title: [Left-sided endocarditis due to gram-negative bacilli: epidemiology and clinical characteristics].
abstract: BACKGROUND
  The aim of this study is to describe the epidemiological, clinical characteristics, and outcome of patients with left-side endocarditis caused by gram-negative bacteria.
  
  
  METHODS
  Prospective multicenter study of left-sided infective endocarditis reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2008.
  
  
  RESULTS
  Among the 961 endocarditis, 24 (2.5%) were caused by gram-negative bacilli. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Salmonella enterica. Native valves (85.7%) were mainly affected, most of them with previous valve damage (57%). Comorbidity was greater (90% vs 39%; P=.05) than in endocarditis due to other microorganism, the most frequent being, diabetes, hepatic cirrhosis and neoplasm. A previous manipulation was found in 47.6% of the cases, and 37% were considered hospital-acquired. Renal failure (41%), central nervous system involvement (33%) and ventricular dysfunction (45%) were the most frequent complications. Five cases (21%) required cardiac surgery, mostly due to ventricular dysfunction. More than 50% of cases were treated with aminoglycosides, but this did not lead to a better outcome or prognosis. Mortality (10 patients) was higher than that reported with other microorganisms (41% vs 35%; P=.05).
  
  
  CONCLUSIONS
  Left-sided endocarditis due to gram-negative bacilli is a rare disease, which affects patients with major morbidities and often with a previous history of hospital manipulations. Cardiac, neurological and renal complications are frequent and associated with a high mortality. The association of aminoglycosides in the antimicrobial treatment did not involve a better outcome or prognosis.
authors.affiliation: Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España. mariamnoureddine@hotmail.com
authors.forename: Mariam
authors.initials: M
authors.lastname: Noureddine
authors.forename: Javier
authors.initials: J
authors.lastname: de la Torre
authors.forename: Radka
authors.initials: R
authors.lastname: Ivanova
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Martínez
authors.forename: Jose María
authors.initials: JM
authors.lastname: Lomas
authors.forename: Antonio
authors.initials: A
authors.lastname: Plata
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez
authors.forename: Jose María
authors.initials: JM
authors.lastname: Reguera
authors.forename: Josefa
authors.initials: J
authors.lastname: Ruiz
authors.forename: Carmen
authors.initials: C
authors.lastname: Hidalgo
authors.forename: Rafael
authors.initials: R
authors.lastname: Luque
authors.forename: María Victoria
authors.initials: MV
authors.lastname: García-López
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D048909:Diabetes Complications / Q000453:epidemiology / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents