title: Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis.
abstract: OBJECTIVE
  We examined the characteristics and outcomes of patients requiring valve surgery during active infective endocarditis (IE), focusing on the impact of antimicrobial therapy.
  
  
  METHODS
  In this retrospective study, medical charts of all consecutive patients admitted to our cardiovascular surgery department from January 1998 to December 2010, with a diagnosis of IE requiring surgical management, were reviewed. Adult patients were enrolled in the study if they had definite or possible active IE and if the antimicrobial treatment was evaluable.
  
  
  RESULTS
  After initial screening of medical records, we selected 173 surgically treated patients (135 men; mean age, 55.8 years). Native valves were involved in 150 (87%) patients. IE mainly involved the aortic valve (n = 113) and then mitral (n = 83), tricuspid (n = 13), and pulmonary (n = 3) valves. The most common causative pathogens were streptococci (n = 70), staphylococci (n = 60), and enterococci (n = 29). Operative mortality was 15%. Multivariate logistic regression analysis demonstrated that adequacy of the overall antimicrobial treatment (adjusted odds ratio, 0.292; 95% confidence interval, 0.117-0.726; P = .008) and temperature greater than 38°C at the time of diagnosis (adjusted odds ratio, 0.288; 95% confidence interval, 0.115-0.724; P = .008) were independently associated with a lower risk of mortality. Conversely, age greater than 60 years (adjusted odds ratio, 4.42; 95% confidence interval, 1.57-12.4; P = .005) was associated with a greater risk of operative mortality.
  
  
  CONCLUSIONS
  Surgery for active IE is still associated with a high mortality rate, but its prognosis is significantly improved by adequate antimicrobial therapy.
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Pôle de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Lille, France. Electronic address: g.fayad@sfr.fr.
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Pôle de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Lille, France.
authors.forename: Andre
authors.initials: A
authors.lastname: Vincentelli
authors.affiliation: Service de Réanimation et Maladies Infectieuses, Centre Hospitalier Chatiliez, Tourcoing, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leroy
authors.affiliation: Département de Bio-Statistiques, CHRU, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Pôle de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Amr
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Pôle de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Pôle de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Lille, France.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Koussa
authors.affiliation: Service de Réanimation et Maladies Infectieuses, Centre Hospitalier Chatiliez, Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006351:Heart Valves / Q000187:drug effects* / Q000382:microbiology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: 35; ICU; IE; infective endocarditis; intensive care unit