title: The changing face of prosthetic valve endocarditis at a tertiary-care hospital: 1986-2005.
abstract: OBJECTIVE
  To investigate changes in the clinical characteristics, etiology and prognosis of prosthetic valve endocarditis at a tertiary-care hospital.
  
  
  METHODS
  Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2).
  
  
  RESULTS
  In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1 and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%, respectively. The patients' mean age (SD) was 52.6+/-16.6 years in P1 and 66.2+/-11.5 years in P2 (P=.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5% in P2 vs. 4.9% in P1; relative risk [RR]=2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs. 31.1% in P1; RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73) underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95% CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1 and 30% in P2 (RR=1; 95% CI, 0.6-1.7).
  
  
  CONCLUSIONS
  Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high.
authors.affiliation: Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Alonso-Valle
authors.forename: Concepción
authors.initials: C
authors.lastname: Fariñas-Alvarez
authors.forename: José M
authors.initials: JM
authors.lastname: Bernal-Marco
authors.forename: José D
authors.initials: JD
authors.lastname: García-Palomo
authors.forename: Francisco
authors.initials: F
authors.lastname: Gutiérrez-Díez
authors.forename: Rafael
authors.initials: R
authors.lastname: Martín-Durán
authors.forename: José Ramón
authors.initials: JR
authors.lastname: de Berrazueta
authors.forename: Jesús
authors.initials: J
authors.lastname: González-Macías
authors.forename: José M
authors.initials: JM
authors.lastname: Revuelta-Soba
authors.forename: María Carmen
authors.initials: MC
authors.lastname: Fariñas
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies