Long-term prognosis of early and late prosthetic valve endocarditis

doi:10.1016/j.amjcard.2004.01.056

The American Journal of Cardiology

Volume 93, Issue 9, 1 May 2004, Pages 1185-1187

https://doi.org/10.1016/j.amjcard.2004.01.056 Get rights and content

Abstract

A prospective series of 78 cases of prosthetic valve endocarditis (PVE) was studied (35 cases of early PVE and 43 cases of late PVE). The in-hospital mortality rate was significantly higher in patients with early PVE (31% vs 9%, p <0.01) because the onset of heart failure was more common in these patients (55% vs 37%, p <0.05). However, event-free survival at 4 years in survivors to the active phase was not different (74% and 82%, respectively).

References (13)

W.G. Daniel et al.
Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions
Am J Cardiol
(1993)
S.P. Calderwood et al.
Prosthetic valve endocarditis. Analysis of factors affecting outcome of therapy
J Thorac Cardiovasc Surg
(1986)
D.T. Durack et al.
New criteria for diagnosis of infective endocarditisutilization of specific echocardiographic findings
Am J Med
(1994)
V.L. Yu et al.
Prosthetic valve endocarditissuperiority of surgical valve replacement versus medical therapy only
Ann Thorac Surg
(1994)
M.G. Threlkeld et al.
Infectious disorders of prosthetic valves and intravascular devices
T.S.A. Ivert et al.
Prosthetic valve endocarditis
Circulation
(1984)

There are more references available in the full text version of this article.

Cited by (43)

Efficacy of Primary Surgical Versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis
2020, Annals of Thoracic Surgery
Left-sided staphylococcal, streptococcal, and enterococcal infective endocarditis (IE) is associated with poor clinical outcomes. Our primary aim is to compare clinical outcomes of staphylococcal, streptococcal, and enterococcal IE patients who undergo valve replacement surgery and outcomes of patients who are treated solely with antibiotics.
All patients were treated medically or surgically for left-sided staphylococcal, streptococcal, or enterococcal IE at our institution from 1998 to 2014 and were retrospectively studied. The primary outcome of interest was 30-day and 1-year mortality, and secondary outcomes included posttreatment septic shock, embolic events, stroke, and end-stage renal disease at 30 days. Inverse probability treatment weights, derived from propensity scores, were used to balance the medical and surgical cohorts across clinical risk factors, The Society of Thoracic Surgeon scores, and pathogens. Outcomes were compared comprehensively and in a staphylococcal-only subanalysis.
Study population consisted of 245 surgical patients and 164 medical patients. Mortality at 30 days was higher in the medical cohort, both in aggregate and for staphylococcal only (all, 7% vs 16%, P < .001; staphylococcal only, 7% vs 22%, P < .001). Surgical patients had a higher incidence of septic shock and renal dysfunction; however, stroke and embolic events at 30 days were not different between cohorts. Cox survival analysis demonstrated that surgical treatment provided a 1-year survival benefit, with a hazard ratio of 0.48 (95% confidence interval, 0.36 to 0.64) that was robust regardless of pathogen.
Compared with medical management, valve replacement surgery in patients with left-sided staphylococcal, streptococcal, or enterococcal IE appears to confer a survival advantage at 30 days and 1 year.
Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review
2018, International Journal of Infectious Diseases
Citation Excerpt :
While methicillin-resistant CoNS may occur after this period, the etiological pattern is similar to that of community-acquired IE. A literature review evaluating the etiology of PVE within 1 year after valve replacement for the years 1970–2015 showed the following prevalence rates from the pooled data of 646 PVE episodes (Gordon et al., 2000; López et al., 2007; Verkkala et al., 1987; Shafer and Hall, 1970; Killen et al., 1970; Ralph-Edwards et al., 1994; Lee et al., 2011; Chen et al., 1990; Heimberger and Duma, 1989; Musci et al., 2010; Sett et al., 1993; Auger et al., 1981; Thuny et al., 2010; Castillo et al., 2004; Grover et al., 1994; Anguera et al., 2006; Wang et al., 2007; Grubitzsch et al., 2014; Hill et al., 2008; Rivas et al., 2005; Nonaka et al., 2013): 41% CoNS, 24% S. aureus, 7% Enterococcus spp, 9% Gram-negative bacilli, 7% Streptococcus spp, and 6% fungi. Overall, the etiology of PVE in the present study was similar to these data.
To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.
Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.
One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.
Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.
7.9 Orthopedic implant use and infection
2017, Comprehensive Biomaterials II
While total joint arthroplasty is one of the most successful procedures in orthopedic surgery, periprosthetic infection is a devastating complication after total joint replacement that can have severe consequences that may lead to limb fusion, limb loss, and even death. Implants used in total joint arthroplasty, and other orthopedic procedures such as trauma and spine, have a propensity for attracting bacteria that lead to colonization and biofilm formation. Biofilms are traditionally resistant to antibiotic treatment strategies, and even when treated, they may leave “persisters” or persistent bacteria that may reinitiate an infection long after the index infection. Additionally, biofilms are difficult to diagnose, as they evade traditional culturing methods for microorganism detection. In order to diagnose periprosthetic joint infections, subjective decisions are usually required using diagnostic criteria combining clinical presentation, laboratory tests, and symptom duration. More recent synovial fluid molecular markers have been investigated for diagnosing periprosthetic joint infection, including C-reactive protein, alpha-defensin and interleukin-6. Treatment for periprosthetic joint infection typically includes antibiotic treatment and revision surgery in one or two stages. However, even with successful treatment, subsequent surgeries often lead to excessive pain, greater bone loss, disability, and astronomical costs to the patient and the health care system. In order to prevent periprosthetic joint infections, smart implants with antimicrobial surfaces have been developed to prevent bacterial attachment and mitigate the risk for biofilm formation. With continued development with antimicrobial coatings, periprosthetic joint infections can potentially become a problem of the past.
Prosthetic Valve Endocarditis
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
Partial oral treatment of endocarditis
2013, American Heart Journal
Citation Excerpt :
The incidence of infective endocarditis (IE) is increasing.1 Mortality remains high—from 9% to 46%2-18—despite improvements in diagnostic tools and novel antibiotics. Management of IE includes antibiotic therapy, diagnostic workup for identification, and treatment of a primary infective focus and, in roughly half of the cases, surgery.
Guidelines for the treatment of left-sided infective endocarditis (IE) recommend 4 to 6 weeks of intravenous antibiotics. Conversion from intravenous to oral antibiotics in clinically stabilized patients could reduce the side effects associated with intravenous treatment and shorten the length of hospital stay. Evidence supporting partial oral therapy as an alternative to the routinely recommended continued parenteral therapy is scarce, although observational data suggest that this strategy may be safe and effective.
This is a noninferiority, multicenter, prospective, randomized, open-label study of partial oral treatment with antibiotics compared with full parenteral treatment in left-sided IE. Stable patients (n = 400) with streptococci, staphylococci, or enterococci infecting the mitral valve or the aortic valve will be included. After a minimum of 10 days of parenteral treatment, stable patients are randomized to oral therapy or unchanged parenteral therapy. Recommendations for oral treatment have been developed based on minimum inhibitory concentrations and pharmacokinetic calculations. Patients will be followed up for 6 months after completion of antibiotic therapy. The primary end point is a composition of all-cause mortality, unplanned cardiac surgery, embolic events, and relapse of positive blood cultures with the primary pathogen.
The Partial Oral Treatment of Endocarditis study tests the hypothesis that partial oral antibiotic treatment is as efficient and safe as parenteral therapy in left-sided IE. The trial is justified by a review of the literature, by pharmacokinetic calculations, and by our own experience.
2023 ESC Guidelines for the management of endocarditis
2023, European Heart Journal

View all citing articles on Scopus

View full text

Long-term prognosis of early and late prosthetic valve endocarditis

Abstract

Am J Cardiol

J Thorac Cardiovasc Surg

Am J Med

Ann Thorac Surg

Infectious disorders of prosthetic valves and intravascular devices

Prosthetic valve endocarditis

Circulation