Early-onset prosthetic valve endocarditis
Thomas F. Keys, MDAddress reprint requests to T.F.K., Department of Infectious Disease, S32, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
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 patients at The Cleveland Clinic.METHODS
Retrospective review of a 5-year case series of patients who acquired bloodstream infections within 60 days of surgery identified through a prospective surveillance program.RESULTS
Sixty-eight of approximately 2100 patients acquired bloodstream infections; 16 (24%) contracted EO-PVE and 52 (76%) did not. Risk factors for EO-PVE included younger age, at least three sets of positive blood culture results, and an organism other than a gram-negative bacillus. The majority of patients with EO-PVE had a recognized source of infection (wound or vascular catheter site), but no infections were attributed to a pulmonary or urinary tract site. Eleven patients (69%) were cured, including six who underwent emergent second operations.CONCLUSION
Patients with multiple blood cultures positive for organisms other than gram-negative bacilli are at risk of EO-PVE, even when a primary wound infection or vascular catheter site infection is recognized and treated.