title: Outcome after surgical treatment performed within the first week of antimicrobial therapy during infective endocarditis: a prospective study.
abstract: BACKGROUND
  An increasing number of patients with infective endocarditis (IE) are operated on before the end of the first week of antimicrobial therapy. The mortality and morbidity of this specific group are unknown.
  
  
  OBJECTIVE
  To evaluate the outcome of patients with IE requiring cardiac surgery performed within the first week of antimicrobial therapy.
  
  
  METHODS
  All consecutive patients with a definite diagnosis of IE operated on within the first week of antimicrobial therapy were followed prospectively. Endpoints were in-hospital mortality and a combined endpoint of long-term cardiovascular death, recurrence and non-infective postoperative valvular dysfunction (PVD). The three main conditions requiring surgery, namely haemodynamic impairment, high embolic risk and periannular extension, were tested as potential predictors of outcome after adjustment for relevant variables.
  
  
  RESULTS
  Among the 95 patients included, surgery was performed a median time of 3 days after starting antimicrobial therapy. In-hospital mortality was 15%. The 3-year cumulative rates of the combined endpoint and of cardiovascular death were 38+/-7% and 27+/-7%, respectively. Recurrence occurred in 12% and PVD in 7%. Periannular extension was the main predictor of in-hospital death and the combined endpoint.
  
  
  CONCLUSIONS
  Despite the short time between starting antimicrobial therapy and performing surgery, the risk of death, recurrence and PVD does not appear excessively high. In the presence of periannular extension, however, surgery is associated with a greater risk of postoperative events.
authors.affiliation: Department of Cardiology, La Timone Hospital, boulevard Jean-Moulin, 13005 Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Sylvain
authors.initials: S
authors.lastname: Beurtheret
authors.forename: Vlad
authors.initials: V
authors.lastname: Gariboldi
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gouriet
authors.forename: Laurence
authors.initials: L
authors.lastname: Tafanelli
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Frédéric
authors.initials: F
authors.lastname: Collart
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D019992:Databases as Topic; D004334:Drug Administration Schedule; D004696:Endocarditis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents