10-year epidemiology of operated endocarditis patients at a tertiary university hospital in Germany a preliminary analysis
Abstract number: 1733_977
Zauner F., Glück T., Salzberger B., Ehrenstein B., Birnbaum D., Linde H.J., Audebert F.X.
Objectives: To describe retrospectively the epidemiology and clinical presentation among patients receiving heart valve surgery for endocarditis at the Regensburg University Medical Center and to compare these data with other national and international cohort studies. To correlate pathogen types with anatomic location and histopathologic damage patterns of affected heart valves.
Methods: 211 intraoperatively confirmed endocarditis episodes of 205 patients were reviewed from September 1994 to February 2005. Data was obtained from surgical records, microbiology results, histopathology reports, in-house charts, and medical charts of admitting hospitals.
Results: Altogether 252 valves were replaced or reconstructed. The median age at the time of operation was 61 years with female patients accounting for 25% of all patients. Heart valves were affected as follows: aortic valve (49.3%), mitral valve (28%), aortic and mitral valve (17.5%), and valves of the right heart (5.2%). Mechanical valves were inserted in 58%, biological valves in 19% of the episodes. Valve reconstruction without replacement was performed in 13% and any kind of combined multiple valve operation was done in 9% of the operations. Postoperative diagnoses were classified into florid natural valve endocarditis (NVE; 58%), florid prosthetic valve endocarditis (PVE; 12%), status after NVE (26%), and status after PVE (4%). As predisposing factor, diabetes mellitus was elicitable in 24% of all patients. Causative organisms could be delineated in 70% of the episodes. Streptococcus viridans spp. accounted for 30.8%, Staphylococcus aureus for 28.7%, Enterococcus spp. for 14.7%, Staphylococcus epidermidis for 9.8%, infections with any two pathogens at a time for 5.6%, Streptococcus spp. for 3.5% and other species for the remaining 7% of episodes with delineation of a causative organism. Among the episodes with confirmed Staphylococcus aureus, the aortic or mitral valves were approximately equally affected. In-hospital mortality after cardiac surgery was 10.4% from the day of surgery and the following 14 days. After 30 days, the mortality rate slightly increased by 3.3% and accounted for 13.7%.
Conclusions: The distribution of affected valves and the 30-days mortality rate in our cohort is consistent with results from current international studies. The spectrum of causative organsims represents spectra observed in similar studies, although Staph. aureus was delineated at a lower rate.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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