Document Detail


Infectious endocarditis in patients with cirrhosis of the liver: a model of infection in the frail patient.
MedLine Citation:
PMID:  20549527     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purposes of this paper was to discover whether cirrhosis is a predisposing cause of infectious endocarditis (IE) and to determine the microbiology, prognosis and the role of cardiac surgery on mortality. A review of cases of IE at a university-affiliated hospital over a period of 10 years was conducted. Thirty-one (9.8%) patients among 316 cases of IE had hepatic cirrhosis. Valve disorders were present in 62.2% of cirrhotic patients and infection occurred on the aortic (48%) and mitral valves (45%). Endocarditis was hospital-acquired in 14 (45%) and 11 (17.7%) cirrhotic patients and controls, respectively (odds ratio [OR] 3.82; 95% confidence interval [CI]: 1.46-9.99; p = 0.005). Staphylococcus aureus was the most common causative microorganism, but β-hemolytic streptococci were most frequently isolated in cirrhotic patients (OR 8.75; 95% CI: 1.7-45.2; p = 0.001). Renal failure was more frequent in patients with cirrhosis (OR 8.23; 95% CI: 3.06-22.2; p = 0.001). Cirrhotic patients had a higher mortality (51% vs. 17.7%; OR 4.95; 95% CI: 1.89-12.91; p = 0.001) associated with the severity of liver disease. Valve replacement was performed less frequently in cirrhotic patients (56.2% vs. 92%) and the operative mortality was extremely high in patients at stages B and C. Hepatic cirrhosis is a frequent comorbid condition in patients with endocarditis. Due to the presence of severe hepatic dysfunction, cardiac surgery is not undertaken even when indicated and mortality is high in stages B and C. Endocarditis is a serious hazard for hospitalized cirrhotic patients.
Authors:
M L Fernández Guerrero; J González López; M Górgolas
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Publication Detail:
Type:  Journal Article     Date:  2010-06-13
Journal Detail:
Title:  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology     Volume:  29     ISSN:  1435-4373     ISO Abbreviation:  Eur. J. Clin. Microbiol. Infect. Dis.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804297     Medline TA:  Eur J Clin Microbiol Infect Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1271-5     Citation Subset:  IM    
Affiliation:
Division of Infectious Diseases (Department of Medicine), Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Avda. Reyes Católicos, 2, 28040 Madrid, Spain. mlfernandez@fjd.es
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bacteria / classification,  isolation & purification
Cross Infection / epidemiology
Endocarditis, Bacterial / epidemiology*,  microbiology,  mortality,  surgery
Female
Heart Valves / pathology
Hospitals, University
Humans
Liver Cirrhosis / complications*,  mortality,  pathology
Male
Middle Aged
Postoperative Complications / epidemiology,  mortality
Renal Insufficiency / epidemiology
Severity of Illness Index

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