Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Fang, G.    Yu, V. L.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Prosthetic Valve Endocarditis Resulting from Nosocomial Bacteremia: A Prospective, Multicenter Study

Guodong Fang; Thomas F. Keys; Layne O. Gentry; Alan A. Harris; Nilda Rivera; Karen Getz; Peter C. Fuchs; Marie Gustafson; Edward S. Wong; Angella Goetz; Marilyn M. Wagener; and Victor L. Yu

1 October 1993 | Volume 119 Issue 7 Part 1 | Pages 560-567

Objective: To determine the incidence of endocarditis in bacteremic patients with prosthetic heart valves and the risk factors for and the effect of duration of antibiotic therapy on development of endocarditis in such patients.

Design: Multicenter, prospective observational study.

Setting: Six university teaching hospitals with high-volume cardiothoracic surgery.

Participants: One hundred seventy-one consecutive patients with prosthetic heart valves who developed bacteremia during hospitalization.

Measurements and Main Results: Patients were evaluated when they were identified as having bacteremia and 1, 2, 6, and 12 months after its occurrence. Of 171 patients, 74 (43%) developed endocarditis: Fifty-six (33%) had prosthetic valve endocarditis at the time bacteremia was discovered ("endocarditis at outset"), whereas 18 (11%) developed endocarditis a mean of 45 days after bacteremia was discovered ("new endocarditis"). Mitral valve location and staphylococcal bacteremia (Staphylococcus aureus or S. epidermidis) were significantly associated with the development of "new" endocarditis. All 18 cases of new endocarditis were nosocomial, and in 6 of these cases (33%) bacteremia was acquired via intravascular devices. Twenty-one patients without evidence of endocarditis at the time of bacteremia received short-term antibiotic therapy (<14 days); 1 patient (5%) developed endocarditis. Eleven of 70 patients (16%) who received long-term antibiotic therapy (>14 days) developed endocarditis (P > 0.2).

Conclusions: Bacteremic patients with prosthetic heart valves were at notable risk for developing endocarditis, even when they received antibiotic therapy before endocarditis developed and regardless of the duration of such therapy. Intravascular devices were a common portal of entry.

Author and Article Information

From the University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh, Pennsylvania; The Cleveland Clinic, Cleveland, Ohio; Baylor University, Houston, Texas; Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois; St. Vincent Hospital and Medical Center, Portland, Oregon; Hunter-McGuire Veterans Affairs Medical Center, Richmond, Virginia.
Requests for Reprints: Victor L. Yu, MD, Division of Infectious Diseases, University of Pittsburgh Medical Center, Montefiore Building W931, Pittsburgh, PA 15213.
Acknowledgments: The authors thank Rebecca A. Barto, PhD, Michael Scheld, MD, Donald Grandis, MD, Randall Starling, MD, L. Douglas Cowgill, MD, David Durack, MD, and Stephen B. Calderwood, MD, for their critical review of the manuscript.

This article has been cited by other articles:

				T. E. David Surgical Treatment of Aortic Valve Endocarditis Card. Surg. Adult, January 1, 2008; 3(2008): 949 - 956. [Full Text]

				S. C. Stamou, G. Petterson, and A. M. Gillinov Surgical Treatment of Mitral Valve Endocarditis Card. Surg. Adult, January 1, 2008; 3(2008): 1069 - 1078. [Full Text]

				S. Morpeth, D. Murdoch, C. H. Cabell, A. W. Karchmer, P. Pappas, D. Levine, F. Nacinovich, P. Tattevin, N. Fernandez-Hidalgo, S. Dickerman, et al. Non-HACEK Gram-Negative Bacillus Endocarditis Ann Intern Med, December 18, 2007; 147(12): 829 - 835. [Abstract] [Full Text] [PDF]

				A. Wang, E. Athan, P. A. Pappas, V. G. Fowler Jr, L. Olaison, C. Pare, B. Almirante, P. Munoz, M. Rizzi, C. Naber, et al. Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis JAMA, March 28, 2007; 297(12): 1354 - 1361. [Abstract] [Full Text] [PDF]

				J. J. Curtin and R. M. Donlan Using Bacteriophages To Reduce Formation of Catheter-Associated Biofilms by Staphylococcus epidermidis. Antimicrob. Agents Chemother., April 1, 2006; 50(4): 1268 - 1275. [Abstract] [Full Text] [PDF]

				B. Mahesh, G. Angelini, M. Caputo, X. Y. Jin, and A. Bryan Prosthetic Valve Endocarditis Ann. Thorac. Surg., September 1, 2005; 80(3): 1151 - 1158. [Abstract] [Full Text] [PDF]

				P. Rivas, J. Alonso, J. Moya, M. de Gorgolas, J. Martinell, and M. L. Fernandez Guerrero The Impact of Hospital-Acquired Infections on the Microbial Etiology and Prognosis of Late-Onset Prosthetic Valve Endocarditis Chest, August 1, 2005; 128(2): 764 - 771. [Abstract] [Full Text] [PDF]

				V. G. Fowler Jr, M. K. Olsen, G. R. Corey, C. W. Woods, C. H. Cabell, L. B. Reller, A. C. Cheng, T. Dudley, and E. Z. Oddone Clinical Identifiers of Complicated Staphylococcus aureus Bacteremia Arch Intern Med, September 22, 2003; 163(17): 2066 - 2072. [Abstract] [Full Text] [PDF]

				T. E. David Surgical Treatment of Aortic Valve Endocarditis Card. Surg. Adult, January 1, 2003; 2(2003): 857 - 866. [Full Text]

				S. M. Gordon, J. M. Serkey RN, T. F. Keys, T. Ryan, C. A. Fatica RN, S. K. Schmitt, J. A. Borsh RN, D. M. Cosgrove III, and J.-P. Yared Secular Trends in Nosocomial Bloodstream Infections in a 55-Bed Cardiothoracic Intensive Care Unit Ann. Thorac. Surg., January 1, 1998; 65(1): 95 - 100. [Abstract] [Full Text] [PDF]

				D. D. Muehrcke, B. W. Lytle, and D. M. Cosgrove III Surgical and Long-Term Antifungal Therapy for Fungal Prosthetic Valve Endocarditis Ann. Thorac. Surg., September 1, 1995; 60(3): 538 - 543. [Abstract] [Full Text]