Outcome of Listeria monocytogenes prosthetic valve endocarditis: as bad as it looks?
In 1998 we presented 1 successfully treated case of Listeria monocytogenes prosthetic valve endocarditis and made a review of all the cases that had been published to date. We carry out an up-to-date review through Pub-Med of every case of Listeria monocytogenes prosthetic valve endocarditis; mortality rate is calculated and data from several clinical and therapeutical variables are collected; Fisher's exact test is used to identify those variables significantly associated with mortality. Four out of 23 patients died in hospital (17%); among all the variables included, only peripheral embolism (p=0.024), onset on a mechanical prosthesis (p=0.035) and having used only 1 antibiotic instead of a combination of drugs (p=0.026) were independently associated with mortality. Although the overall number of cases is too low to draw definite conclusions (n=23), mortality rate is lower than previously believed. Some variables that have traditionally been associated with a poor prognosis for endocarditides are not for the case of Listeria monocytogenes on valvular prostheses. It seems prudent to treat affected patients with a combination of ampicillin -- or vancomycin, if there is a history of beta-lactam allergy and ampicillin desensitization is not possible -- plus an aminoglycoside.
Miguel-Yanes
Jose M De
JM
Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain. jmdmiguel@i4con.com
González-Ramallo
Víctor J
VJ
Pastor
Luis
L
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008088:Listeriosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D012720:Severity of Illness Index; D013030:Spain; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents