Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario

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 Católica de...

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Autores principales:	Braun J,Sandra, Escalona P,Alex, Chamorro S,Gastón, Corbalán H,Ramón, Pérez C,Carlos, Labarca L,Jaime, Irarrázaval L,Manuel José, Zalaquett S,Ricardo, Rodríguez V,José Antonio, Casanegra P,Pablo
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2000
Materias:	Aortic valve Cardiac procedures Cardiovascular diseases Endocarditis, bacterial Mitral valve
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700002
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spelling	oai:scielo:S0034-988720000007000022000-09-01Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinarioBraun J,SandraEscalona P,AlexChamorro S,GastónCorbalán H,RamónPérez C,CarlosLabarca L,JaimeIrarrázaval L,Manuel JoséZalaquett S,RicardoRodríguez V,José AntonioCasanegra P,Pablo Aortic valve Cardiac procedures Cardiovascular diseases Endocarditis, bacterial Mitral valve 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 Católica de Chile 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 valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had 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% had 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 valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20).info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.128 n.7 20002000-07-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700002es10.4067/S0034-98872000000700002
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Aortic valve Cardiac procedures Cardiovascular diseases Endocarditis, bacterial Mitral valve
spellingShingle	Aortic valve Cardiac procedures Cardiovascular diseases Endocarditis, bacterial Mitral valve Braun J,Sandra Escalona P,Alex Chamorro S,Gastón Corbalán H,Ramón Pérez C,Carlos Labarca L,Jaime Irarrázaval L,Manuel José Zalaquett S,Ricardo Rodríguez V,José Antonio Casanegra P,Pablo Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
description	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 Católica de Chile 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 valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had 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% had 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 valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20).
author	Braun J,Sandra Escalona P,Alex Chamorro S,Gastón Corbalán H,Ramón Pérez C,Carlos Labarca L,Jaime Irarrázaval L,Manuel José Zalaquett S,Ricardo Rodríguez V,José Antonio Casanegra P,Pablo
author_facet	Braun J,Sandra Escalona P,Alex Chamorro S,Gastón Corbalán H,Ramón Pérez C,Carlos Labarca L,Jaime Irarrázaval L,Manuel José Zalaquett S,Ricardo Rodríguez V,José Antonio Casanegra P,Pablo
author_sort	Braun J,Sandra
title	Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
title_short	Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
title_full	Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
title_fullStr	Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
title_full_unstemmed	Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
title_sort	endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario
publisher	Sociedad Médica de Santiago
publishDate	2000
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700002
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Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario

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