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Outcome and Treatment of Bartonella Endocarditis
Didier Raoult, MD, PhD;
Pierre-Edouard Fournier, MD, PhD;
François Vandenesch, MD, PhD;
Jean-Luc Mainardi, MD, PhD;
Susannah J. Eykyn, FRCP, FRCS, FRCPath;
James Nash, MD;
Edward James, MD;
Catherine Benoit-Lemercier, MD;
Thomas J. Marrie, MD
Arch Intern Med. 2003;163:226-230.
Background Endocarditis caused by Bartonella species is a potentially lethal infection characterized by a subacute evolution and severe valvular lesions.
Objectives To evaluate the outcome of patients with Bartonella endocarditis and to define the best antibiotic regimen using the following measures: recovery, relapse, or death.
Methods We performed a retrospective study on 101 patients who were diagnosed in our laboratory as having Bartonella endocarditis between January 1, 1995, and April 30, 2001. Bartonella infection was diagnosed using immunofluorescence with a 1:800 cutoff, polymerase chain reaction amplification of DNA, and/or culture findings of Bartonella species from whole blood, serum, and/or valvular biopsy specimens. A standardized questionnaire was completed by investigators for each patient.
Results Twelve of the 101 patients died and 2 relapsed. Patients receiving an aminoglycoside were more likely to fully recover (P = .02), and those treated with aminoglycosides for at least 14 days were more likely to survive than those with shorter therapy duration (P = .02).
Conclusion Effective antibiotic therapy for Bartonella endocarditis should include an aminoglycoside prescribed for a minimum of 2 weeks.
From the Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseille, France; (Drs Raoult and Fournier); Laboratoire de Microbiologie, Hôpital Edouard Herriot, Lyon, France; (Dr Vandenesch); Service de Microbiologie, Hôpital Georges Pompidou (Dr Mainardi), and Laboratoire de Microbiologie, Hôpital Bichat (Dr Benoit-Lemercier), Paris, France; Department of Infection, St Thomas' Hospital (Dr Eykyn), and Microbiology Department, St Bartholomew's Hospital (Dr James), London, England; Public Health Laboratory Service, William Harvey Hospital, Willesborough, Ashford, England; (Dr Nash); and Department of Medicine, University of Alberta, Edmonton (Dr Marrie).
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