Log in | Register

Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients

Bruno Mourvillier| Jean-Louis Trouillet| Jean-François Timsit| Jérome Baudot| Jean Chastre| Bernard Régnier| Claude Gibert| Michel Wolff
Original
Volume 30, Issue 11 / November , 2004

Pages 2046 - 2052

Abstract

Objective

To identify factors associated with in-hospital outcome of adult patients admitted to the ICU with infective endocarditis (IE).

Design and setting

Retrospective study performed in the two medical ICUs of a teaching hospital.

Patients and participants

The charts of all 228 consecutive patients aged 18 years or older admitted with infective IE between January 1993 and December 2000 were reviewed. All patients satisfied the modified Duke’s criteria for definite IE.

Measurements and results

There were 146 episodes of native valve endocarditis and 82 of prosthetic valve endocarditis. Staphylococcus aureus was the predominant causative micro-organism. Most complications occurred early during the course of IE. One-half of the patients underwent cardiac surgery during the same hospitalization and had a better outcome than nonoperated patients. The overall in-hospital mortality rate was 45% (102/228). Multivariate analysis revealed the following clinical factors in patients with native valve IE as independently associated with outcome: septic shock (odds ratio 4.81), cerebral emboli (3.00), immunocompromised state (2.88), and cardiac surgery (0.475); in patients with prosthetic valve IE the factors were: septic shock (4.07), neurological complications (3.1), and immunocompromised state (3.46).

Conclusions

IE still carries high morbidity and mortality rates for the subset of patients requiring ICU admission. Most complications occur early making the decision process for optimal medical and surgical management more difficult. Surgical treatment appears to improve in-hospital outcome.

Keywords

References

  1. Hoen B, Alla F, Selton-Suty C, Beguinot I, Bouvet A, Briancon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Lemoing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F (2002) Changing profile of infective endocarditis. Results of a 1-year survey in France. JAMA 288:75–81
    • View reference on publisher's website
    • View reference on PubMed
  2. Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, Levison M, Chamber HF, Dajani AS, Gewitz MH, Newburger JW, Gerber MA, Shulman ST, Pallasch TJ, Gage TW, Ferrieri P (1998) Diagnosis and management of infective endocarditis and its complications. Circulation 98:2936–2948
    • View reference on PubMed
  3. Mylonakis E, Calderwood SB (2001) Infective endocarditis in adults N Engl J Med 345:1318–1330
  4. Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, Woods CW, Reller CB, Ryan T, Fowler VG Jr (2002) Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 162:90–94
    • View reference on publisher's website
    • View reference on PubMed
  5. Calderwood SB, Swinski LA, Karchmer AW, Waternaux CM, Buckley MJ (1986) Prosthetic valve endocarditis: analysis of factors affecting outcome of therapy. J Thorac Cardiovasc Surg 92:776–783
    • View reference on PubMed
  6. Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ (2003) Complicated left-sided native valve endocarditis in adults. Risk classification for mortality. JAMA 289:1933–1940
    • View reference on publisher's website
    • View reference on PubMed
  7. Karth GD, Koreny M, Binder T, Knapp S, Zauner C, Valentin A, Honninger R, Heinz G, Siostrzonek C (2002) Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis. Crit Care 6:149–154
    • View reference on PubMed
  8. Wolff M, Witchitz S, Chastang C, Régnier B, Vachon F (1995) Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision. Chest 108:688–694
    • View reference on PubMed
  9. Gouello JP, Asfar P, Brenet O, Kouatchet A, Berhelot G, Alquier P (2000) Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases. Crit Care Med 28:377–382
    • View reference on PubMed
  10. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638
    • View reference on publisher's website
    • View reference on PubMed
  11. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on an European/North American mulicenter study. JAMA 270:2957–2963
  12. Fagon JY, Chastre J, Novara A, Medioni P, Gibert C (1993) Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunction and/or infection: the ODIN model. Intensive Care Med 19:137–144
  13. Fernandez-Guerrero ML, Verdejo, C Azofra J, de Gorgolas M (1995) Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. Clin Infect Dis 20:16–23
    • View reference on PubMed
  14. Bone RC, Sibbald WJ, Sprung CL (1992) The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 101:1481–1483
    • View reference on PubMed
  15. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer AS, Kaye D, Bisno AL, Ferrieri P, Shulman ST, Durack DT (1995) Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. JAMA 274:1706–1713
    • View reference on PubMed
  16. Pettersson G, Carbon C and the Endocarditis Working Group of the International Society of Chemotherapy (1998) Recommendations for the surgical treatment of endocarditis. Clin Microb Infect 4 [Suppl 3]:3S34–3S46
  17. Francioli PB (1997) Complications of infective endocarditis. In: Scheld WM, Whitley RJ, Durack DT (eds) Infections of the central nervous system. Lippincott-Raven, Philadelphia, pp 523–553
  18. Anderson DJ, Goldstein LB, Wilkinson WE, Corey GR, Cabell CH, Sanders LL, Sexton DJ (2003) Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis. Neurology 61:1341–1346
    • View reference on PubMed
  19. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P (2000) Neurologic manifestations of infective endocarditis. A 17-year experience in a teaching hospital in Finland. Arch Intern Med 160:2781–2787
    • View reference on publisher's website
    • View reference on PubMed
  20. Roder BL, Wandall DA, Espersen F, Frimodt-Moller N, Skinhoj P, Rosdahl VT (1997) Neurologic manifestations in Staphylococcus aureus endocarditis: a review of 260 bacteremic cases in nondrug addicts. Am J Med 102:379–386
    • View reference on PubMed
  21. Steckelberg JM, Murphy JG, Ballard D, Bailley K, Tajik AJ, Taliercio CP, Guliani ER, Wilson WR (1991) Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 114:635–640
    • View reference on PubMed
  22. Di Salvo G, Habib G, Pergola V, Aviernos JF, Philip E, Casalta JP, Vailloud JM, Derumeaux G, Gouvernet J, Ambrosi P, Lambert M, Ferracci A, Raoult D (2001) Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 37:1069–1076
  23. Vilacosta I, Graupner C, San Roman Alberto J, Sarria C, Ronderos R, Fernandez C, Mancini L, Sanz O Sanmartin JV, Stoermann W (2002) Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol 39:1489–1495
    • View reference on publisher's website
    • View reference on PubMed
  24. Hecht S, Berger M (1992) Right-sided endocarditis in intravenous drug users. Prognostic features in 102 cases. Ann Intern Med 117:560–566
    • View reference on PubMed
  25. Akowuah EF, Davies W, Oliver S, Stephens J, Riaz I, Zadk P, Cooper G (2003) Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment. Heart 89:269–272
    • View reference on publisher's website
    • View reference on PubMed
  26. John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB (1998) Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death. Clin Infect Dis 26:1302–1309
    • View reference on PubMed
  27. Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, Monro JC (2000) Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg 69:1448–1454
    • View reference on publisher's website
    • View reference on PubMed
  28. Tornos P, Almirante B, Mirabet S, Permanyer G, Pahissa A, Soler-Soler J (1999) Infective endocarditis due to Staphylococcus aureus. Deleterious effect of anticoagulant therapy. Arch Intern Med 159:473–475
    • View reference on publisher's website
    • View reference on PubMed
  29. Vickram HR, Buenconsejo J, Hasbun R, Quagliarello VJ (2003) Impact of valve surgery on 6-month mortality in adults with complicated left-sided native valve endocarditis. JAMA 290:3207–3214
  30. Eishi K, Kawazoe K, Kuryama Y, Kitoh Y, Kawaschima Y, Omae T (1995) Surgical management of infective endocarditis associated with cerebral complications: multicenter retrospective study in Japan. J Thorac Cardiovasc Surg 110:1745–1755
    • View reference on PubMed
  31. Parrino PE, Kron IL, Ross SD, Shockey KS, Kron AM, Towler MA, Tribble CG (1999) Does a focal neurological deficit contraindicate operation in a patient with endocarditis? Ann Thorac Surg 67:59–64
    • View reference on PubMed
  32. Rubinovitch B, Pittet D (2002) Infective endocarditis: too ill to be operated? Crit Care 6:106–107
    • View reference on publisher's website
    • View reference on PubMed
  33. Moreillon P, Que YA (2004) Infective endocarditis. Lancet 363:139–149
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement