Long term follow up of prosthetic valve endocarditis: what characteristics identify patients who were treated successfully with antibiotics alone?
Why the study?
Does antibiotic treatment alone prevent increased rates of reinfection, reoperation, or death compared to combined antibiotic and surgical treatment in patients with prosthetic valve endocarditis?
Key Points
- To identify clinical characteristics and predictors that enable safe treatment of prosthetic valve endocarditis using antibiotics alone without requiring reoperation.
- Retrospectively evaluated 49 episodes of definite prosthetic valve endocarditis diagnosed by Duke criteria between 1980 and 1997 at a single tertiary care center.
- Categorized patients into an antibiotic-only group (n = 10; mean follow-up of 41 ± 32 months) and a combined surgical plus antibiotic group (n = 39; mean follow-up of 45 ± 24 months).
- Compared survival and recurrence rates between groups using Kaplan-Meier survival curves and the log-rank test.
- Enterococcal infections were more frequent in the antibiotic group (50% vs. surgery group, p = 0.005), whereas staphylococcal infections (55%, p = 0.048), annular abscesses (p < 0.0001), and aortoventricular dehiscence (p = 0.02) predominated in the surgery group; no antibiotic-group patient had heart failure.
- Long-term follow-up showed late mortality was 18% in the antibiotic group versus 14% in the surgery group, five-year recurrent endocarditis was 16% versus 14%, event-related mortality was 3% versus 14%, and reoperation rates were 19% versus 14%.
Structured PICO
Does antibiotic treatment alone prevent increased rates of reinfection, reoperation, or death compared to combined antibiotic and surgical treatment in patients with prosthetic valve endocarditis?
P
Population
49 episodes of definite prosthetic valve endocarditis (Duke criteria) diagnosed at one institution between 1980 to 1997
I
Intervention
Antibiotic treatment alone
C
Comparator
Combined antibiotic and surgical treatment
O
Outcome
Late mortality, five year rates of recurrent endocarditis, event related mortality, and the need for reoperationhard clinical
Haemodynamically stable patients with non-staphylococcal prosthetic valve endocarditis can be safely treated with antibiotics alone without an increased rate of reinfection, reoperation, or death.
Authors
Discussion
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Implication
Supports antibiotic monotherapy in stable non-staphylococcal prosthetic valve endocarditis; leaves open confirmation by randomized trials.
Cite This Study
Truninger et al. (1999) studied this question.