Septic Endocarditis and Parenteral Feeding

To the Editor.— Doctors Alderson and Bernhardt attributed theCandidaendocarditis of the tricuspid valve to antibiotic therapy and the trauma of the central venous pressure (CVP) catheter (224:517, 1973). Perhaps an important factor not stressed was the use of the catheter for parenteral feeding. In the past 18 months we have seen, at autopsy, four patients with endocarditis of the tricuspid valve associated with the CVP catheter. In two of the patients, the valve lesions were destructive and heavily infected with gram-positive cocci, one of which was documented by culture to beStaphylococcus aureus. The other two cases had bland thrombotic vegetative lesions without significant valve damage. The catheters in the two infected cases were used for parenteral feedings, while in those patients with bland vegetations, the catheters were used only to monitor the CVP. Becker et al1reported three cases of endocarditis of the right heart associated