European Heart Journal Advance Access originally published online on January 25, 2007
European Heart Journal 2007 28(6):760-765; doi:10.1093/eurheartj/ehl486
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Definition, clinical profile, microbiological spectrum, and prognostic factors of early-onset prosthetic valve endocarditis
1 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, C/Ramón y Cajal 3, 47005 Valladolid, Spain
2 Hospital Clínico San Carlos, Madrid, Spain
3 Complejo Hospitalario Xeral Calde, Lugo, Spain
4 Hospital Universitario Río Hortega, Valladolid, Spain
Received 16 May 2006; revised 20 December 2006; accepted 3 January 2007; online publish-ahead-of-print 25 January 2007.
* Corresponding author. Tel: +34 983420000; fax: +34 983255305. E-mail address: javihouston{at}yahoo.es
Aim There is no agreement in the best cutoff time to distinguish between early- and late- onset prosthetic valve endocarditis (PVE). Our objectives are to define early-onset PVE according to the microbiological spectrum and to analyse the profile and short-term prognosis of this entity.
Methods and results The microbiological profile of 172 non-drug users, who were patients with PVE, were compared according to the time elapsed from surgery among 640 endocarditis diagnosed between 1996 and 2004. There were no differences in the microbiological profile of patients with PVE occurred within 2 months of valve replacement and those accounting between 2 and 12 months. The proportion of coagulase-negative Staphylococci (CNS) was higher during the first year post-intervention (37 vs. 18%, P = 0.005) and Streptococci viridans were more common after 1 year (18 vs. 1%, P = 0.001). The percentage of methicilin-resistant CNS strains was higher before 1 year (77 vs. 30%, P = 0.004). Early-onset PVE represented 38% of all episodes of PVE, CNS being the most frequent isolated microorganisms (37%), most of them methicilin resistant (77%). In-hospital mortality of patients who needed urgent surgery was 46% and elective surgery 25%. Overall, in-hospital mortality was 38% and no differences were seen between surgical and medical groups (32 vs. 45%, P = 0.30). Periannular complications were associated with higher in-hospital mortality (60 vs. 27%, P = 0.007).
Conclusion According to the microbiological profile, the most appropriate cutoff time to distinguish between early- and late-onset PVE was 1 year. Methicilin-resistant CNS are the most frequent pathogens and periannular complications, the only risk factor for in-hospital mortality.
Key Words: Early-onset prosthetic valve endocarditis • Coagulase-negative Staphylococcus • Prognosis
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