title: Endocarditis associated with prosthetic cardiac valves.
abstract: Clinical features, microbiology, therapy and outcome of 26 episodes of prosthetic valve endocarditis occurring at Westmead Hospital from 1979 to 1989 were examined retrospectively. Presentation with a new or changed cardiac murmur was associated with early onset infection (within 12 months of prosthetic valve insertion; P = 0.0033). Corynebacteria were the commonest cause of early onset endocarditis (4 of 11 episodes) and Streptococcus viridans of late onset endocarditis (4 of 15 episodes). Nine of 11 episodes responded to antimicrobial therapy and 12 of 15 to medical-surgical therapy. There was a trend towards increased mortality in patients with early onset endocarditis presenting with a new or changed cardiac murmur (4 of 9 v. 1 of 17, P = 0.068), suggesting early surgery should be considered in this group. Analysis of antibiograms and published reports indicated that vancomycin and an aminoglycoside should be recommended as empirical therapy for endocarditis occurring 12 to 18 months after prosthetic valve insertion.
authors.affiliation: Department of Infectious Diseases and Microbiology, Westmead Hospital, NSW.
authors.forename: S C
authors.initials: SC
authors.lastname: Chen
authors.forename: T C
authors.initials: TC
authors.lastname: Sorrell
authors.forename: D E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: P J
authors.initials: PJ
authors.lastname: Collignon
authors.forename: E J
authors.initials: EJ
authors.lastname: Wright
mesh_terms: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003354:Corynebacterium Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014640:Vancomycin