Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997.
BACKGROUND
We reviewed all cases of early onset prosthetic valve endocarditis (EO-PVE) occurring less than 12 months after valve operation among 7,043 patients undergoing heart valve replacements or repairs at The Cleveland Clinic between 1992 and 1997.


METHODS
Cases were defined by the Duke criteria and identified through prospective surveillance.


RESULTS
Seventy-seven cases of EO-PVE were identified (1 per 100 procedures), and during the study period the incidence of EO-PVE decreased from 1.5% (1992 to 1994) to 0.7% (1995 to 1997) (p < 0.01). The incidence of EO-PVE for rings (0.2%; 4 of 1,992) was significantly lower than for mechanical (1.6%; 28 of 1,731) and bioprosthetic valves (1.1%; 41 of 3,320) (p < 0.001). The incidence of EO-PVE was also significantly lower for mitral valve versus aortic valve surgeries (0.6% versus 1.4%, p < 0.001). The most common pathogens causing EO-PVE were coagulase-negative staphylococci (52%), fungi (13%), Staphylococcus aureus (10%), and enterococci (8%). Patients undergoing combined surgical and medical treatment of EO-PVE had a significantly higher 30-day, 2-year, and 3-year survival than medically treated patients, although patients judged to be too ill to survive surgery accounted for two-thirds of the patients treated medically.


CONCLUSIONS
There is a 1% incidence rate of EO-PVE among patients undergoing valve operations at our institution, usually caused by coagulase-negative staphylococci, and combined surgical and medical treatment is associated with improved survival compared with medical treatment alone.
Gordon
S M
SM
Department of Infectious Diseases, The Cleveland Clinic Foundation, Ohio 44195-5066, USA. gordons@cesmtp.ccf.org
Serkey
J M
JM
Longworth
D L
DL
Lytle
B W
BW
Cosgrove
D M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004696:Endocarditis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000628:therapy; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011183:Postoperative Complications; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000209:etiology; D013997:Time Factors