Contemporary clinical profile and outcome of prosthetic valve endocarditis.

By Andrew Wang, E. Athan, P. Pappas, V. Fowler, L. Olaison, C. Paré, B. Almirante, P. Muñoz, M. Rizzi, C. Naber and 9 more. Journal of the American Medical Association (JAMA), 2007

647 citations recorded by the source corpus.

CONTEXT Prosthetic valve endocarditis (PVE) is associated with significant mortality and morbidity. The contemporary clinical profile and outcome of PVE are not well defined. OBJECTIVES To describe the prevalence, clinical characteristics, and outcome of PVE, with attention to health care-associated infection, and to determine prognostic factors associated with in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational cohort study conducted at 61 medical centers in 28 countries, including 556 patients with definite PVE as defined by Duke University diagnostic criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to August 2005. MAIN OUTCOME MEASURE In-hospital mortality. RESULTS Definite PVE was present in 556 (20.1%) of 2670 patients with infective endocarditis. Staphylococcus aureus was the most common causative organism (128 patients [23.0%]), followed by coagulase-negative staphylococci (94 patients [16.9%]). Health care-associated PVE was present in 203 (36.5%) of the overall cohort. Seventy-one percent of health care-associated PVE occurred within the first year of valve implantation, and the majority of cases were diagnosed after the early (60-day) period. Surgery was performed in 272 (48.9%) patients during the index hospitalization. In-hospital death occurred in 127 (22.8%) patients and was predicted by older age, health care-associated infection (62/203 [30.5%]; adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.08-2.44; P = .02), S aureus infection (44/128 [34.4%]; adjusted OR, 1.73; 95% CI, 1.01-2.95; P = .05), and complications of PVE, including heart failure (60/183 [32.8%]; adjusted OR, 2.33; 95% CI, 1.62-3.34; P<.001), stroke (34/101 [33.7%]; adjusted OR, 2.25; 95% CI, 1.25-4.03; P = .007), intracardiac abscess (47/144 [32.6%]; adjusted OR, 1.86; 95% CI, 1.10-3.15; P = .02), and persistent bacteremia (27/49 [55.1%]; adjusted OR, 4.29; 95% CI, 1.99-9.22; P<.001). CONCLUSIONS Prosthetic valve endocarditis accounts for a high percentage of all cases of infective endocarditis in many regions of the world. Staphylococcus aureus is now the leading cause of PVE. Health care-associated infection significantly influences the clinical characteristics and outcome of PVE. Complications of PVE strongly predict in-hospital mortality, which remains high despite prompt diagnosis and the frequent use of surgical intervention.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Surgery

View Paper: https://www.semanticscholar.org/paper/a0a25a211cea003d221a8ca742551139d954e5f4

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Citations in the corpus

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “I B Early surgery (during initial hospitalization befor e completion of a full therapeutic course of antibiotics) for IE is indicated in patients with evidence of persistent infection as manifested by persistent bacteremia or fevers lasting longer than 5 to 7 days after onset of appropriate antimicr”
2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “I B Early surgery (during initial hospitalization befor e completion of a full therapeutic course of antibiotics) for IE is indicated in patients with evidence of persistent infection as manifested by persistent bacteremia or fevers lasting longer than 5 to 7 days after onset of appropriate antimicr”
Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. (2012, methodology): “The mode of IE acquisition was categorized on the basis of 3 mutually exclusive classes: (1) injection drug use–associated IE, (2) community-acquired IE, and (3) healthcare-associated IE, which included nosocomial and nonnosocomial IE, according to prior definitions [6, 14–16] described in detail in”
GUIDELINES ON THE PREVENTION, DIAGNOSIS, AND TREATMENT OF INFECTIVE ENDOCARDITIS (NEW VERSION 2009) (2010, neutral): “Similar data have been reported by others.(106,283) Although no evidence-based data exist, a surgical strategy is recommended for PVE in high-risk subgroups identified by prognostic assessment, i.”