[Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis].
Patients with infective endocarditis (IE) were studied to assess incidence, clinical features and mortality in a population with either persistent (PF) or recurrent fever (RF) during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8%) had fever during treatment: 35 had PF and 16 had RF (Group 1). This group was compared with 35 patients with IE without fever (Group 2). Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly). However, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with MRSA (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in Group 1 (p<0.05). The most common causes of PF were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). On the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with RF. The overall mortality was 39.5%, distributed as follows: 52.2% of Group 1 and in 22.9% of Group 2 (p=0.007). The presence of comorbidities, major vessel embolization, heart failure, MRSA infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in Group 1 (p<0.05). We propose an evaluation method during the treatment of patients affected by this type of fever.
Carena
José
J
Servicio de Clínica Médica, Hospital Luis Lagomaggiore, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina. carena@lanet.com.ar
Marcucci
Guillermo
G
Salomón
Susana
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D016009:Chi-Square Distribution; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality / Q000628:therapy*; D013290:Streptococcal Infections / Q000401:mortality / Q000628:therapy