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Persistent bacteraemic infective endocarditis

Abstract number: 1733_976

Findova L., Demitrovicova A., Krcmery V., Kisac P., Marks P.

Objectives: Persistent bacteraemic infective endocarditis (PBIE) is defined as persistence of positive blood cultures for 3 or more days despite antibiotic therapy. The reason for persistence of bacteraemia is deficient or inappropriate selection of antimicrobials, resistant organism, foreign body or prosthetic endocarditis. Objective of the study was to analyse persistent IE.

Methods: Within 606 cases of IE in last 23 years in Slovakia, 85 (14%) fulfilled the definition and had positive blood cultures for 3 or more days (3 to 7 positive blood cultures). We compared these 85 cases of PBIE to 606 cases of all IE from the database of the national survey.

Results: Several risk factors were observed more frequently among persistent IE: elderly age (60% vs. 33%, p < 0.045), diabetes mellitus (26.9% vs. 11.4%, p < 0.03), prior cardiosurgery (20% vs. 9.9%), prior surgery (19.4% vs. 42.7%), p for both is 0.04, right side IE (17.6% vs 11.4%, p < 0.01) and prosthetic valve (32.9% vs 2.4%, p < 0.001). Also aetiology was different in persistent IE in comparison to all IE. Viridans streptococci (37.5% vs. 15.2%, p < 0.01), coagulase-negative staphylococci (51.8% vs. 21.9%, p < 0.02) and enterococci (23.5% vs. 7.6%, p < 0.01) were observed more frequently among persistent IE and vice versa, embolisation (7.1% vs. 35.5%, p < 0.01), rheumatic fever (9% vs 22.3%, p < 0.05) were less frequent. However, mortality and type of intervention (surgery, antimicrobials only) were similar in both groups. This surprising finding is difficult to explain because persistent bacteraemia in IE should be logically related with increased death rate.

Conclusion: Diabetics or elderly patients after prior surgery as well as those with prosthetic or right side endocarditis may suffer from PBIE with multiple positive blood cultures. However, risk of embolisation as well as mortality rate were surprisingly lower.

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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