Brucella endocarditis: the importance of surgical timing after medical treatment (five cases)

INTRODUCTION: Brucella endocarditis is a disease that is hard to treat medically and has a high mortality. Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair. METHODS: Five patients who were admitted to our institution with a diagnosis of Brucella endocarditis were medically treated with doxycycline (200 mg/d), rifampin (600 mg/d), and ceftriaxone (2 g/d). Preoperative mean medical treatment time was 5.2 weeks (range, 4-6 weeks). The patients were taken for operation when their general status improved. We report in this study the results of these patients. RESULTS: Three patients had aortic valve replacement whereas 2 had both aortic and mitral valve replacements. No mortality or morbidity was encountered in the patients. Mean postoperative hospitalization time was 15 days (range, 12-19 days). The patients were discharged with doxycycline (200 mg/d) and rifampin (600 mg/d) but without antipyretic medication. Postoperative antibiotherapy was continued up to a mean of 3.6 months (range, 2-6 months). Mean postoperative follow-up time was 15.8 months. None of the patients needed hospitalization in their follow-up time. CONCLUSION: Adequate preoperative antibiotherapy, immediate surgery, and continuation of postoperative antibiotherapy according to clinical progress seem to be a convenient treatment strategy for Brucella endocarditis.