SFGH am report pearls: endocarditis

    • AHA/ACC guideline for the management of patients with valvular heart disease
      • Class 1 indications for early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics):
        • valve dysfunction resulting in HF (level of evidence: B)
        • left sided endocarditis from staph aureus, fungal, or other highly resistant organisms (level of evidence: B)
          • staph prosthetic valve endocarditis is associated with a mortality rate as high as 70%
        • heart block, annular or aortic abscess, or destructive penetrating lesions (level of evidence: B)
        • persistent infection manifest by persistent bacteremia or fevers lasting longer than 5-7 days after onset of appropriate antimicrobial therapy (level of evidence: B)
        • patients with prosthetic valve endocarditis presenting with relapsing infection after a complete course of antibiotics and subsequent negative blood cultures without other source for portal of infection (level of evidence: C)
  • reminder on level of evidence interpretation: 
  • level of evidence A: data from multiple randomized clinical trials
  • level of evidence B: data from single randomized trial or nonrandomized studies
  • level of evidence C: consensus opinion of experts

aha endocarditis figure

  • Rabkin et al (2012)
    • retrospecitve review of 197 consecutive operations for infective endocarditis at a single institution; compares patients with IVDU (n = 64) and non-IVDU history (n = 133)
    • survival after 5 years of follow-up was 47% for patients with IVDU and 71% for non-IVDU (similar 30 day survival)
    • IVDU was an independent risk factor for diminished survival (p=0.03), but not for reoperation
    • 43 patients had preoperative septic cerebral emboli, none had a perioperative hemorrhagic event

Nishimura RA, Otto CM, Bonow RO, et al. 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 Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.

Rabkin DG, Mokadam NA, Miller DW, et al. Long-term outcome for the surgical treatment of infective endocarditis with a focus on intravenous drug users. Ann Thorac Surg 2012; 93:51.

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