ETIOLOGY AND RISK-FACTORS OF 180 CASES OF NATIVE VALVE ENDOCARDITIS -REPORT FROM A 5-YEAR NATIONAL PROSPECTIVE SURVEY IN SLOVAK REPUBLIC

Risk factors, etiology, and outcome of 180 cases of infective endocard itis (IE) in the Slovak Republic for 5 years were prospectively studie d in a national survey. According to the Duke Endocarditis Service Cri teria (1994), 169 cases were considered defective and 21 possible/prob able. The aortic valve was infected in 46.7%, mitral in 47.2%, and tri cuspidal/pulmonary in 6.1% of cases. The majority of endocartis cases was caused by Staphylococcus aureus and coagulase-negative staphylococ ci (CNS) (33.3%); only 12.2% were due to viridans streptococci; 11.7% were due to Enterococcus faecalis; 6.1% due to Haemophilus spp.; 10.1% due to other organisms; and 26.7% were culture negative. Single posit ive culture of CNS were not considered clinically significant. More th an 25% of 180 patients were older than 60 years. Rheumatic fever was a risk factor in 35.5%, dental surgery in 20.5%, prior cardiosurgery in 7.8%, and neoplasia in 6.7%. All patients were treated with antimicro bials (average length of therapy was 29.5 days) and 33.3% of patients also had surgery (valvular prosthesis replacement). Forty (22.2%) died , and 140 (77.8%) survived at day 60 after the diagnosis of endocardit is was made. All 40 deaths were attributable to infection. Univariate analysis comparing deaths and survivors did not show significant diffe rences in most of the recorded risk factors between both groups, excep t age >60 (40.0% versus 21.4%, p <0.05), staphylococcal etiology (55.0 % versus 27.1%, p <0.04), and antibiotic therapy <21 days (without sur gery) (65.0% versus 3.6%, p <0.01). These risk factors were significan tly more frequently associated with deaths. Viridans streptococcal IE and surgical therapy in addition to antibiotics were associated with l ower mortality in comparison to staphylococcal endocarditis (p <0.045) or to cases treated with antibiotics only (p <0.05). In comparison to other nationally based surveys in Europe (Greece, Croatia, France), t he percentage of culture-negative endocarditis and spectrum of pathoge ns differed significantly. (C) Elsevier Science Inc.