Background: Infective endocarditis (IE) is one of the most life threatening infections in both medical and surgical practices. In the last few years, changes in its epidemiology, diagnostic methods and therapeutical trends have appeared. We analysed our experience in the diagnosis and treatment of IE.
Methods: The clinical records of patients admitted to our hospital with definitive (Group I) and highly probable (Group II) diagnosis of IE, during a period of five years (1990-1994), were retrospectively reviewed. Age, sex, clinical features, risk, factors, echocardiographic abnormalities, microbiologic and surgical findings, as well as mortality were recorded. In addition, an evaluation was made of the accuracy of the diagnostic criteria proposed by Von Reyn versus those brought forward by Duke University.
Results: One hundred thirty one patients were included, 99 in Group I and 32 in Group II. The mean age was 35 years. Native valve endocarditis was present in 88 patients and prosthetic valve endocarditis in 43 patients. Streptococcus sp. (48%) was the most frequently causative german and 16.7% of cases were culture negative. The sensitivity of transesophageal echocardiography was higher than transthoracic echocardiography in the diagnosis of both vegetations (76% vs 55%) and abscesses (30% vs 16.5%), (p < 0.05). Vegetations (95%) were the most frequent surgical finding followed by abscesses (23%). Inpatient mortality was 22% in Group I and 45% in Group II (p < 0.05). The sensitivity of Von Reyn's diagnostic criteria and that of Duke's University group was 49% and 85.8% (p < 0.05). Mean follow up was 531 days. Two patients had a new event of IE and no outpatient deaths were recorded.
Conclusion: IE is a medical and surgical emergency. Because of the high mortality rate, in the medically treated group, surgery should be considered in all cases as early as possible in the course of the disease.