Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis

ObjectivesWe examined the characteristics and outcomes of patients requiring valve surgery during active infective endocarditis (IE), focusing on the impact of antimicrobial therapy.MethodsIn this retrospective study, medical charts of all consecutive patients admitted to our cardiovascular surgery department from January 1998 to December 2010, with a diagnosis of IE requiring surgical management, were reviewed. Adult patients were enrolled in the study if they had definite or possible active IE and if the antimicrobial treatment was evaluable.ResultsAfter initial screening of medical records, we selected 173 surgically treated patients (135 men; mean age, 55.8 years). Native valves were involved in 150 (87%) patients. IE mainly involved the aortic valve (n = 113) and then mitral (n = 83), tricuspid (n = 13), and pulmonary (n = 3) valves. The most common causative pathogens were streptococci (n = 70), staphylococci (n = 60), and enterococci (n = 29). Operative mortality was 15%. Multivariate logistic regression analysis demonstrated that adequacy of the overall antimicrobial treatment (adjusted odds ratio, 0.292; 95% confidence interval, 0.117-0.726; P = .008) and temperature greater than 38°C at the time of diagnosis (adjusted odds ratio, 0.288; 95% confidence interval, 0.115-0.724; P = .008) were independently associated with a lower risk of mortality. Conversely, age greater than 60 years (adjusted odds ratio, 4.42; 95% confidence interval, 1.57-12.4; P = .005) was associated with a greater risk of operative mortality.ConclusionsSurgery for active IE is still associated with a high mortality rate, but its prognosis is significantly improved by adequate antimicrobial therapy.