EARLY-ONSET PROSTHETIC VALVE ENDOCARDITIS

BACKGROUND Endocarditis following cardiac valve implantation is a rare but serious complication. OBJECTIVE To determine the risk and outcome of early-onset prosthetic valve endocarditis (EO-PVE) in adult patien ts at The Cleveland Clinic. METHODS Retrospective review of a 5-year c ase series of patients who acquired bloodstream infections within 60 d ays of surgery identified through a prospective surveillance program. RESULTS Sixty-eight of approximately 2100 patients acquired bloodstrea m infections; 16 (24%) contracted EO-PVE and 52 (76%) did not. Risk fa ctors for EO-PVE included younger age, at least three sets of positive blood culture results, and an organism other than a gram-negative bac illus. The majority of patients with EO-PVE had a recognized source of infection (wound or vascular catheter site), but no infections were a ttributed to a pulmonary or urinary tract site. Eleven patients (69%) were cured, including six who underwent emergent second operations. CO NCLUSION Patients with multiple blood cultures positive for organisms other than gram-negative bacilli are at risk of EO-PVE, even when a pr imary wound infection or vascular catheter site infection is recognize d and treated.