title: Influence of preoperative antibiotherapy on valve culture results and outcome of endocarditis requiring surgery.
abstract: OBJECTIVE
  Although medical-surgical therapy can reduce mortality in patients with infective endocarditis (IE), the optimal timing of surgery remains controversial. We evaluated the influence of preoperative antimicrobial therapy duration on positivity of valve culture and outcome.
  
  
  METHODS
  We retrospectively studied 94 consecutive patients admitted in our intensive care unit (ICU) and operated before completion of standard antimicrobial therapy.
  
  
  RESULTS
  Of 90 valves cultured, 46 were positive. In univariate analysis, time between diagnosis and surgery as well as duration of adequate therapy before surgery was shorter in patients with positive valve cultures as compared to those with negative cultures. A preoperative duration of adequate therapy > or =7 days was strongly associated with negative valve cultures (76% vs. 22%, P<0.001). Logistic regression analysis identified duration of preoperative adequate antimicrobial therapy as an independent risk factor for positive valve culture. However, there was no significant difference between patients with positive or negative valve culture regarding the occurrence of complications, ICU and hospital length of stay, hospital and long-term mortality, endocarditis relapse and reinfection, as well as treatment failure.
  
  
  CONCLUSIONS
  Although the duration of adequate preoperative antimicrobial therapy is associated with the positivity of valve culture, the latter factor does not influence short- or long-term outcome.
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, Avenue du Marechal de Lattre de Tassigny, 94010 Créteil, France. armand.dessap@hmn.aphp.fr
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Guillaume
authors.initials: G
authors.lastname: Voiriot
authors.forename: Firas
authors.initials: F
authors.lastname: Ali
authors.forename: Nejla
authors.initials: N
authors.lastname: Aissa
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D003131:Combined Modality Therapy; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006351:Heart Valves / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents