Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients |
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Authors: | Mourvillier Bruno Trouillet Jean-Louis Timsit Jean-François Baudot Jérome Chastre Jean Régnier Bernard Gibert Claude Wolff Michel |
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Institution: | 1.Service de Réanimation Médicale et des Maladies Infectieuses, H?pital Bichat-Claude-Bernard, AP-HP, 46 rue Henri-Huchard, 75877 Paris Cedex 18, France ; |
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Abstract: | Objective To identify factors associated with in-hospital outcome of adult patients admitted to the ICU with infective endocarditis
(IE).
Design and setting Retrospective study performed in the two medical ICUs of a teaching hospital.
Patients and participants The charts of all 228 consecutive patients aged 18 years or older admitted with infective IE between January 1993 and December
2000 were reviewed. All patients satisfied the modified Duke’s criteria for definite IE.
Measurements and results There were 146 episodes of native valve endocarditis and 82 of prosthetic valve endocarditis. Staphylococcus aureus was the predominant causative micro-organism. Most complications occurred early during the course of IE. One-half of the
patients underwent cardiac surgery during the same hospitalization and had a better outcome than nonoperated patients. The
overall in-hospital mortality rate was 45% (102/228). Multivariate analysis revealed the following clinical factors in patients
with native valve IE as independently associated with outcome: septic shock (odds ratio 4.81), cerebral emboli (3.00), immunocompromised
state (2.88), and cardiac surgery (0.475); in patients with prosthetic valve IE the factors were: septic shock (4.07), neurological
complications (3.1), and immunocompromised state (3.46).
Conclusions IE still carries high morbidity and mortality rates for the subset of patients requiring ICU admission. Most complications
occur early making the decision process for optimal medical and surgical management more difficult. Surgical treatment appears
to improve in-hospital outcome.
Electronic Supplementary Material Supplementary material is available for this article if you access the article at . A link in the frame on the left on that page takes you directly to the supplementary material. |
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Keywords: | Infective endocarditis Intensive care medicine Native valve endocarditis Prognostic Prosthetic valve endocarditis |
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