Characteristics and prognosis of patients requiring valve surgery during active infective endocarditis.

Despite significant progress having been made indiagnostic and therapeutic modalities, infective endo-carditis (IE) remains a serious infectious process, associ-ated with considerable morbidity and mortality.Antibiotics represent the cornerstone in the managementof IE, yet despite appropriate antibiotic use surgicalintervention may be necessary in cases with substantialintracardiac destruction, or when there is a low likeli-hood of cure with medical therapy alone. Recentlyacquired data (1,2) have suggested that the indicationsfor surgery have increased during the past decade, andthat early surgery for IE is now more common (3). Suchan expeditious operation could be indicated while theinfection is still active in clinical situations, such as valvedysfunction, organ failure, the development of abscessesor large vegetations, embolization (peripheral or cere-bral), prosthetic valve endocarditis (PVE) or fungal infec-tion. Hence, a multidisciplinary approach is necessary totreat these patients, and this must involve specialists ininfectious diseases, cardiology, cardiac surgery, andanesthesiology.The results of several studies have shown thatappropriate antibiotic therapy improves the outcomeof patients suffering from severe bacterial or fungalinfection, and that the involvement of an infectiousdisease specialist could potentially increase appropri-ate antibiotic use (4–7). However, to the best of thepresent authors’ knowledge, the impact of appropriateantibiotic treatment on the prognosis of IE has rarelybeen studied. Since 1998, an infectious disease special-ist (O.L.) has provided consultations at the authors’surgical unit and has established postoperative antimi-crobial therapy in collaboration with anesthesiologistsand cardiac surgeons. This collaboration has providedthe opportunity to evaluate the prognostic impact ofthe adequacy of antimicrobial treatment.The study aim was to describe the authors’ 12-yearexperience of surgical treatment for active IE, and to