Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario / Infectious endocarditis: short and long term results in 261 cases managed by a multidisciplinary approach

RESUMO

Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Cat-lica de Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ñ 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85 percent of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91 percent of aortic and 96 percent of mitral IE, rupture or prosthesis dehiscence in 67 percent of aortic and 52 percent of mitral IE and abscesses in 51 percent of aortic and 15 percent of mitral IE. Fifty one percent developed heart failure and 34 percent had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27 percent). Of all patients, 40 percent were treated exclusively with antibiotics, 52 percent were operated on and 8 percent had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3 percent 13 percent in the medical, 9 percent in the surgical and 81 percent in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73 percent at 5 years and 66 percent at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE