LATE PROSTHETIC VALVE ENDOCARDITIS

Prosthetic valve endocarditis remains an extremely serious complicatio n, with a low but increasing incidence. 'Late' endocarditis, occurring more than 60 days after surgery, is relatively infrequently associate d with staphylococci, Gram-negative bacteria and fungi so characterist ic of the endocarditis chat occurs earlier. A probable source of infec tion can be Sound in 25%-80% of patients, the most frequent causes bei ng dental procedures, urological infections and interventions, and ind welling catheters. The most common organisms are S. epidermidis, S. au reus, viridans streptococci and enterococci. The general principles of antibiotic treatment are similar to those for native valve endocardit is, but antibiotic treatment needs to be more prolonged and dosages sh ould be used which result in maximal, non-toxic concentrations. Oral a nticoagulants should be stopped and replaced by intravenous heparins. Surgical reintervention is called for if there are large highly mobile vegetations in the mitral position or within 72 h if there are cerebr al thrombo-embolic episodes.