Infective endocarditis: short and long term results in 261 cases managed by a multidiciplinary approach

Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endoca rditis (IE). Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Catolica de Chtle Hospital. Patients and methods: The clinical history, diagnosis, tre atment and outcome of 261 episodes (Duke criteria) of IE admitted between J anuary 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic value and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 +/- 16 years. Seventy five had a definite diagnosis of IE (Duke). A. viridans, staphlococci nad enterococci together constituted 85% of the isolated bacterial strains. Twe nty seven bad culture-negative IE, related to a high incidence of antibioti c therapy prior to diagnosis. Transesophageal echocardiography was performe d in 102 cases and it detected vegetations in 91% of aortic and 96% of mitr al IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent d eveloped heart failure and 34% bad embolic events. S. aureus IE was associa ted to a higher incidence of embolic events, complications which contraindi cated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surg ical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non- operable groups. The type of treatment and mortality rates did not differ between IE of native values and prosthetic valves. Long term fo llow up showed survival rates of 73% at 5 years and 55% at 10 years. Conclu sion: A multidisciplinary approach may be very helpful to improve the progn osis of IE.