Sök artiklar i SveMed+

Tidskrift

Sammanfattning

Introduction: In the last decade the tools for diagnosing infectious endocarditis (IE) have improved and become more systematic with the use of transesophageal echocardiography (TEE) and implementation of Duke's diagnostic criteria. A more aggressive use of surgical intervention has also been observed. However, no studies have evaluated to what extent these developments have affected the prognosis of IE. The purpose of this study was therefore (1) to describe the epidemiology and clinical pattern of IE in the last decade and (2) to determine whether the prognosis of IE has improved compared to reports from earlier studies. Materials and methods: Clinical data from 135 patients with a clinical diagnosis of IE were obtained retrospectively from hospital case records; these were analysed and compared with data from previous studies. Results: The in-hospital mortality rate in this study was 14% (CL, 95%: 8.2-19.9%). Earlier studies report mortality rates between 16 and 33%. Patients with Staphylococcus aureus IE (SAIE) had a significantly higher mortality rate (38%). 21% of all patients underwent valvular surgery. Heart surgery was more often performed on patients with infection of the aortic valve. CRP was the best marker for assessing the efficacy of the chosen antibiotic treatment. Conclusion: This study indicates that the prognosis of patients with IE has improved, probably due to earlier diagnosis following improved and more widespread use of TEE and systematic diagnostic criteria. However, patients with SAIE still face a very high risk of a fatal outcome. A further improvement of the prognosis is likely to be achieved by increased intensive care, earlier surgical intervention and strict use of well-defined diagnostic criteria. It is recommended that all patients with SAIE be treated in cardiovascular centers with heart surgery facilities.

MeSH