Management of Brucella endocarditis: results of the Gulhane study.
Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.
Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology (IDCM), Sanliurfa, Turkey.
Suda Tekin
ST
Koruk
Hakan
H
Erdem
Ibrahim
I
Koruk
Ayşe
A
Erbay
Yasemin
Y
Tezer-Tekce
Ali Rıza
AR
Erbay
Saim
S
Dayan
Ozcan
O
Deveci
Asuman
A
Inan
Derya Ozturk
DO
Engin
Rahmet
R
Guner
Nebahat
N
Dikici
Elif
E
Doyuk-Kartal
Behice
B
Kurtaran
Filiz
F
Pehlivanoglu
Oguz Resat
OR
Sipahi
Aysun
A
Yalci
Mucahit
M
Yemisen
Sema
S
Alp-Cavus
Serap
S
Gencer
Gokhan
G
Guzel
Oral
O
Oncul
Mehmet
M
Parlak
Esra
E
Kazak
Necla
N
Tulek
Asim
A
Ulcay
Umit
U
Savasci
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000008:administration & dosage / Q000494:pharmacology; D001021:Aortic Valve / Q000382:microbiology; D002002:Brucella / Q000302:isolation & purification* / Q000472:pathogenicity; D002006:Brucellosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002443:Ceftriaxone / Q000008:administration & dosage / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000382:microbiology; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D000617:Aminoglycosides; D002443:Ceftriaxone