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Intensive Care Medicine

, Volume 30, Issue 11, pp 2046–2052 | Cite as

Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients

  • Bruno Mourvillier
  • Jean-Louis Trouillet
  • Jean-François Timsit
  • Jérome Baudot
  • Jean Chastre
  • Bernard Régnier
  • Claude Gibert
  • Michel WolffEmail author
Original

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.

Keywords

Infective endocarditis Intensive care medicine Native valve endocarditis Prognostic Prosthetic valve endocarditis 

Notes

Acknowledgements

We are indebted to Mrs. Janet Jacobson for assistance in the preparation of the manuscript.

Supplementary material

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(PDF 63 KB)

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Bruno Mourvillier
    • 1
  • Jean-Louis Trouillet
    • 1
    • 2
  • Jean-François Timsit
    • 1
  • Jérome Baudot
    • 1
    • 3
  • Jean Chastre
    • 1
    • 4
  • Bernard Régnier
    • 1
  • Claude Gibert
    • 1
    • 5
  • Michel Wolff
    • 1
    Email author
  1. 1.Service de Réanimation Médicale et des Maladies InfectieusesHôpital Bichat-Claude-Bernard, AP-HP75877 Paris Cedex 18France
  2. 2.Service de Réanimation Médicale, Institut de CardiologieGroupe Hospitalier Pitié-Salpétrière, AP-HP75651 Paris Cedex 13France
  3. 3.Service de Réanimation Médicale, Institut de CardiologieGroupe Hospitalier Pitié-Salpétrière, AP-HP75651 Paris Cedex 13France
  4. 4.Service de Réanimation Médicale, Institut de CardiologieGroupe Hospitalier Pitié-Salpétrière, AP-HP75651 Paris Cedex 13France
  5. 5.Service de Réanimation Médicale, Institut de CardiologieGroupe Hospitalier Pitié-Salpétrière, AP-HP75651 Paris Cedex 13France

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