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029 CLINICAL PROFILE OF 272 CONSECUTIVE CASES OF INFECTIVE ENDOCARDITIS
S10
Abstracts from the 10th International Symposium on Modern Concepts in Endocarditis & Cardiovascular Infections
029 CLINICAL PROFILE OF 272 CONSECUTIVE CASES OF INFECTIVE ENDOCARDITIS L. Soriente1 , L. Greco2 , R. Ascoli1 , G. Mastrogiovanni3 , V. Paolillo1 , M. Mazzeo2 . 1 Struttura Complessa di Cardiologia, 2 Unit` a Operativa di Malattie Infettive, 3 Struttura Complessa di Cardiochirurgia, Azienda Ospedaliera S. Giovanni di Dio e Ruggi d’Aragona Salerno, Italy Infective endocarditis is still considered a severe cardiac disease: although uncommon (annual incidence 1.7 6.2 cases per 100,000 population), endocarditis constitutes a potentially life-threatening disease (mortality rate 20 25%), with increasing incidence. From 1992 to 2008 we identified 272 consecutive cases of I.E., 13 cases per year in the first 9 years, and an annual rate of 21 cases per year in the last 8 years. The age ranged from 6 to 82 years with increasing incidence among elderly in the last 8 years. In the last 8 years I.E. was more frequent among elderly patients: we have now 75% of patients over 61 y. versus 57% in the first period. Vegetations were observed in 75% of NV, in 17% PV, in 8% of observed intracardiac catheters. Endocarditis associated with intracardiac catheters had an important increase in the last 8 years; from 3% in the first 9 years to 9% in the last period. Predisposing factors in our patients were degenerative valve lesions (40%), congenital heart disease (17%), end stage kidney failure (13%), immunosuppression (8%), IV drug use (4%). The infective organisms were identified in 63% patients with decisive predominance of gram positive (streptococci and staphylococci), especially among patients over 60. Predisposing conditions were more evident in elders (90% versus 40%). Complications were more frequent in older patients; 20% of patients had thromboembolic events; among these patients 50% had proven large size mobile vegetations (>10 mm); in 28% severe valvular regurgitation was documented; in 11% abscesses and pseudoaneurism were displayed; 12% had valvular dehiscence. Preoperative abscesses were more frequently observed after 1999 (5% versus 17% after 1999), when we started performing TEE to all endocarditis patients; TEE is more sensitive in detecting intracardiac complications. Antibiotic therapy was effective in 65%, with 9% in hospital mortality rate; 35% underwent surgery, with 3.7% operative mortality in NVE versus 30% in PVE. Surgery was performed promptly as aggressive treatment of I.E. (less than 14 d.) in 24% of cases, when rapid onset of valvular destruction was documented, despite efficacy of antimicrobial therapy against highly susceptible strains. Between 1992 and 2008, 39 patients were admitted with right sided IE with 14% increase in the last 3 y., due to escalation of population with risk factors: Tesio catheters, intracavitary devices (PM-CD), IVDA, immunocompromised. 30% of our patients with right side IE had Tesio catheters for HD; the main clinical presentation was persistent fever in all patients, with pleuropolmonary manifestations in 17%; staphylococcus epidermidis was the causative agent in 60% of patients. Albeit effectiveness of prolonged antibiotherapy the removal of infected material was the only method to cure definitively intracavitary device associated endocarditis.
Abstracts from the 10th International Symposium on Modern Concepts in Endocarditis & Cardiovascular Infections
029 CLINICAL PROFILE OF 272 CONSECUTIVE CASES OF INFECTIVE ENDOCARDITIS L. Soriente1 , L. Greco2 , R. Ascoli1 , G. Mastrogiovanni3 , V. Paolillo1 , M. Mazzeo2 . 1 Struttura Complessa di Cardiologia, 2 Unit` a Operativa di Malattie Infettive, 3 Struttura Complessa di Cardiochirurgia, Azienda Ospedaliera S. Giovanni di Dio e Ruggi d’Aragona Salerno, Italy Infective endocarditis is still considered a severe cardiac disease: although uncommon (annual incidence 1.7 6.2 cases per 100,000 population), endocarditis constitutes a potentially life-threatening disease (mortality rate 20 25%), with increasing incidence. From 1992 to 2008 we identified 272 consecutive cases of I.E., 13 cases per year in the first 9 years, and an annual rate of 21 cases per year in the last 8 years. The age ranged from 6 to 82 years with increasing incidence among elderly in the last 8 years. In the last 8 years I.E. was more frequent among elderly patients: we have now 75% of patients over 61 y. versus 57% in the first period. Vegetations were observed in 75% of NV, in 17% PV, in 8% of observed intracardiac catheters. Endocarditis associated with intracardiac catheters had an important increase in the last 8 years; from 3% in the first 9 years to 9% in the last period. Predisposing factors in our patients were degenerative valve lesions (40%), congenital heart disease (17%), end stage kidney failure (13%), immunosuppression (8%), IV drug use (4%). The infective organisms were identified in 63% patients with decisive predominance of gram positive (streptococci and staphylococci), especially among patients over 60. Predisposing conditions were more evident in elders (90% versus 40%). Complications were more frequent in older patients; 20% of patients had thromboembolic events; among these patients 50% had proven large size mobile vegetations (>10 mm); in 28% severe valvular regurgitation was documented; in 11% abscesses and pseudoaneurism were displayed; 12% had valvular dehiscence. Preoperative abscesses were more frequently observed after 1999 (5% versus 17% after 1999), when we started performing TEE to all endocarditis patients; TEE is more sensitive in detecting intracardiac complications. Antibiotic therapy was effective in 65%, with 9% in hospital mortality rate; 35% underwent surgery, with 3.7% operative mortality in NVE versus 30% in PVE. Surgery was performed promptly as aggressive treatment of I.E. (less than 14 d.) in 24% of cases, when rapid onset of valvular destruction was documented, despite efficacy of antimicrobial therapy against highly susceptible strains. Between 1992 and 2008, 39 patients were admitted with right sided IE with 14% increase in the last 3 y., due to escalation of population with risk factors: Tesio catheters, intracavitary devices (PM-CD), IVDA, immunocompromised. 30% of our patients with right side IE had Tesio catheters for HD; the main clinical presentation was persistent fever in all patients, with pleuropolmonary manifestations in 17%; staphylococcus epidermidis was the causative agent in 60% of patients. Albeit effectiveness of prolonged antibiotherapy the removal of infected material was the only method to cure definitively intracavitary device associated endocarditis.