Why the study?
What clinical criteria differentiate sustained bacteremia with versus without proved infection in patients with prosthetic cardiac valves?
What clinical criteria differentiate sustained bacteremia with versus without proved infection in patients with prosthetic cardiac valves?
In patients with prosthetic valves and sustained bacteremia, late onset, gram-positive organisms, lack of an obvious source, and new murmurs strongly suggest prosthetic valve infection, which carries a very high mortality rate.
Answers are grounded in this paper and cite their sources.
These features may warrant heightened suspicion for prosthetic valve infection; leaves open prospective validation of diagnostic thresholds.
In 22 patients with prosthetic heart valves, 24 episodes of sustained bacteremia were analyzed to discover criteria that might help differentiate those bacteremias with (11 patients) and those without (13 patients) proved infection of the prosthetic valves. In nine of the patients with prosthetic-valve infection positive blood cultures developed 25 or more days after the operation (median, 60 days), with gram-positive organisms (10 of 11), no obvious source for bacteremia (11 of 11) and new or changing murmurs (10 of 11). The group without proved valvular infection had bacteremia earlier (median, 12 days), with gram-negative bacilli (nine of 13), and had obvious possible sources of bacteremia (12 of 13). Changes in murmurs did not develop. All patients with proved valvular infection died whereas seven of 13 without proved infection were cured with medical therapy alone.
No takes yet. Share an insight, caveat, or question.
Sande et al. (1972) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: