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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective study 31 cases of proved and 10 of highly suspected bacterial endocarditis were analysed. Valve incompetence was the usual consequence but stenosis occurred in 3 cases, all fatal. Congestive heart failure developed in two-thirds. Secondary manifestations were common and as often caused by alpha-streptococci as by other bacteria. Initial antibiotic treatment was mainly applied according to a fixed schedule, generally with continuous intravenous infusion, followed by oral therapy. In 10 patients, the infection was still active after 6 weeks of therapy. Therefore, we now use intermittent injections or infusions for at least 4--6 weeks. Within a year, 9 patients died from uncontrolled infection together with congestive heart failure, and 1 from heart failure and active chronic endocarditis. In 4, myocardial abscesses or inflammations were found. All 10 had underlying factors or advanced stages of the disease. Of 18 patients with alpha-streptococci or enterococci none died from endocarditis, as against 10 of 23 with other or unknown bacteria. Follow-up yielded valuable information on one-third of the patients. The mortality during the initial hospital stay was 22%, after 1 year 24% and after 5 years 39%.
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PMID:Bacterial endocarditis. II. A prospective study with clinical, laboratory and therapeutic observations. 41 66

The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and multivariate analysis. The principal causative organisms were Staphylococcus aureus (33%), streptococci (20%), coagular-negative staphylococci (12%), enterococci (10%) and gram-negative bacilli (9%). The 4 month survival rate was 66% (42 deaths). The main predictive factor for death was infection with S. aureus (75% vs 15% with other organisms). In S. aureus infection, multivariate analysis identified the following predictive factors for death: a prothrombin ratio less than 30% (RR = 8.3), mediastinitis (RR = 4.9), cardiac failure (RR = 4.4) and septic shock (RR = 2.6). In cases of infection with other organisms, the following factors were predictive of death: a prothrombin ratio of less than 30% (RR = 32.26), renal failure (RR = 7.31) and cardiac failure (RR = 6.07). In patients with S. aureus infection, survival was better after than without surgery: 9/20 (45%) versus 0/20 (p < 0.001). In infection with other organisms, there was no difference in a survival after surgical (89%) or medical therapy (81%). Chronic endocarditis relapses over 1 to 5 years was observed in 9 cases. All patients were reoperated a total number of 18 times with 5 deaths. Very prolonged antibiotic therapy is recommended in these patients. The authors conclude that endocarditis not due to S. aureus and without complications may be treated medically. Rapid reoperation is necessary in all other cases.
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PMID:[Prognostic factors of prosthetic valve endocarditis. Apropos of 122 cases]. 876 Jun 51