• Online Features  This Article  • Full text  • PDF  • eTable  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Cardiovascular System  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Drug Therapy  • Drug Therapy, Other  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Elisabeth Botelho-Nevers, MD; Franck Thuny, MD; Jean Paul Casalta, MD; Hervé Richet, MD, PhD; Frédérique Gouriet, MD, PhD; Frédéric Collart, MD; Alberto Riberi, MD; Gilbert Habib, MD; Didier Raoult, MD, PhD

Arch Intern Med. 2009;169(14):1290-1298.

Background  Despite improvements in medical and surgical therapy, infective endocarditis (IE) is still associated with a severe prognosis and remains a therapeutic challenge. We aimed to evaluate the impact of a standardized diagnostic and therapeutic protocol on mortality and to correlate the outcome with compliance with our management-based protocol.

Methods  We conducted an observational before-after study that included 333 consecutive patients treated for IE at a referral center from 1991 to 2006, which was divided into 2 periods: period 1 (1991-2001), before implementation of our therapeutic protocol (n = 173), and period 2 (2002-2006), after implementation of our protocol (n = 160). Our protocol was created by a multidisciplinary task force including a sampling of biological specimens, the use of only 4 antimicrobial agents, a standardized duration of treatment, standardized surgical indications, and 1 year of close follow-up. Because our protocol was based on a local consensus by physicians and surgeons, it was not possible to randomize the study.

Results  The 1-year mortality significantly decreased from 18.5% during period 1 to 8.2% during period 2 (hazard ratio, 0.41; 95% confidence interval, 0.21-0.79 [P = .008]). After multivariable analysis, the management during period 2 remained a strong protective factor (adjusted hazard ratio, 0.26; 95% confidence interval, 0.09-0.76 [P = .01]). During period 2, we observed a statistically significantly better compliance in antimicrobial therapy and fewer cases of renal failure. Deaths by embolic events and multiple organ failure syndrome also significantly decreased during period 2.

Conclusion  A dramatic reduction in mortality was observed during this study, suggesting that a management-based approach has a significant impact on IE outcome.

Author Affiliations: Laboratoire de Microbiologie, Centre National de la Recherche Scientifique, Unite Mixte de Recherche 6236, Institut Fédératif de Recherche 48, Université de la Méditerranée (Drs Botelho-Nevers, Thuny, Casalta, Richet, Gouriet, and Raoult), and Services de Cardiologie Adulte (Drs Thuny and Habib) and de Chirurgie Cardiaque, Hôpital de la Timone (Drs Collart and Riberi), Marseille, France.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Can We Really Achieve a 1-Year Mortality Rate Lower Than 10% in Patients With Infective Endocarditis?
Pierre Tattevin, Erwan Donal, and Matthieu Revest
Arch Intern Med. 2010;170(2):211.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association Between Valvular Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Heart Failure
Kiefer et al.
JAMA 2011;306:2239-2247.
ABSTRACT | FULL TEXT  

Histoplasma capsulatum Prosthetic Valve Endocarditis with Negative Fungal Blood Cultures and Negative Histoplasma Antigen Assay in an Immunocompetent Patient
Jinno et al.
J. Clin. Microbiol. 2010;48:4664-4666.
ABSTRACT | FULL TEXT  

Mechanism of Outside-In {alpha}IIb{beta}3-Mediated Activation of Human Platelets by the Colonizing Bacterium, Streptococcus gordonii
Keane et al.
Arterioscler. Thromb. Vasc. Bio. 2010;30:2408-2415.
ABSTRACT | FULL TEXT  

Chapter 57 Acute valve disease and endocarditis
Ducrocq et al.
The ESC Textbook of Acute and Intensive Cardiac Care 2010;1:med-9780199584314-chapter-med-9780199584314-chapter.
ABSTRACT | FULL TEXT  

Can We Really Achieve a 1-Year Mortality Rate Lower Than 10% in Patients With Infective Endocarditis?
Tattevin et al.
Arch Intern Med 2010;170:211-211.
FULL TEXT  

Can We Really Achieve a 1-Year Mortality Rate Lower Than 10% in Patients With Infective Endocarditis?--Reply
Thuny et al.
Arch Intern Med 2010;170:211-212.
FULL TEXT