Document Detail


Outcome after surgical treatment performed within the first week of antimicrobial therapy during infective endocarditis: a prospective study.
MedLine Citation:
PMID:  19059563     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: An increasing number of patients with infective endocarditis (IE) are operated on before the end of the first week of antimicrobial therapy. The mortality and morbidity of this specific group are unknown.
AIMS: To evaluate the outcome of patients with IE requiring cardiac surgery performed within the first week of antimicrobial therapy.
METHODS: All consecutive patients with a definite diagnosis of IE operated on within the first week of antimicrobial therapy were followed prospectively. Endpoints were in-hospital mortality and a combined endpoint of long-term cardiovascular death, recurrence and non-infective postoperative valvular dysfunction (PVD). The three main conditions requiring surgery, namely haemodynamic impairment, high embolic risk and periannular extension, were tested as potential predictors of outcome after adjustment for relevant variables.
RESULTS: Among the 95 patients included, surgery was performed a median time of 3 days after starting antimicrobial therapy. In-hospital mortality was 15%. The 3-year cumulative rates of the combined endpoint and of cardiovascular death were 38+/-7% and 27+/-7%, respectively. Recurrence occurred in 12% and PVD in 7%. Periannular extension was the main predictor of in-hospital death and the combined endpoint.
CONCLUSION: Despite the short time between starting antimicrobial therapy and performing surgery, the risk of death, recurrence and PVD does not appear excessively high. In the presence of periannular extension, however, surgery is associated with a greater risk of postoperative events.
Authors:
Franck Thuny; Sylvain Beurtheret; Vlad Gariboldi; Julien Mancini; Jean-François Avierinos; Alberto Riberi; Jean-Paul Casalta; Frédérique Gouriet; Laurence Tafanelli; Roch Giorgi; Frédéric Collart; Didier Raoult; Gilbert Habib
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Publication Detail:
Type:  Journal Article     Date:  2008-11-18
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  101     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:    2008 Nov-Dec
Date Detail:
Created Date:  2008-12-08     Completed Date:  2009-02-26     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  687-95     Citation Subset:  IM    
Affiliation:
Department of Cardiology, La Timone Hospital, boulevard Jean-Moulin, 13005 Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Infective Agents / administration & dosage*
Cardiac Surgical Procedures* / adverse effects,  mortality
Combined Modality Therapy
Databases as Topic
Drug Administration Schedule
Endocarditis / drug therapy*,  mortality,  surgery*
Female
Heart Valve Prosthesis / adverse effects*
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Prosthesis-Related Infections / drug therapy*,  mortality,  surgery*
Recurrence
Risk Assessment
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Infective Agents
Comments/Corrections
Comment In:
Arch Cardiovasc Dis. 2008 Nov-Dec;101(11-12):685-6   [PMID:  19059562 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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