Trends in neurological complications of endocarditis.
Neurological complications (NCs) are a major cause of morbidity and mortality in patients with infectious endocarditis (IE). The frequency of these complications has been found to remain constant since the preantibiotic era despite profound epidemiological changes and therapeutic advances. We have reviewed retrospectively all the cases of IE attended at a single institution between 1985 and 2003, aiming to study the clinical characteristics of the NCs, and to analyse possible temporal trends in their frequency. Among 550 patients with IE, 71 (13%) suffered NCs. NCs presented more frequently in native (NVE) and prosthetic (PVE) valve endocarditis (17% and 20%, respectively) than in endocarditis associated with drug addiction (IDU-NVE) or pacemeker (6% and 9%, respectively). Cerebrovascular disorders were the most frequent NCs (60% of the patients had ischemic events and 21% had haemorrhages). Meningitis and cerebral abscess occurred in 16% and 3% of patients with NCs, respectively, and diffuse encephalopathy in 13%. Staphylococus aureus infection was the only factor associated with NCs, but only in NVE. During the study period there was a trend for increasing frequency of NCs in IE patients, probably associated to several factors: a decrease in IDUNVE, an increase in more aggressive nosocomial acquired NVE, and an increase in NVE caused by S. aureus. Mortality among patients with NCs (34%) was significantly higher than in IE patients without them (11%). During the study period mortality increased in patients with NVE and NCs.
Corral
Iñigo
I
Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034 Madrid, Spain. icorral.hrc@salud.madrid.org
Martín-Dávila
Pilar
P
Fortún
Jesús
J
Navas
Enrique
E
Centella
Tomasa
T
Moya
José Luis
JL
Cobo
Javier
J
Quereda
Carmen
C
Pintado
Vicente
V
Moreno
Santiago
S
D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000453:epidemiology / Q000382:microbiology; D015984:Causality; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D004696:Endocarditis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification