Cartón J A, Maradona J A, Asensi Alvarez V
Servicio de Medicina Interna, Enfermedades Infecciosas, Hospital Central de Asturias.
Rev Clin Esp. 1995 Nov;195(11):744-51.
To know the validity and current prognosis of clinical prototypes assigned to streptococcal endocarditis (STREPEND) and Staphylococcus aureus endocarditis (SAE).
Fifty-four patients with SAE were compared with 43 patients with STREPEND diagnosed from 1984 to 1994 following a retrospective cohort study model.
The incidence of SAE and STREPEND was 0.21 and 0.17, respectively, per 1,000 hospital admissions. The acquisition of community endocarditis (non drug abusers vs. drug abusers) and nosocomial endocarditis was 74% (31% vs. 43%) and 26% for SAE; the corresponding values for STREPEND: 89% (70% vs. 19%) and 11%, respectively. The overall mortality rate for STREPEND/SAE was 9%/26% (among drug abusers there were no fatalities recorded), whereas in non drug abusers the mortality rate reached 41% and for nosocomial forms 36%. SAE was independently associated with drug abuse habits, right-sided heart infection, development of embolism and a high mortality rate. In contrast, by means of the multivariant analysis, STREPEND was independently associated with a subacute onset form, left-sided heart infection, cardiac surgery, and a low mortality rate.
Traditional stereotypes of the two main etiologies for endocarditis are still valid, although at present it is important to differentiate nosocomial endocarditis and in non drug abusers. Chemoprophylaxis compliance is low for STREPEND: Given the poor prognosis of SAE at the left heart side a more aggressive surgical attitude would be warranted.
