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  • Title: [Infective endocarditis in valve prostheses].
    Author: Sanguinetti M.
    Journal: Cardiologia; 1991 Dec; 36(12 Suppl 1):125-36. PubMed ID: 1841761.
    Abstract:
    Prosthetic valve endocarditis (PVE) has existed for about 30 years. Its incidence and mortality have decreased compared to the '60s, but they are still remarkable. The distinction between early and late forms of PVE is still justified, only if considered critically. At present the incidence of early PVE is 1% or less. It is caused mainly by staphylococci, Gram-negative bacilli, and fungi, which infect the prosthesis during or immediately after surgery; it carries a mortality of 30-60%. The incidence of late PVE is approximately 1% per year; pathogenesis and clinical features are similar to infective endocarditis (IE) on native valves. Streptococci are the most frequent causative organisms and current mortality is 25-35%. The diagnosis of PVE can be difficult; a strong clinical suspicion, blood cultures, and echocardiography are the most valuable tools. The antibiotic treatment follows the general indications for IE, but in PVE the associations of 2 or more antibiotics are the rule and need to be used according to established protocols. The occurrence of prosthetic dysfunction, para-annular abscesses, and embolism is frequent in PVE and makes prognosis worse. In all cases of complicated PVE or in those due to resistant organisms, an early reintervention must be associated to medical therapy. The surgical treatment of PVE often implies difficult and complex procedures, but early and long-term results are better than those obtained with medical treatment alone. Pharmacological prevention of embolism remains an unsolved problem. The prophylaxis of early PVE has made remarkable progress in the last 20 years and present results appear hard to improve. The prophylaxis of late PVE requires a more widespread awareness of this problem even outside the setting of cardiology and cardiac surgery.
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