Early-onset prosthetic valve endocarditis.
BACKGROUND
Endocarditis following cardiac valve implantation is a rare but serious complication.


OBJECTIVE
To determine the risk and outcome of early-onset prosthetic valve endocarditis (EO-PVE) in adult patients at The Cleveland Clinic.


METHODS
Retrospective review of a 5-year case series of patients who acquired bloodstream infections within 60 days of surgery identified through a prospective surveillance program.


RESULTS
Sixty-eight of approximately 2100 patients acquired bloodstream infections; 16 (24%) contracted EO-PVE and 52 (76%) did not. Risk factors for EO-PVE included younger age, at least three sets of positive blood culture results, and an organism other than a gram-negative bacillus. The majority of patients with EO-PVE had a recognized source of infection (wound or vascular catheter site), but no infections were attributed to a pulmonary or urinary tract site. Eleven patients (69%) were cured, including six who underwent emergent second operations.


CONCLUSIONS
Patients with multiple blood cultures positive for organisms other than gram-negative bacilli are at risk of EO-PVE, even when a primary wound infection or vascular catheter site infection is recognized and treated.
Keys
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Department of Infectious Disease, Cleveland Clinic Foundation, OH 44195.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D016470:Bacteremia / Q000382:microbiology* / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome