title: Two weeks of postsurgical therapy may be enough for high-risk cases of endocarditis caused by Streptococcus viridans or Streptococcus bovis.
abstract: The duration of antimicrobial therapy after surgery for infective endocarditis (IE) is controversial. A short course of postsurgical therapy is currently accepted only for patients with negative valve culture. We performed a retrospective (1994-2008) analysis of patients who underwent surgery for IE in our hospital and had a high risk of complications ( one of more of the following: <2 weeks of antibiotic treatment before surgery; embolism; perivalvular extension; and positive valve culture) to compare outcomes of patients who received short-course antimicrobial therapy (SAT) (median 15 days) or long-course antimicrobial therapy (LAT) (median 32 days), irrespective of the results of valve culture. Our endpoints included length of hospital stay, renal and hepatic failure, relapse, re-infection, and mortality rates 1 year after surgery. During the study period, 140 patients underwent surgery for IE (valve replacement, 87.9%). Of these, 133 fulfilled the high-risk group criteria and 92 completed the antimicrobial schedule. Comparison of patients receiving SAT (37) and LAT (55) showed that the SAT group had a shorter length of hospital stay (29 vs. 40 days, p 0.01), and a trend towards lower frequency of renal failure (5.4% vs. 18.2%, p 0.11) and hepatic failure (5.4% vs. 9.1%, p 0.69), whereas mortality (5.4% vs. 3.6%, p 1), relapse (0% vs. 1.8%, p 1) and re-infection (5.4% vs. 3.6%, p 1) rates were similar between both groups. Multivariate analysis showed that IE caused by Streptococcus viridans or Streptococcus bovis was independently associated with SAT. Postsurgical SAT is safe, especially when IE is caused by Streptococcus viridans or Streptococcus bovis, even in patients at high risk of complications.
authors: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: P
authors: P
authors: Muñoz
authors: M
authors: M
authors: Giannella
authors: F
authors: F
authors: Scoti
authors: M
authors: M
authors: Predomingo
authors: D
authors: D
authors: Puga
authors: A
authors: A
authors: Pinto
authors: J
authors: J
authors: Roda
authors: M
authors: M
authors: Marin
authors: E
authors: E
authors: Bouza
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D016985:Streptococcus bovis / Q000472:pathogenicity*; D013997:Time Factors; D016896:Treatment Outcome; D034363:Viridans Streptococci / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents