Endocarditis infecciosa por enterococo: descripción de 12 casos / Enterococcal infective endocarditis: description of 12 cases

Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve,and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them

[Enterococcal infective endocarditis: description of 12 cases]. / Endocarditis infecciosa por enterococo: descripción de 12 casos.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.