Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization.
OBJECTIVE
To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization.


METHODS
Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to alpha-haemolytic streptococci; 15 due to beta-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery.


RESULTS
For alpha-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1-20) and 16 (4-58) days of treatment, respectively, P < 0.001. For beta-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received < or = 4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received < or = 8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received < or = 4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with beta-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative.


CONCLUSIONS
Our findings support current treatment guidelines for endocarditis caused by alpha-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.
Upton
Arlo
A
Departments of Clinical Microbiology, Auckland District Health Board, Auckland, New Zealand.
Drinkovic
Dragana
D
Pottumarthy
Sudha
S
West
Teena
T
Morris
Arthur J
AJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D006351:Heart Valves / Q000187:drug effects / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013242:Sterilization / Q000379:methods; D034366:Streptococcus anginosus / Q000187:drug effects / Q000302:isolation & purification*; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents