Enterococcal prosthetic valve infective endocarditis: report of 45 episodes from the International Collaboration on Endocarditis-merged database
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Enterococcal prosthetic valve infective endocarditis (PVE) is an incompletely understood disease. In the present study, patients with enterococcal PVE were compared to patients with enterococcal native valve endocarditis (NVE) and other types of PVE to determine differences in basic clinical characteristics and outcomes using a large multicenter, international database of patients with definite endocarditis. Forty-five of 159 (29%) cases of definite enterococcal endocarditis were PVE. Patients with enterococcal PVE were demographically similar to patients with enterococcal NVE but had more intracardiac abscesses (20% vs. 6%; p=0.009), fewer valve vegetations (51% vs. 79%; p<0.001), and fewer cases of new valvular regurgitation (12% vs. 45%; p=0.01). Patients with either enterococcal PVE or NVE were elderly (median age, 73 vs. 69; p=0.06). Rates of in-hospital mortality, surgical intervention, heart failure, peripheral embolization, and stroke were similar in both groups. Patients with enterococcal PVE were also demographically similar to patients with other types of PVE, but mortality may be lower (14% vs. 26%; p=0.08). Notably, 93% of patients with enterococcal PVE came from European centers, as compared with only 79% of patients with enterococcal NVE (p=0.03). Thus, patients with enterococcal PVE have higher rates of myocardial abscess formation and lower rates of new regurgitation compared to patients with enterococcal NVE, but there are no differences between the groups with regard to surgical or mortality rates. In contrast, though patients with enterococcal PVE and patients with other types of PVE share similar characteristics, mortality is higher in the latter group. Importantly, the prevalence of enterococcal PVE was higher in the European centers in this study.
KeywordsEndocarditis Infective Endocarditis Prosthetic Valve European Center Prosthetic Heart Valve
The following investigators were members of the International Collaboration on Endocarditis Study Group and were involved in implementing and updating the endocarditis databases: Miró JM, del Río A, Benito N, Claramonte X, Díaz ME, Baraldes A, Jiménez-Expósito MJ, Moreno A, Gatell JM, Marco F, García de la María C, Armero Y, Almela M, Jiménez de Anta MT, Paré JC, Azqueta M, Mestres CA, Cartaña R, Pomar JL, Perez N, Ramírez J, and Ribalta T (Barcelona); Stolley P (Baltimore); Hoen B, Selton-Suty C, Doco-Lecompte T, Duchêne F, Khayat N, Bernard Y, Chirouze C, Carteaux JP, Chocron S, Weber M, and Plésiat P (Besançon/Nancy, France); Corey GR, Sexton DJ, Fowler VG Jr, Woods CW, Wang A, Peterson GE, Jollis JG, Anderson DJ, Singh R, Cabell CH, Glower D, Chen A, and Stafford J (Durham, North Carolina, USA); Olaison L, Thalme A, and the Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis (Gothenburg, Sweden); Eykyn S (London); Raoult D, Habib G, Casalta JP, Barrau K, and Fournier PE (Marseille, France); and Abrutyn E, Strom BL, Berlin JA, Kinman JL, Feldman RS, Stolley PD, Levison ME, Korzeniowski OM, and Kaye E (Philadelphia, PA, USA).
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