Infective Endocarditis Remains a Lethal Threat

Nearly one in five patients dies in hospital and S. aureus infection increases risk of death

15 mar 2009-- Despite recent advances in diagnosis and treatment, infective endocarditis continues to be frequently fatal, with acute presentations more common than previously thought and a high rate of Staphylococcus aureus infection, according to study findings published in the Mar. 9 issue of the Archives of Internal Medicine.

David R. Murdoch, M.D., of the University of Otago in Christchurch, New Zealand, and colleagues studied 2,781 patients (mean age 57.9) who were admitted to 58 hospitals in 25 countries between June 1, 2000, through Sept. 1, 2005. Of these, 17.7 percent died in hospital.

The researchers found that 77 percent of patients presented within 30 days of disease onset but had few of the classic clinical symptoms. They identified Staphylococcus aureus as the most common pathogen (31.2 percent) and found that it was associated with an increased risk of in-hospital death (odds ratio, 1.54). Surgery was performed on 48.2 percent of patients and was associated with a decreased risk of in-hospital death (odds ratio, 0.61), the report indicates.

"In addition, we have found initial evidence that early surgery may be important in improving patient outcomes," the authors write. "Because nearly 50 percent of patients with infective endocarditis undergo surgery, early identification of surgical indications may improve mortality."

Several of the study authors report relationships with the pharmaceutical industry, including companies that market treatment for endocarditis.

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