Document Detail


The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS).
MedLine Citation:
PMID:  18035080     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of antimicrobial therapy and the temporal incidence of stroke in patients with IE and to determine if this time course differs from that shown for embolic events in previous studies. METHODS: Prospective incidence cohort study involving 61 tertiary referral centers in 28 countries. Case report forms were analyzed from 1437 consecutive patients with left-sided endocarditis admitted directly to participating centers. RESULTS: The crude incidence of stroke in patients receiving appropriate antimicrobial therapy was 4.82/1000 patient days in the first week of therapy and fell to 1.71/1000 patient days in the second week. This rate continued to decline with further therapy. Stroke rates fell similarly regardless of the valve or organism involved. After 1 week of antimicrobial therapy, only 3.1% of the cohort experienced a stroke. CONCLUSIONS: The risk of stroke in IE falls dramatically after the initiation of effective antimicrobial therapy. The falling risk of stroke in patients with IE as a whole precludes stroke prevention as the sole indication for valvular surgery after 1 week of therapy.
Authors:
Stuart A Dickerman; Elias Abrutyn; Bruno Barsic; Emilio Bouza; Enrico Cecchi; Asuncion Moreno; Thanh Doco-Lecompte; Damon P Eisen; Claudio Q Fortes; Vance G Fowler; Stamatios Lerakis; Jose M Miro; Paul Pappas; Gail E Peterson; Ethan Rubinstein; Daniel J Sexton; Fredy Suter; Pilar Tornos; Dominique W Verhagen; Christopher H Cabell;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-09-12
Journal Detail:
Title:  American heart journal     Volume:  154     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-23     Completed Date:  2007-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1086-94     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, New York University School of Medicine, New York, NY, USA. dickes01@med.nyu.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Anti-Infective Agents / therapeutic use*
Cohort Studies
Endocarditis, Bacterial / complications*,  drug therapy,  microbiology
Female
Heart Valve Diseases / surgery
Humans
Male
Middle Aged
Risk Factors
Stroke / epidemiology*,  etiology
Chemical
Reg. No./Substance:
0/Anti-Infective Agents

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


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