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Enterococcal endocarditis: a comparison of patients with native and prosthetic valve endocarditis and analysis of risk factors of mortality

Abstract number: 1733_968

Fernández-Guerrero M., Goyenechea A., Salinas A., Fernández Roblas R., Fraile J., De Górgolas M.

Background: Enterococci are the third leading cause of infectious endocarditis. Mortality of enterococcal endocarditis although relatively low, has not changed in the last decades. We investigated the risk factors of mortality in a single institution and whether infections occurring on prosthetic valves are associated with a poorer prognosis.

Methods: Retrospective review of 44 consecutive episodes of enterococcal endocarditis with strict case definitions according to the modified Duke's criteria from a prospective observational cohort of cases of infectious endocarditis. The main outcome measure was in-hospital mortality. Stepwise logistic regression analysis was applied to identify risk factors for mortality.

Results: 27 patients (61.3%) had NVE and 17 (38.6%) PVE. Predisposing heart conditions were observed in 77.7% of patients with NVE. A portal of entry was suspected or determined in 38.2% and the genitourinary tract was the most common source of the infection (29.7%). Comorbidities were present in 52.2% of cases. Twelve episodes (25.5%) were acquired during hospitalisation (7 NVE and 5 PVE). Only 3 isolates of Enterococcus faecalis were highly-resistant to aminoglycosides. Eighteen patients (40.9%) needed valve replacement due to cardiac failure or relapse. The comparison between cases of NVE and PVE did not show differences regarding symptoms, complications, or the need of surgical treatment (12/44% vs 6/35%; ns). The mean time to diagnosis was shorter in patients with PVE than NVE (30±18 days vs 9±6 days) and murmurs were more commonly found in patients with NVE (25/96% vs 10/59%; p 0.02). Eight out of 47 (17%) episodes were fatal. The mortality rate of patients with PVE and NVE were not significantly different (2/11.7% vs 6/22% respectively; ns). Age over seventy (p 0.05), heart failure (OR 1.61;CI:1.15–2.25; p 0.001) and nosocomial acquisition (OR 8.05; 95% CI:1.50–43.2; p 0.01) were associated with mortality. In the multivariate analysis, only nosocomial acquisition increased the risk of mortality.

Conclusions: Enterococcal endocarditis occurring on prosthetic valves are not associated with an increased need of valve replacement nor mortality. In this series, nosocomial acquisition of endocarditis was the most important factor determining outcome.

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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