Abstract

Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE). Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Catolica de Chtle Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic value and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 +/- 16 years. Seventy five had a definite diagnosis of IE (Duke). A. viridans, staphlococci nad enterococci together constituted 85% of the isolated bacterial strains. Twenty seven bad culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% bad embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non- operable groups. The type of treatment and mortality rates did not differ between IE of native values and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 55% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE.