title: Management strategies and outcome for prosthetic valve endocarditis.
abstract: The aim of this study was to assess the impact of an operative protocol with a multidisciplinary approach on the outcome of patients with prosthetic valve endocarditis (PVE). A formal policy for the care of PVE was introduced at our hospital in 2003 in which patients were referred to and managed by a preexisting team involving a cardiologist, a specialist in infectious diseases, and a cardiac surgeon. All patients underwent transesophageal echocardiography as soon as clinical suspicion of PVE arose. If high-risk conditions such as heart failure, ring abscess, conditions associated with impending malfunctioning of the prosthesis, or vegetations at high risk for systemic embolization were found during the initial multidisciplinary evaluation (performed within 12 hours of admission), patients were operated on within 48 hours. Stable patients were evaluated weekly by the multidisciplinary team, and on-treatment surgery was performed whenever high-risk conditions developed or when there was persistent fever/bacteremia after 1 week of adequate antibiotic therapy. Comparing the period 2003 through 2009 with 1996 through 2002 (when a multidisciplinary policy was not followed), patients with PVE were more numerous (61 vs 38), older (mean age 68.3 vs 63.1, p = 0.01), and had more co-morbidities (mean Charlson index 3.15 vs 2.42, p = 0.03). The most frequent causative organisms were Staphylococci in both periods. In the second period, fewer patients had delayed diagnosis (39% vs 71%, p = 0.03), heart failure (20% vs 45%, p = 0.01), abscess (20% vs 39%, p = 0.04), culture-negative infective endocarditis (11% vs 29%, p = 0.03), and worsened renal function (21% vs 42%, p = 0.04). A significant reduction in in-hospital mortality (53% to 23%, p = 0.04) and 3-year mortality (60% to 28%, p = 0.001) was observed, driven by the increased number of patients successfully treated with medical therapy alone (44% vs 16%, p = 0.04). In conclusion, formalized, collaborative management led to significant improvement in PVE-related mortality.
authors.affiliation: Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy. Electronic address: fchirillo@tin.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Chirillo
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Scotton
authors.forename: Francesco
authors.initials: F
authors.lastname: Rocco
authors.forename: Roberto
authors.initials: R
authors.lastname: Rigoli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pedrocco
authors.forename: Paola
authors.initials: P
authors.lastname: Martire
authors.forename: Alessandro
authors.initials: A
authors.lastname: Daniotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Elvio
authors.initials: E
authors.lastname: Polesel
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019468:Disease Management; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents