Document Detail


Definition, clinical profile, microbiological spectrum, and prognostic factors of early-onset prosthetic valve endocarditis.
MedLine Citation:
PMID:  17255216     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: There is no agreement in the best cutoff time to distinguish between early- and late- onset prosthetic valve endocarditis (PVE). Our objectives are to define early-onset PVE according to the microbiological spectrum and to analyse the profile and short-term prognosis of this entity. METHODS AND RESULTS: The microbiological profile of 172 non-drug users, who were patients with PVE, were compared according to the time elapsed from surgery among 640 endocarditis diagnosed between 1996 and 2004. There were no differences in the microbiological profile of patients with PVE occurred within 2 months of valve replacement and those accounting between 2 and 12 months. The proportion of coagulase-negative Staphylococci (CNS) was higher during the first year post-intervention (37 vs. 18%, P = 0.005) and Streptococci viridans were more common after 1 year (18 vs. 1%, P = 0.001). The percentage of methicilin-resistant CNS strains was higher before 1 year (77 vs. 30%, P = 0.004). Early-onset PVE represented 38% of all episodes of PVE, CNS being the most frequent isolated microorganisms (37%), most of them methicilin resistant (77%). In-hospital mortality of patients who needed urgent surgery was 46% and elective surgery 25%. Overall, in-hospital mortality was 38% and no differences were seen between surgical and medical groups (32 vs. 45%, P = 0.30). Periannular complications were associated with higher in-hospital mortality (60 vs. 27%, P = 0.007). CONCLUSION: According to the microbiological profile, the most appropriate cutoff time to distinguish between early- and late-onset PVE was 1 year. Methicilin-resistant CNS are the most frequent pathogens and periannular complications, the only risk factor for in-hospital mortality.
Authors:
Javier López; Ana Revilla; Isidre Vilacosta; Eduardo Villacorta; Carlos González-Juanatey; Itziar Gómez; María Jesús Rollán; José Alberto San Román
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-01-25
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-16     Completed Date:  2008-02-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  760-5     Citation Subset:  IM    
Affiliation:
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, C/Ramón y Cajal 3, Valladolid, Spain. javihouston@yahoo.es
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cross Infection / microbiology,  mortality,  surgery
Endocarditis, Bacterial / microbiology*,  mortality,  surgery
Female
Heart Valve Prosthesis*
Humans
Male
Middle Aged
Prognosis
Prosthesis-Related Infections / microbiology*,  mortality,  surgery
Treatment Outcome

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