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. 2000 May;83(5):525–530. doi: 10.1136/heart.83.5.525

Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study

J Castillo 1, M Anguita 1, A Ramirez 1, J Siles 1, F Torres 1, D Mesa 1, M Franco 1, I Munoz 1, M Concha 1, F Valles 1
PMCID: PMC1760814  PMID: 10768901

Abstract

OBJECTIVE—To determine the clinical features and long term prognosis of infective endocarditis in patients who were not drug addicts.
DESIGN—Prospective case series.
SETTING—A university hospital that is both a referral and a primary care centre.
PATIENTS—138 consecutive cases of infective endocarditis diagnosed and treated from January 1987 to March 1997.
RESULTS—Mean patient age was 44 (20) years old. 95 patients (69%) had native valve endocarditis and 43 (31%) had prosthetic valve endocarditis. Staphylococci were the causal microorganisms in 34% of cases and streptococci in 33%. Severe complications occurred in 83% of patients and 51% of patients underwent surgery during the active phase (22% was emergency surgery). Inpatient mortality was 21%. During a follow up of 56 (44) months, 10 patients (9%) needed late cardiac surgery and seven (5% of the whole series) died. Overall 10 year survival was 71%. There were no significant differences in survival depending on the type of treatment received during the hospital stay (medical or combined medical-surgical).
CONCLUSIONS—A high early surgery rate is related to good long term results and does not increase in-hospital mortality. Medical treatment, however, also offers favourable long term results in cases of responsive infective endocarditis where poor prognostic factors are absent.


Keywords: infective endocarditis; staphylococci; streptococci

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Figure 1  .

Figure 1  

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Kaplan-Meier survival curves. Follow up event free survival in a series of 138 cases of infective endocarditis.

Figure 2  .

Figure 2  

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Kaplan-Meier survival curves. Follow up event free survival in 109 survivors to the active phase.

Figure 3  .

Figure 3  

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Overall survival curves according to the type of infective endocarditis. Differences between native (NVE) and prosthetic (PVE) valve endocarditis, and between late and one year PVE, are significant.

Figure 4  .

Figure 4  

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Overall survival curves in 109 survivors to the active phase according to the type of infective endocarditis. Differences between NVE and all PVE are significant but not between NVE and late PVE.

Figure 5  .

Figure 5  

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Follow up event free survival curves in 109 survivors to the active phase depending on the treatment (medical or combined medical-surgical) received in the active phase. No significant differences in survival were observed.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acar J., Michel P. L., Varenne O., Michaud P., Rafik T. Surgical treatment of infective endocarditis. Eur Heart J. 1995 Apr;16 (Suppl B):94–98. doi: 10.1093/eurheartj/16.suppl_b.94. [DOI] [PubMed] [Google Scholar]
  2. Calderwood S. B., Swinski L. A., Karchmer A. W., Waternaux C. M., Buckley M. J. Prosthetic valve endocarditis. Analysis of factors affecting outcome of therapy. J Thorac Cardiovasc Surg. 1986 Oct;92(4):776–783. [PubMed] [Google Scholar]
  3. Cormier B., Vahanian A. Echocardiography and indications for surgery. Eur Heart J. 1995 Apr;16 (Suppl B):68–71. doi: 10.1093/eurheartj/16.suppl_b.68. [DOI] [PubMed] [Google Scholar]
  4. Delahaye F., Ecochard R., de Gevigney G., Barjhoux C., Malquarti V., Saradarian W., Delaye J. The long term prognosis of infective endocarditis. Eur Heart J. 1995 Apr;16 (Suppl B):48–53. doi: 10.1093/eurheartj/16.suppl_b.48. [DOI] [PubMed] [Google Scholar]
  5. Delahaye F., Goulet V., Lacassin F., Ecochard R., Selton-Suty C., Hoen B., Etienne J., Briançon S., Leport C. Characteristics of infective endocarditis in France in 1991. A 1-year survey. Eur Heart J. 1995 Mar;16(3):394–401. doi: 10.1093/oxfordjournals.eurheartj.a060923. [DOI] [PubMed] [Google Scholar]
  6. Durack D. T., Lukes A. S., Bright D. K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200–209. doi: 10.1016/0002-9343(94)90143-0. [DOI] [PubMed] [Google Scholar]
  7. Hermans P. E. The clinical manifestations of infective endocarditis. Mayo Clin Proc. 1982 Jan;57(1):15–21. [PubMed] [Google Scholar]
  8. Hogevik H., Olaison L., Andersson R., Lindberg J., Alestig K. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore) 1995 Nov;74(6):324–339. doi: 10.1097/00005792-199511000-00003. [DOI] [PubMed] [Google Scholar]
  9. Horstkotte D., Piper C., Niehues R., Wiemer M., Schultheiss H. P. Late prosthetic valve endocarditis. Eur Heart J. 1995 Apr;16 (Suppl B):39–47. doi: 10.1093/eurheartj/16.suppl_b.39. [DOI] [PubMed] [Google Scholar]
  10. Ivert T. S., Dismukes W. E., Cobbs C. G., Blackstone E. H., Kirklin J. W., Bergdahl L. A. Prosthetic valve endocarditis. Circulation. 1984 Feb;69(2):223–232. doi: 10.1161/01.cir.69.2.223. [DOI] [PubMed] [Google Scholar]
  11. Malquarti V., Saradarian W., Etienne J., Milon H., Delahaye J. P. Prognosis of native valve infective endocarditis: a review of 253 cases. Eur Heart J. 1984 Oct;5 (Suppl 100):11–20. doi: 10.1093/eurheartj/5.suppl_c.11. [DOI] [PubMed] [Google Scholar]
  12. Mullany C. J., Chua Y. L., Schaff H. V., Steckelberg J. M., Ilstrup D. M., Orszulak T. A., Danielson G. K., Puga F. J. Early and late survival after surgical treatment of culture-positive active endocarditis. Mayo Clin Proc. 1995 Jun;70(6):517–525. doi: 10.4065/70.6.517. [DOI] [PubMed] [Google Scholar]
  13. Sandre R. M., Shafran S. D. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis. 1996 Feb;22(2):276–286. doi: 10.1093/clinids/22.2.276. [DOI] [PubMed] [Google Scholar]
  14. Schulz R., Werner G. S., Fuchs J. B., Andreas S., Prange H., Ruschewski W., Kreuzer H. Clinical outcome and echocardiographic findings of native and prosthetic valve endocarditis in the 1990's. Eur Heart J. 1996 Feb;17(2):281–288. doi: 10.1093/oxfordjournals.eurheartj.a014846. [DOI] [PubMed] [Google Scholar]
  15. Tornos M. P., Almirante B., Soler Soler J. Historia natural y pronóstico de la endocarditis infecciosa. Rev Esp Cardiol. 1998;51 (Suppl 2):40–43. [PubMed] [Google Scholar]
  16. Tornos M. P., Permanyer-Miralda G., Olona M., Gil M., Galve E., Almirante B., Soler-Soler J. Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study. Ann Intern Med. 1992 Oct 1;117(7):567–572. doi: 10.7326/0003-4819-117-7-567. [DOI] [PubMed] [Google Scholar]
  17. Tornos P., Almirante B., Olona M., Permanyer G., González T., Carballo J., Pahissa A., Soler-Soler J. Clinical outcome and long-term prognosis of late prosthetic valve endocarditis: a 20-year experience. Clin Infect Dis. 1997 Mar;24(3):381–386. doi: 10.1093/clinids/24.3.381. [DOI] [PubMed] [Google Scholar]
  18. Von Reyn C. F., Levy B. S., Arbeit R. D., Friedland G., Crumpacker C. S. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981 Apr;94(4 Pt 1):505–518. doi: 10.7326/0003-4819-94-4-505. [DOI] [PubMed] [Google Scholar]
  19. Werner G. S., Schulz R., Fuchs J. B., Andreas S., Prange H., Ruschewski W., Kreuzer H. Infective endocarditis in the elderly in the era of transesophageal echocardiography: clinical features and prognosis compared with younger patients. Am J Med. 1996 Jan;100(1):90–97. doi: 10.1016/s0002-9343(96)90017-0. [DOI] [PubMed] [Google Scholar]
  20. van der Meer J. T., Thompson J., Valkenburg H. A., Michel M. F. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med. 1992 Sep;152(9):1863–1868. doi: 10.1001/archinte.152.9.1863. [DOI] [PubMed] [Google Scholar]

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