- Email: [email protected]
057 THE FREQUENCY AND FEATURES OF INFECTIVE ENDOCARDITIS IN NEWBORN AND INFANTS WITH SEVERE SEPSIS
Frail Patients younger patients. Age was not a predictor of in-hospital mortality according to multivariable analysis. Conclusions: Age per se, is not a predictor of in-hospital mortality in IE. Endocarditis in octogenarians has a more insidious and benign clinical course. The likelihood of transesophageal echocardiography for the detection of vegetations is lower in octogenarians. Surgery in elderly patients with IE is a good alternative to medical treatment. 056 INFECTIVE ENDOCARDITIS IN ELDERLY PATIENTS OVER 65 YEARS A. Slavcovici1 *, A. Radulescu1 , N. Hagau2 , D. Tatulescu1 , D. Bedeleanu3 , M. Barsan3 , A. Topan1 , C. Marcu1 . 1 University of Medicine and Pharmacy, Infectious Diseases, Cluj-Napoca, Romania, 2 County Teaching Hospital, Anesthesiology and Intensive Care, Cluj-Napoca, Romania, 3 “Nicolae Stancioiu” Heart Institute, Cardiovascular Surgery, Cluj-Napoca, Romania Introduction: Increasing medium life span and the impact of interventional medicine in individuals over 65 years is reflected in the morbidity and the etiology of infective endocarditis (IE) in this group of age. Objectives: The evaluation of the epidemiological, bacteriologic features and the most encountered complications of IE in patients over 65 years. Methods: From 1998 to 2008, 270 consecutive episodes of definite IE, according to modified Duke criteria, admitted in the University Hospital of Infectious Diseases Cluj-Napoca were retrospectively rewieved. We compared 62 episodes of IE in patients over 65 years with 208 IE in patients under this age. The data base and statistical analysis were done in EPIINFO6 software. Results: Among 270 episodes of IE, 62 (23%) occurred in patients over 65 years, median 68 years (range of age 65 89 years), the sex ratio M/F was 1.3/1. A prosthetic valve IE was identified in 26% of patients over 65 years. Within the 62 cases of IE in the elderly, 34% were considered nosocomial infections. Case-fatality rate did not differ in the two subgroups (6.4% vs 6.7%). Invasive procedures or genitourinary diseases were significantly associated with IE in patients over 65 years in comparison with those of less than 65 years (p = 0.001, OR = 6.68, CI [2.8 16]). Other possible causes of bacteremia were gastrointestinal invasive procedures or chronic digestive diseases (11%). The etiology was dominated by Gram-positive cocci (83%): Enterococcus spp. 32%, staphylococci 24%, oral streptococci 17% and other streptococci 12%. We found a significant correlation between IE in patients over 65 years and enterococcal etiology (p = 0.002, OR = 3.68, CI [1.4 9.5]). There were no significant associations between the comparison subgroups with clinical manifestations, major complications, in-hospital mortality, the need of surgical treatment. Conclusions: Within our IE episodes, the elderly patients represent a major subgroup and nosocomial IE was found in one third. Significant correlations were found for genitourinary invasive procedures and the enterococcal etiology. These findings are most useful in the management of IE.
S21
057 THE FREQUENCY AND FEATURES OF INFECTIVE ENDOCARDITIS IN NEWBORN AND INFANTS WITH SEVERE SEPSIS M. Soboleva1 *, E. Soboleva1 , M. Skobljakova2 . 1 Novosibirsk State Medical University, Pediatric, Novosibirsk, Russian Federation, 2 Regional Hospital N1, Cardiology/Rheumatology Unit, Novosibirsk, Russian Federation Background: Patient with sepsis is the special “risk group” of development Infective Endocarditis (IE) due bacteremia, endothelium damaging, thrombinemia, more invasive manipulation and immunological immature. Methods: 732 case of severe sepsis: 373 patient (pts) have survived and 449 pts died. All child had not congenital heart disease and was in age from few days till 12 month, study period went from Jan. 1988 till Dec. 2008. Duration and kind of bacteremia was taken into account. The diagnosis of IE was strictly defined according to modified Duke criteria. In the population of patients who died, the gross morphology, histological assay and post-mortem microbiological investigation was realized. Results: The main reasons of the death in septic patient included infective shock and multiple organ failure (MOF) and IE as a main reason of the death not once was recorded. The frequency IE in surviving from sepsis population was 0.8% (3 pts). It was acute (2 pts) and subacute (1 pt) IE; causative pathogens were S. aureus (2 pts), E. faecalis + C. albicans (1 pt) with multivalvular damaging. Surgical intervention in 100% was needed. In population who died, IE wasn’t so clear before death and was special post-mortem discovery in 7 cases (1.6%). In 5 of 7 cases there was distinct prevalence of myocardium and pericardium damaging: multiple abscess and purulent pericarditis. In all cases there was multivalvular damaging with little size of vegetations; the mitral valve was more affected, than aortal, tricuspid insufficiency was permanent. Causative pathogen of IE in this group was S. aureus (3 pts), S. pyogenes + C. albicans (2 pts), P. aeruginosae (1 pt), P. mirabilis (1 pt). Conclusion: Despite our expectation due existing multiple risk factors for IE in newborn and infants with severe sepsis IE still rare disease in this population. The myocardium and pericardium involvement in inflammation sometimes more strongly vs endocardium. In surviving population IE is very severe disease with high necessity of surgeon intervention.
S21
057 THE FREQUENCY AND FEATURES OF INFECTIVE ENDOCARDITIS IN NEWBORN AND INFANTS WITH SEVERE SEPSIS M. Soboleva1 *, E. Soboleva1 , M. Skobljakova2 . 1 Novosibirsk State Medical University, Pediatric, Novosibirsk, Russian Federation, 2 Regional Hospital N1, Cardiology/Rheumatology Unit, Novosibirsk, Russian Federation Background: Patient with sepsis is the special “risk group” of development Infective Endocarditis (IE) due bacteremia, endothelium damaging, thrombinemia, more invasive manipulation and immunological immature. Methods: 732 case of severe sepsis: 373 patient (pts) have survived and 449 pts died. All child had not congenital heart disease and was in age from few days till 12 month, study period went from Jan. 1988 till Dec. 2008. Duration and kind of bacteremia was taken into account. The diagnosis of IE was strictly defined according to modified Duke criteria. In the population of patients who died, the gross morphology, histological assay and post-mortem microbiological investigation was realized. Results: The main reasons of the death in septic patient included infective shock and multiple organ failure (MOF) and IE as a main reason of the death not once was recorded. The frequency IE in surviving from sepsis population was 0.8% (3 pts). It was acute (2 pts) and subacute (1 pt) IE; causative pathogens were S. aureus (2 pts), E. faecalis + C. albicans (1 pt) with multivalvular damaging. Surgical intervention in 100% was needed. In population who died, IE wasn’t so clear before death and was special post-mortem discovery in 7 cases (1.6%). In 5 of 7 cases there was distinct prevalence of myocardium and pericardium damaging: multiple abscess and purulent pericarditis. In all cases there was multivalvular damaging with little size of vegetations; the mitral valve was more affected, than aortal, tricuspid insufficiency was permanent. Causative pathogen of IE in this group was S. aureus (3 pts), S. pyogenes + C. albicans (2 pts), P. aeruginosae (1 pt), P. mirabilis (1 pt). Conclusion: Despite our expectation due existing multiple risk factors for IE in newborn and infants with severe sepsis IE still rare disease in this population. The myocardium and pericardium involvement in inflammation sometimes more strongly vs endocardium. In surviving population IE is very severe disease with high necessity of surgeon intervention.