Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study.

OBJECTIVE—To determine the clinical features and long term prognosis of infective endocarditis in patients who were not drug addicts. DESIGN—Prospective case series. SETTING—A university hospital that is both a referral and a primary care centre. PATIENTS—138 consecutive cases of infective endocarditis diagnosed and treated from January 1987 to March 1997. RESULTS—Mean patient age was 44 (20) years old. 95 patients (69%) had native valve endocarditis and 43 (31%) had prosthetic valve endocarditis. Staphylococci were the causal microorganisms in 34% of cases and streptococci in 33%. Severe complications occurred in 83% of patients and 51% of patients underwent surgery during the active phase (22% was emergency surgery). Inpatient mortality was 21%. During a follow up of 56 (44) months, 10 patients (9%) needed late cardiac surgery and seven (5% of the whole series) died. Overall 10 year survival was 71%. There were no significant differences in survival depending on the type of treatment received during the hospital stay (medical or combined medical-surgical). CONCLUSIONS—A high early surgery rate is related to good long term results and does not increase in-hospital mortality. Medical treatment, however, also offers favourable long term results in cases of responsive infective endocarditis where poor prognostic factors are absent. Keywords: infective endocarditis; staphylococci; streptococci