title: Infective endocarditis-related stroke: diagnostic delay and prognostic factors.
abstract: Infective endocarditis is frequently revealed by complications such as stroke, but the diagnostic delay between stroke and infective endocarditis may be long. We retrospectively reviewed all cases of infective endocarditis-associated stroke referred to our institution from 2000 to 2007, with special attention to diagnostic delay and survival. Most (26) of the 34 studied patients presented with stroke before diagnosis of infective endocarditis. The median delay before infective endocarditis diagnosis was 8 d (0-40 d), and was longer in cases with negative blood cultures. Diagnostic delay had no influence upon survival. When diagnosis of infective endocarditis occurred first, stroke developed in 3 patients during the first week of antibiotic therapy; in 3 patients, stroke occurred after valvular surgery. Overall survival was 67.6%; a small vegetation and non-staphylococcal aetiology were associated with a better outcome. In conclusion, infective endocarditis diagnosis is frequently delayed in patients presenting with stroke, particularly if blood cultures are sterile. The risk of delayed stroke after valvular surgery must be considered.
authors.affiliation: Infectious Diseases Unit, Grenoble University Hospital, Grenoble, France. OEpaulard@chu-grenoble.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Epaulard
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roch
authors.forename: Leila
authors.initials: L
authors.lastname: Potton
authors.forename: Patricia
authors.initials: P
authors.lastname: Pavese
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Brion
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Stahl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001769:Blood / Q000382:microbiology; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents