Early-onset prosthetic valve endocarditis

BACKGROUND Endocarditis following cardiac valve implantation is a rare but serious complication.

OBJECTIVE To determine the risk and outcome of early-onset prosthetic valve endocarditis (EO-PVE) in adult patients at The Cleveland Clinic.

METHODS Retrospective review of a 5-year case series of patients who acquired bloodstream infections within 60 days of surgery identified through a prospective surveillance program.

RESULTS Sixty-eight of approximately 2100 patients acquired bloodstream infections; 16 (24%) contracted EO-PVE and 52 (76%) did not. Risk factors for EO-PVE included younger age, at least three sets of positive blood culture results, and an organism other than a gram-negative bacillus. The majority of patients with EO-PVE had a recognized source of infection (wound or vascular catheter site), but no infections were attributed to a pulmonary or urinary tract site. Eleven patients (69%) were cured, including six who underwent emergent second operations.

CONCLUSION Patients with multiple blood cultures positive for organisms other than gram-negative bacilli are at risk of EO-PVE, even when a primary wound infection or vascular catheter site infection is recognized and treated.