97 What is the morbidity and mortality of
endocarditis with modern day management (and
how many relapse)?
Peter Wilson
Despite progress in management, morbidity and mortality remain
major problems for the patient with endocarditis, both during the
acute phase and as the result of long term complications after a
bacteriological cure. Improvements in microbiological diagnosis,
types of antibiotic treatment and timing of surgical intervention
have improved the outlook for some patients but the impact has
been minor with some of the more invasive pathogens. The
infection can relapse and vegetations can be reinfected. Healed
vegetations may leave valvular function so compromised that
surgery is required.
In 140 patients with acute infective endocarditis, 48 (34%)
required valve replacement during treatment.^1 Heart failure
occurred in 46 patients. During the active disease, 22 patients (16%)
died. Medical treatment alone cured 80 patients. Relapse occurred
in 3 (2.7%) of 112 patients all within one month of discharge.
Recurrence was observed in 5 (4%) patients between 4 months and
15 years after the first episode. In the follow up period, another 16
patients died of cardiac causes, most within five years. Of 34
patients with late prosthetic valve endocarditis, 27 (79%) survived
their hospital admission but 11 had further surgery during the next
five years, usually following cardiac failure.^2 In another study, 91
(70%) of 130 patients survived hospitalisation for native valve
endocarditis and 17 of 60 initially treated medically required
surgery during a mean 9 year follow up.^3 During follow up, 29
(22%) patients died, 13 from cardiac causes.
RReeffeerreenncceess
1 Tornos P, Sanz E, Permanyer-Miralda G et al. Late prosthetic valve endo-
carditis. Immediate and long term prognosis. Chest1992; 110011 : 37–41.
2 Tornos MP, Permanyer-Miralda G, Olona M et al. Long-term
complications of native valve infective endocarditis in non-addicts.
Ann Intern Med1992; 111177 : 567–72.
3 Verheul HA, Van Den Brink RBA, Van Vreeland T et al. Effects of
changes in management of active infective endocarditis on outcome in
a 25 year period. Am J Cardiol1993; 7722 : 682–7.