Résumé
Five patients who had permanent pacemaker and infective endocarditis were analyzed. Diagnose was confirmed by a positive blood cultures in all patients and 2 of them had identifiable vegetation in the echocardiogram too. The etiologic agent was Staphylococcus aureus in 3, Staphylococcus epidermidis in 1 and Staphylococcus viridans in 1. Three patients were treated with antibiotics alone: one had no clinical conditions to be operated, one died before surgery and one had good response to antimicrobial therapy alone. Two patients were submitted to antibiotic therapy and surgical removal of the pacemaker system, without complications. It was concluded that the surgical removal of the pacemaker system, as soon as possible, is the choice's therapy
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Endocardite bactérienne/microbiologie , Infections à staphylocoques/microbiologie , Infections à streptocoques/microbiologie , Staphylococcus aureus , Staphylococcus epidermidis , Streptococcus , Échocardiographie , Endocardite bactérienne/diagnostic , Endocardite bactérienne/thérapie , Infections à staphylocoques/diagnostic , Infections à staphylocoques/thérapie , Infections à streptocoques/diagnostic , Infections à streptocoques/thérapieRésumé
Two patients with chronic valvular heart disease and myocardial infarction were assisted at our hospital. Both of them were febrile and only one had petechiae associated with signs of valvular involvement led to suspicion of infective endocarditis. Although blood cultures were negative, echocardiographic, surgical and anatomopathologic findings were compatible with infective endocarditis. They required cardiac surgery during the acute phase of the infection because they presented progressive hemodynamic deterioration and no satisfactory response to antimicrobial regimen too. One patient died at late follow-up (two weeks after the hospital discharge) and the other survived, but with signs of cardiac failure (class II of NYHA) one year after the procedure