Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Infective Endocarditis in a Community Hospital

Infective Endocarditis in a Community Hospital Abstract Recent reviews from major university centers of infective endocarditis have stressed an increase in unusual infections owing to virulent pathogens. This article compares the 40 episodes of infective endocarditis at a community hospital complex with the recent literature. It was observed that the majority of infecting microorganisms were penicillin-susceptible streptococci similar to those seen in the early antibiotic era. An older patient population was encountered, but overall mortality was low. Streptococcus bovis was a frequent cause of both natural and prosthetic valve infections. Symptoms lasting longer than two months were associated with vegetations demonstrated by echocardiography and high morbidity. Clinical features in this series that significantly correlated with a poor prognosis were height of fever at admission, the failure of fever to resolve within one week of appropriate therapy, the degree of peripheral leukocytosis, gross hematuria, and CNS signs. Conservative parenteral treatment closely monitored by serum bactericidal levels was employed. No relapses occurred among patients surviving initial therapy. (Arch Intern Med 1982;142:789-792) References 1. Pelletier L, Petersdorf R: Infective endocarditis: A review of 125 cases from the University of Washington Hospitals, 1963-1972. Medicine 1977;56:287-313.Crossref 2. Garvey G, Neu H: Infective endocarditis—an evolving disease: Review of endocarditis at Columbia-Presbyterian Medical Center, 1968-1973. Medicine 1978;57:105-127.Crossref 3. Lerner P, Weinstein L: Infective endocarditis in the antibiotic era. N Engl J Med 1966;274:199-205, 259-265, 323-331, 388-393.Crossref 4. Kaye D: Cure rates and long-term prognosis and treatment of complications of infective endocarditis , in Kaye D (ed): Infective Endocarditis . Baltimore, University Park Press, 1976, pp 201-228. 5. Lennette EH, Balows A, Hauster JP, et al: Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980. 6. Schlichter JG, MacLean H: A method for determining the effective therapeutic level in the treatment of subacute bacterial endocarditis with penicillin. Am Heart J 1971;34:1-90. 7. Schlichter JG, MacLean J, Milzer A: Effective penicillin therapy in subacute bacterial endocarditis and other chronic infections. Am J Med Sci 1949;217:600-608.Crossref 8. Pien FD, Williams RD, Vosti KL: Comparison of broth and human serum as the diluent in the serum bactericidal test. Antimicrob Agents Chemother 1975;7:113-114.Crossref 9. Friedberg C, Goldman H, Field L: Study of bacterial endocarditis. Arch Intern Med 1961;107:74-83.Crossref 10. Dormer A: Bacterial endocarditis. Br Med J 1953;1:63-69.Crossref 11. Afremou M: A review of 202 cases of bacterial endocarditis, 1948-1952. Ill Med J 1955;107:67-72. 12. Churchill M, Geraci J, Hunder G: Musculoskeletal manifestations of bacterial endocarditis. Ann Intern Med 1977;87:754-759.Crossref 13. Heffner J: Extracardiac manifestations of bacterial endocarditis. West J Med 1979;131:85-91. 14. Lachman AS, Bramwell-Jones DM, La Kier JB, et al: Infective endocarditis on the billowing mitral leaflet syndrome. Br Heart J 1975;37:326-330.Crossref 15. Bouza E, Meyer R, Busch D: Group G streptococcal endocarditis. Am Soc Clin Pathol 1976;20:108-111. 16. Klein R, Catalano M, Edberg S, et al: Streptococcus bovis, septicemia, and carcinoma of the colon. Ann Intern Med 1979;91:560-562.Crossref 17. Phair JP, Tan J, Venezio FR, et al: Therapy of infective endocarditis due to penicillin-susceptible streptococci: Duration of disease in a major determinant of outcome , in Bisno A (ed): Treatment of Infective Endocarditis . New York, Grune & Stratton Inc, 1981. 18. Kaye D: Antibiotic treatment of streptococcal endocarditis. Am J Med 1980;69:650-652.Crossref 19. Phair JP, Tan J: Therapy of Streptococcus viridans endocarditis , in Kaplan EL, Taranta AV (eds): Infective Endocarditis . Dallas, American Heart Association Symposium, 1977, p 55. 20. Davis R, Strom J, Frishman W, et al: The demonstration of vegetations by echocardiography in bacterial endocarditis: An indication for early surgical intervention. Am J Med 1980;69:57-63.Crossref 21. Zimezt I: Nervous system complications in bacterial endocarditis. Am J Med 1969;47:593-605.Crossref 22. Pruitt A, Rubin R, Karchmer AW, et al: Neurological complications of bacterial endocarditis. Medicine 1978;57:329-342.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Loading next page...
 
/lp/american-medical-association/infective-endocarditis-in-a-community-hospital-0MfkckHuBA
Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340170145023
Publisher site
See Article on Publisher Site

Abstract

Abstract Recent reviews from major university centers of infective endocarditis have stressed an increase in unusual infections owing to virulent pathogens. This article compares the 40 episodes of infective endocarditis at a community hospital complex with the recent literature. It was observed that the majority of infecting microorganisms were penicillin-susceptible streptococci similar to those seen in the early antibiotic era. An older patient population was encountered, but overall mortality was low. Streptococcus bovis was a frequent cause of both natural and prosthetic valve infections. Symptoms lasting longer than two months were associated with vegetations demonstrated by echocardiography and high morbidity. Clinical features in this series that significantly correlated with a poor prognosis were height of fever at admission, the failure of fever to resolve within one week of appropriate therapy, the degree of peripheral leukocytosis, gross hematuria, and CNS signs. Conservative parenteral treatment closely monitored by serum bactericidal levels was employed. No relapses occurred among patients surviving initial therapy. (Arch Intern Med 1982;142:789-792) References 1. Pelletier L, Petersdorf R: Infective endocarditis: A review of 125 cases from the University of Washington Hospitals, 1963-1972. Medicine 1977;56:287-313.Crossref 2. Garvey G, Neu H: Infective endocarditis—an evolving disease: Review of endocarditis at Columbia-Presbyterian Medical Center, 1968-1973. Medicine 1978;57:105-127.Crossref 3. Lerner P, Weinstein L: Infective endocarditis in the antibiotic era. N Engl J Med 1966;274:199-205, 259-265, 323-331, 388-393.Crossref 4. Kaye D: Cure rates and long-term prognosis and treatment of complications of infective endocarditis , in Kaye D (ed): Infective Endocarditis . Baltimore, University Park Press, 1976, pp 201-228. 5. Lennette EH, Balows A, Hauster JP, et al: Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980. 6. Schlichter JG, MacLean H: A method for determining the effective therapeutic level in the treatment of subacute bacterial endocarditis with penicillin. Am Heart J 1971;34:1-90. 7. Schlichter JG, MacLean J, Milzer A: Effective penicillin therapy in subacute bacterial endocarditis and other chronic infections. Am J Med Sci 1949;217:600-608.Crossref 8. Pien FD, Williams RD, Vosti KL: Comparison of broth and human serum as the diluent in the serum bactericidal test. Antimicrob Agents Chemother 1975;7:113-114.Crossref 9. Friedberg C, Goldman H, Field L: Study of bacterial endocarditis. Arch Intern Med 1961;107:74-83.Crossref 10. Dormer A: Bacterial endocarditis. Br Med J 1953;1:63-69.Crossref 11. Afremou M: A review of 202 cases of bacterial endocarditis, 1948-1952. Ill Med J 1955;107:67-72. 12. Churchill M, Geraci J, Hunder G: Musculoskeletal manifestations of bacterial endocarditis. Ann Intern Med 1977;87:754-759.Crossref 13. Heffner J: Extracardiac manifestations of bacterial endocarditis. West J Med 1979;131:85-91. 14. Lachman AS, Bramwell-Jones DM, La Kier JB, et al: Infective endocarditis on the billowing mitral leaflet syndrome. Br Heart J 1975;37:326-330.Crossref 15. Bouza E, Meyer R, Busch D: Group G streptococcal endocarditis. Am Soc Clin Pathol 1976;20:108-111. 16. Klein R, Catalano M, Edberg S, et al: Streptococcus bovis, septicemia, and carcinoma of the colon. Ann Intern Med 1979;91:560-562.Crossref 17. Phair JP, Tan J, Venezio FR, et al: Therapy of infective endocarditis due to penicillin-susceptible streptococci: Duration of disease in a major determinant of outcome , in Bisno A (ed): Treatment of Infective Endocarditis . New York, Grune & Stratton Inc, 1981. 18. Kaye D: Antibiotic treatment of streptococcal endocarditis. Am J Med 1980;69:650-652.Crossref 19. Phair JP, Tan J: Therapy of Streptococcus viridans endocarditis , in Kaplan EL, Taranta AV (eds): Infective Endocarditis . Dallas, American Heart Association Symposium, 1977, p 55. 20. Davis R, Strom J, Frishman W, et al: The demonstration of vegetations by echocardiography in bacterial endocarditis: An indication for early surgical intervention. Am J Med 1980;69:57-63.Crossref 21. Zimezt I: Nervous system complications in bacterial endocarditis. Am J Med 1969;47:593-605.Crossref 22. Pruitt A, Rubin R, Karchmer AW, et al: Neurological complications of bacterial endocarditis. Medicine 1978;57:329-342.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1982

References