Definition, clinical profile, microbiological spectrum, and prognostic factors of early-onset prosthetic valve endocarditis.
OBJECTIVE
There is no agreement in the best cutoff time to distinguish between early- and late- onset prosthetic valve endocarditis (PVE). Our objectives are to define early-onset PVE according to the microbiological spectrum and to analyse the profile and short-term prognosis of this entity.


RESULTS
The microbiological profile of 172 non-drug users, who were patients with PVE, were compared according to the time elapsed from surgery among 640 endocarditis diagnosed between 1996 and 2004. There were no differences in the microbiological profile of patients with PVE occurred within 2 months of valve replacement and those accounting between 2 and 12 months. The proportion of coagulase-negative Staphylococci (CNS) was higher during the first year post-intervention (37 vs. 18%, P = 0.005) and Streptococci viridans were more common after 1 year (18 vs. 1%, P = 0.001). The percentage of methicilin-resistant CNS strains was higher before 1 year (77 vs. 30%, P = 0.004). Early-onset PVE represented 38% of all episodes of PVE, CNS being the most frequent isolated microorganisms (37%), most of them methicilin resistant (77%). In-hospital mortality of patients who needed urgent surgery was 46% and elective surgery 25%. Overall, in-hospital mortality was 38% and no differences were seen between surgical and medical groups (32 vs. 45%, P = 0.30). Periannular complications were associated with higher in-hospital mortality (60 vs. 27%, P = 0.007).


CONCLUSIONS
According to the microbiological profile, the most appropriate cutoff time to distinguish between early- and late-onset PVE was 1 year. Methicilin-resistant CNS are the most frequent pathogens and periannular complications, the only risk factor for in-hospital mortality.
López
Javier
J
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, C/Ramón y Cajal 3, Valladolid, Spain. javihouston@yahoo.es
Revilla
Ana
A
Vilacosta
Isidre
I
Villacorta
Eduardo
E
González-Juanatey
Carlos
C
Gómez
Itziar
I
Rollán
María Jesús
MJ
San Román
José Alberto
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome