology, Instituto de Cardiologia y Cirugia Cardiovascular, Fundacion Favaloro, Buenos Aires, Argentina (Dr Casabé); Diagnostic Medlab, Auckland City Hospital, Auckland, New Zealand (Dr Morris).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Heart Valve Infections
Janet M. Torpy, Alison E. Burke, and Richard M. Glass
JAMA. 2007;297(12):1396.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)
Endorsed by the European Society of Clinical Micro et al.
Eur Heart J 2009;30:2369-2413.
FULL TEXT
Outcomes of double valve surgery for active infective endocarditis
Sheikh et al.
J. Thorac. Cardiovasc. Surg. 2009;138:69-75.
ABSTRACT
| FULL TEXT
Health Care-Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition
Benito et al.
ANN INTERN MED 2009;150:586-594.
ABSTRACT
| FULL TEXT
Prophylactic antibiotic treatment to prevent infective endocarditis: new guidance from the National Institute for Health and Clinical Excellence
Brooks
Heart 2009;95:774-780.
FULL TEXT
Coagulase-negative staphylococcal prosthetic valve endocarditis--a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study
Chu et al.
Heart 2009;95:570-576.
ABSTRACT
| FULL TEXT
The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis
Thuny et al.
Eur Heart J 2009;0:ehp089v1-ehp089.
ABSTRACT
| FULL TEXT
Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis-Prospective Cohort Study
Murdoch et al.
Arch Intern Med 2009;169:463-473.
ABSTRACT
| FULL TEXT
Outcomes of surgical intervention for isolated active mitral valve endocarditis.
Sheikh et al.
J. Thorac. Cardiovasc. Surg. 2009;137:110-116.
ABSTRACT
| FULL TEXT
CHAPTER 22 Infective Endocarditis
Daniel and Flachskampf
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT
| FULL TEXT
Long-term Outcome of Infective Endocarditis in Non-Intravenous Drug Users
Martinez-Selles et al.
Mayo Clin Proc. 2008;83:1213-1217.
ABSTRACT
| FULL TEXT
Aortic Allograft Valve Reoperation: Surgical Challenges and Patient Risks
Nowicki et al.
Ann. Thorac. Surg. 2008;86:761-768.
ABSTRACT
| FULL TEXT
Heart Valves Should Not Be Routinely Cultured
Munoz et al.
J. Clin. Microbiol. 2008;46:2897-2901.
ABSTRACT
| FULL TEXT
Adult congenital heart disease: a 2008 overview
Bedard et al.
Br Med Bull 2008;85:151-180.
ABSTRACT
| FULL TEXT
The Year in Valvular Heart Disease.
Rahimtoola
J Am Coll Cardiol 2008;51:760-770.
FULL TEXT
Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy
KIM and KEYS
Cleveland Clinic Journal of Medicine 2008;75:89-92.
FULL TEXT
Non-HACEK Gram-Negative Bacillus Endocarditis
Morpeth et al.
ANN INTERN MED 2007;147:829-835.
ABSTRACT
| FULL TEXT
Use of Antimicrobial Catheter Lock Solutions to Prevent Catheter-Related Bacteremia
Bleyer
CJASN 2007;2:1073-1078.
ABSTRACT
| FULL TEXT
Prosthetic Valve Endocarditis
Journal Watch Cardiology 2007;2007:2-2.
FULL TEXT
New Clinical Insights into Prosthetic Valve Endocarditis
JWatch Infect. Diseases 2007;2007:2-2.
FULL TEXT
|
