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

  1. Guodong Fang, MD;
  2. Thomas F. Keys, MD;
  3. Layne O. Gentry, MD;
  4. Alan A. Harris, MD;
  5. Nilda Rivera, RN;
  6. Karen Getz, RN;
  7. Peter C. Fuchs, MD;
  8. Marie Gustafson, RN;
  9. Edward S. Wong, MD;
  10. Angella Goetz, RN, MNEd;
  11. Marilyn M. Wagener, MPH; and
  12. Victor L. Yu, MD
  1. 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.

    Abstract

    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.

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    1. Ann Intern Med October 1, 1993 vol. 119 no. 7 Part 1 560-567
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