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

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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.

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Acknowledgements

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

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Author notes

  1. Jean-Louis Trouillet

    Present address: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France

  2. Jérome Baudot

    Present address: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France

  3. Jean Chastre

    Present address: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France

  4. Claude Gibert

    Present address: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France

Authors and Affiliations

  1. Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, AP-HP, 46 rue Henri-Huchard, 75877 Paris Cedex 18, France

    Bruno Mourvillier, Jean-Louis Trouillet, Jean-François Timsit, Jérome Baudot, Jean Chastre, Bernard Régnier, Claude Gibert & Michel Wolff

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  1. Bruno Mourvillier
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Correspondence to Michel Wolff.

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Mourvillier, B., Trouillet, JL., Timsit, JF. et al. Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med 30, 2046–2052 (2004). https://doi.org/10.1007/s00134-004-2436-9

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