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Differences between early and late prosthetic valve endocarditis in a series of 169 cases

Abstract number: 1733_751

Plata A., Reguera J.M., Alarcon A., Galvez J., Ruiz J., de la Torre J., Lomas J.M., Hidalgo-Tenorio C., Haro J.L., Colmenero for the Andalusian Group for the Study of Cardiovascular Infections J.D.

Objectives: To determine the clinical, epidemiological, diagnostic, and therapeutic differences between early (EP) and late (LP) prosthetic valve endocarditis in a series of 169 cases of prosthetic valve endocarditis.

Method: Descriptive study of 169 cases of prosthetic valve endocarditis from a series of 696 left-sided infectious endocarditis from six second- or third-level Andalusian hospitals from 1985 to 2005. Early prosthetic endocarditis was considered up to 12 months after surgery.

Results: No major differences in age, gender or valve affected were found. Clinical presentation was more acute in EP (15.7±18 days) than in LP (41±107 days) and there were more congestive heart failure (NYHA III/IV: 22.7% vs 14.8%). Other clinical signs like fever, splenomegaly and constitutional syndrome were more frequent in LP than EP.

Clinical complications (CNS affectation, systemic embolisms, ocular or skin involvement) were more frequently registered in LP, but the complications related to poorer prognosis (renal failure, septic shock or distress) were more frequent in EP.

Microbiology: EP: S. coagulase negative (50%), S. aureus (13%). LP: S. coagulase negative (22.8%), S. viridans (20.8%). Vancomicin was needed in 63% of EP and 27.7% of LP. Transthoracic echocardiography reaveled diagnosis more frequently in EP than in LP (66.6% vs 41.2%) and so did transoesophageal echocardiography (91% vs 84.7%). 63.2% of the EP and ``only'' 41.6% of the LE needed surgery. The most frequent indication for surgery for both was right ventricular failure. The complications found in ultrasound or surgery (abscess, fistula, ...) were more frequent in EP (66%) than in LP (27.7%). Related mortality was 55.9% in EP versus 31.7% in LP.

Conclusions: Attending the different physiopathology between EP and LP we have found the following differences:

1. LP is more insidiosus and needs more days of simptoms for its diagnosis.

2. Transoesophageal echocardiography is better than transthoracic echocardiography for the diagnosis in EP and LP.

3. S. coagulase negative is still the most frequent microrganism in EP and in LP the aetiology is similar to native endocarditis.

4. EP patients develop more complications (annular abscess, fistula, ...) leaving them in a worse basal situation (NYHA) and a greater need for surgery together with an increased mortality.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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