Brucella endocarditis: the importance of surgical timing after medical treatment (five cases).
BACKGROUND
Brucella endocarditis is a disease that is hard to treat medically and has a high mortality. Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair.


METHODS
Five patients who were admitted to our institution with a diagnosis of Brucella endocarditis were medically treated with doxycycline (200 mg/d), rifampin (600 mg/d), and ceftriaxone (2 g/d). Preoperative mean medical treatment time was 5.2 weeks (range, 4-6 weeks). The patients were taken for operation when their general status improved. We report in this study the results of these patients.


RESULTS
Three patients had aortic valve replacement whereas 2 had both aortic and mitral valve replacements. No mortality or morbidity was encountered in the patients. Mean postoperative hospitalization time was 15 days (range, 12-19 days). The patients were discharged with doxycycline (200 mg/d) and rifampin (600 mg/d) but without antipyretic medication. Postoperative antibiotherapy was continued up to a mean of 3.6 months (range, 2-6 months). Mean postoperative follow-up time was 15.8 months. None of the patients needed hospitalization in their follow-up time.


CONCLUSIONS
Adequate preoperative antibiotherapy, immediate surgery, and continuation of postoperative antibiotherapy according to clinical progress seem to be a convenient treatment strategy for Brucella endocarditis.
Department of Cardiolvascular Surgery, Ataturk Education and Research Hospital, Izmir, Turkey.
Ibrahim
I
Ozsöyler
Levent
L
Yilik
Sahin
S
Bozok
Sibel
S
El
Bilgin
B
Emrecan
Serdar
S
Biçeroğlu
Ali
A
Gürbüz
D000328:Adult; D000900:Anti-Bacterial Agents; D001021:Aortic Valve; D002006:Brucellosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve; D013997:Time Factors
D000900:Anti-Bacterial Agents