973. Medical vs. Medical and Surgical Treatment for Brucella Endocarditis: a Review of the Literature
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Endocarditis is the most common cardiovascular complication and the leading cause of death in brucellosis. Unfortunately, the treatment methods (medical, surgical, or both), the choice of antibiotics, and duration of medical treatment are not clear because of the low number of patients and lack of controlled trials.This review was undertaken to determine the role of surgery in brucella endocarditis by reviewing all cases of brucella endocarditis since the advent of surgical intervention for this condition.

Methods: In a comprehensive search using “brucella endocarditis” and “brucella AND endocarditis” as keywords in Pubmed and Google search engines, 95 articles in english (266 analyzable cases) (1966-2010) were identified and variables (demographics, risk factors,  treatment, and outcome) were recorded. Reports prior to 1966 were excluded to eliminate potential bias related to limited antibiotic access and heart surgery techniques at that time. Linear and Logistic regression was performed to assess the role of surgery in treatment of brucella endocarditis in this study.

Results: The aortic valve was the most commonly involved valve, and the average size of the vegetations was large (mean vegetation size of 121.5 mm). 79.4% of cases were treated by combined medical and surgical intervention. Mortality was increased with medical treatment alone (OR 15.8, 95% CI 4.6-54), or presence of congestive heart failure (OR 3.78, 95% CI 1.1-12.5). A positive blood culture decreased mortality (OR .2, 95% CI .1-.6). Most isolates were Brucella melitensis but the type of isolate (melitensis vs. abortus) did not affect mortality (p=1.0). The presence of prosthetic valve endocarditis did not significantly increase mortality compared to native valves.Rifampin/ tetracyclin plus aminoglycoside or cotrimoxazole were the most commonly used antimicrobial regimen. However, the choice of antibiotics, antibiotic regimens or the length of treatment with antibiotics did not show any significant affect on patient outcome.

Conclusion: In the absence of a controlled trial, surgery should be part of the treatment for brucella endocarditis and medical treatment alone does not seem to be sufficient in most cases.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Maryam Keshtkar-Jahromi, MD, MPH1, Seyed-Mostafa Razavi, MD2, Marzieh KeshtkarJahromi, MD2, Sharareh Gholamin, MD2, Mian Hossain, PHD3 and Mohammed Sajadi, MD3, (1)Deaprtment of Internal Medicine, Union Memorial Hospital, Baltimore, MD, (2)Clin Res&Dev Ctr, Shahid Modarres Hosp, Tehran, Iran, (3)University of Maryland, Sch of Med and Institute of Human Virology, Baltimore, MD

Disclosures:

M. Keshtkar-Jahromi, None

S. M. Razavi, None

M. KeshtkarJahromi, None

S. Gholamin, None

M. Hossain, None

M. Sajadi, None

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