Abstract | BACKGROUND: The culture of removed cardiac tissues during cardiac surgery of left-sided infective endocarditis (LSIE) helps to guide antibiotic treatment. Nevertheless, the prognostic information of a positive valve culture has never been explored. METHODS: Among 1078 cases of LSIE consecutively diagnosed in 3 tertiary centers, we selected patients with positive blood cultures who underwent surgery during the active period of infection and in whom surgical biological tissues were cultured (n = 429). According to microbiological results, we constructed 2 groups: negative valve culture (n=218) and concordant positive valve culture (CPVC) (n=118). We compared their main features and performed a multivariable analysis of in-hospital mortality. RESULTS: Patients with CPVC presented more nosocomial origin (32% vs 20%, P = .014), more septic shock (21% vs 11%, P = .007), and higher Risk-E score (29% vs 21%, P = .023). Their in-hospital mortality was higher (35% vs 19%, P = .001), despite an earlier surgery (3 vs 11 days from antibiotic initiation, P < .001). Staphylococcus species (61% vs 42%, P = .001) and Enterococcus species (20% vs 9%, P = .002) were more frequent in the CPVC group, whereas Streptococcus species were less frequent (14% vs 42%, P < .001). Independent predictors for in-hospital mortality were renal failure (odds ratio [OR], 2.6 [95% confidence interval {CI}, 1.5-4.4]), prosthesis (OR, 1.9 [95% CI, 1.1-3.5]), Staphylococcus aureus (OR, 1.8 [95% CI, 1.02-3.3]), and CPVC (OR, 2.3 [95% CI, 1.4-3.9]). CONCLUSIONS: Valve culture in patients with active LSIE is an independent predictor of in-hospital mortality.
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Authors | Pablo Elpidio García-Granja, Javier López, Isidre Vilacosta, Cristina Sarriá, Raquel Ladrón, Carmen Olmos, Carmen Sáez, Luis Maroto, Salvatore Di Stefano, Itziar Gómez, J Alberto San Román, Endocarditis and Valvulopathies (ENDOVAL) Group |
Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 68
Issue 6
Pg. 1017-1023
(03 05 2019)
ISSN: 1537-6591 [Electronic] United States |
PMID | 30107544
(Publication Type: Journal Article, Multicenter Study)
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Copyright | © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected]. |
Topics |
- Adult
- Aged
- Cardiac Surgical Procedures
(adverse effects)
- Comorbidity
- Disease Susceptibility
- Endocarditis
(diagnosis, etiology, mortality, surgery)
- Female
- Heart Diseases
(complications, surgery)
- Heart Valves
(microbiology, surgery)
- Hospital Mortality
- Humans
- Male
- Middle Aged
- Prognosis
- Prosthesis-Related Infections
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