Background: Prosthetic valve endocarditis is rare but associated with significant mortality.
Methods: Retrospective chart review of patients admitted to our facility for PVE between 2010-2016.
Results: 24 patients with age range 27-78 y, 79% males. Most common comorbidities: heart failure 45%, CKD 25%, DM 16%, immunosuppression 8%, IV drug use 8%. Reasons for initial repair: Aortic stenosis 25%, native valve endocarditis 25%, Mitral valve regurgitation 16%, congenital valve disorders including bicuspid Aortic valve 8%, Aortic Insufficiency 8%, aortic dissection with valve involvement 4%, Mitral Stenosis due to rheumatic disease 4%, tricuspid valve insufficiency 4%, unknown 4%. Patients underwent replacement with mechanical valve 54%, bio-prosthetic valve 33%, unknown 12%. 16% of all patients had their prosthetic valve infected within 6 months of the repair. Common presenting symptoms: fever 58%, abdominal complaints 33%, Altered Mental Status 25%, stroke symptoms 12%, chest pain/dyspnea 20%, asymptomatic (incidental finding on TTE) 8%, septic shock 12%. All patients received broad spectrum IV Antibiotics on presentation, Vancomycin being the most frequently used (58%) in combinations with other IV antibiotics. Most common organisms: Enterococcus Faecalis 29% followed by culture negative infections. 50% of patients with positive cultures didnt received the recommended antibiotics by AHA guidelines and 66.6% of them needed surgical intervention or had re-infection with 60% mortality rate compared to patient treated with guideline directed therapy. 6 patients died, 14 recovered, 7 patients required re-admission, 2 of which due to GI bleed and 5 with recurrence of infection, 4 patients with persistent infection needed surgical repair (1 with perivalvular abscess, 3 severe infection non-responding to prolonged Antibiotic therapy). Rate of reinfection was higher with Aortic valve as well as mortality rate. No difference in mortality rate between bio-prosthetic and mechanical valve.
Conclusion: PVE associated with significant complications and mortality. Implementing the AHA treatment guidelines was associated with lower rate of complications including readmission, need for surgical intervention and death, further studies needed to enforce these findings.
M. Abdulhaleem, None
M. Hasan, None
S. Altabaqchali, None
F. Ibrahim, None
A. Hassoun, None