Cor Vasa 2010, 52(5-6):340-346 | DOI: 10.33678/cor.2010.086

The diagnosis of infective endocarditis and outcomes of its surgical treatment

Jiří Pol^*, Jan Černý, Jiří Ondrášek, Barbora Žaloudíková, Dušan Vršanský, Tomáš Freiberger, Petr Němec

Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Aim: To compare the sensitivity of standard methods and those of molecular microbiology for identifying the pathogen causing infective endocarditis (IE). To evaluate the outcome of surgical management of IE in our center over the past five years (January 2005 through December 2009). To determine and compare the five-year cumulative survival rates of patients with native-valve and prosthetic-valve IE.

Methods: Data of a total of 113 patients (76 men, 37 women) with a mean age of 57 years, undergoing 117 surgical procedures because of the diagnosis of IE, performed in our center between January 2005 and December 2009, were analyzed. Techniques employed to identify the pathogen included blood culture and culture of specimens obtained during surgery, with the latter examined also using polymerase chain reaction (PCR). The sensitivity of these investigations to detect the infectious agent was determined. We assessed the 30-day and one-year mortality rates, and determined and compared the five-year cumulative survival rates of patients with native-valve and prosthetic-valve endocarditis.

Results: Based on investigations of blood culture, culture and PCR-based examination of specimens obtained intraoperatively, the etiologic agent of IE was identified in 98 (83.8%) cases. The sensitivity of detection was highest with PCR-based examination (77.8%) and lowest with culture of intraoperatively recovered specimens (22.2%). Seven patients died within one month, and 16 patients within one year of surgery, resulting in 30-day and one-year mortality rates of 6.2% and 14.2%, respectively. A total of 89 patients were alive after five years resulting in a 78.8% five-year survival rate. Four patients (3.5%) had surgery for relapse of endocarditis. While no significant difference was found in the five-year survival of patients with native-valve versus prosthetic-valve endocarditis, there was a trend toward poorer survival rates in those with the latter condition.

Conclusions: Unless the infectious agent has been isolated initially from blood culture, culture or PCR-based examination of intra-operatively obtained specimens constitute alternatives to identification of the pathogen causing IE. Given the minimal viability of the infectious agent due to antibiotic treatment, PCR-based examination of intraoperatively obtained specimens is frequently the only option of identifying the microbial or fungal causative agent of endocarditis. We observed a trend toward poorer survival of patients with prosthetic-valve endocarditis; however, the difference was not significant in our series.

Keywords: Infective endocarditis; Diagnosis of infective endocarditis; PCR-based diagnosis

Published: May 1, 2010  Show citation