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The changing clinical aspects of infective endocarditis: descriptive review of 90 episodes in a French teaching hospital and risk factors for death.
Mouly, S; Ruimy, R; Launay, O; Arnoult, F; Brochet, E; Trouillet, J-L; Leport, C; Wolff, M.
Afiliación
  • Mouly S; Department of Intensive Care and Infectious Diseases, Bichat-Claude Bernard Hospital, Paris, France. stephane.mouly@lrb.ap-hop-paris.fr
J Infect ; 45(4): 246-56, 2002 Nov.
Article en En | MEDLINE | ID: mdl-12423613
ABSTRACT

OBJECTIVE:

We wanted to describe the epidemiological aspects of infective endocarditis (IE) in a French hospital and identify the prognostic factors.

METHODS:

We reviewed the clinical, echocardiographic and microbiological features, and the outcome of 89 patients (90 episodes, median age 60 years) with IE over 18 months. Logistic regression analysis was used to identify prognostic factors for death.

RESULTS:

A native valve was involved in 68 cases (75.5%); in 7 of these the patient was an intravenous drug user. A prosthetic valve was involved in 22 cases (24.5%); 5 of these were of early onset. Diagnosis was definite in 87% of cases. Median time to diagnosis was 3 days. Twenty-five patients (28%) were immunocompromised. A portal of entry, usually cutaneous, was identified in 65% of cases. Sixty-two percent of patients had an underlying heart disorder, usually degenerative. The infection involved the left heart in more than 75% of cases. One or more vegetations were detected in 75% of cases. The median size of vegetation was 15 mm. Isolated agents were mainly staphylococci (n=40 (44%), including 12 coagulase-negative isolates), and streptococci (n=23 (25%), including 7 enterococci). In 11 cases (12%), cultures remained negative. Nineteen episodes were nosocomial and Staphylococcus aureus was implicated in 11 of them. Fifty percent of patients had at least one complication heart failure (n=42), kidney failure (n=44), embolism (n=35), septic shock (n=19). Surgery was performed in 49 cases (54%) due to heart failure (n=19), cerebral embolism (n=12), and/or severe valve lesions (n=27). Eighteen patients died, 10 of whom were infected with S. aureus. Nosocomial IE (P=0.0008), heart failure (P=0.004) and prosthetic valve (P=0.01), but not S. aureus were independently associated with death.

CONCLUSIONS:

S. aureus was the main microorganism isolated in our patients. However, it was not independently predictive of fatal outcome.
Asunto(s)
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Endocarditis Bacteriana / Hospitales Universitarios Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: J Infect Año: 2002 Tipo del documento: Article País de afiliación: Francia
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Endocarditis Bacteriana / Hospitales Universitarios Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: J Infect Año: 2002 Tipo del documento: Article País de afiliación: Francia