Infective endocarditis: review of 36 cases

In a retrospective study of cases of infective endocarditis (IE) observed in adult patients, the data of patients hospitalized for definite IE in the Cardiosurgery Unit of ARNAS-Civico in Palermo (Italy) from March 2003 to September 2006 were analysed. All cases were classified according to the modified Duke criteria. In all, 36 immunocompetent patients with "definite" IE were included (20 males and 16 females with a median age of 54 years). The aortic valve (23/36, 64%) was the most commonly involved, followed by the mitral (19/36, 52.7%) and tricuspid valve (4/36, 11%). In 10 patients (27.7%), a double localization was observed. Blood culture yielded a positive result in 15 cases. Staphylococci and enterococci were the pathogens most commonly identified. Valvular diseases and previous cardiosurgical procedures were the risk factors most commonly noted. Four patients developed complications during the course of the disease, one of whom died. In patients with positive blood culture, antibiotics were prescribed on the basis of susceptibility test results. In patients with negative blood culture, empiric therapy was directed against Gram+ bacteria (glycopeptides, aminoglycosides and betalactams). Surgical therapy was necessary in 25 patients (69.4%). The patients were subsequently enrolled in a cardiological and infectivological follow-up. Our results showed that rapid diagnosis, correct antibiotic therapy and early surgical treatment improve the outcome in patients with infective endocarditis