Endocardite infecciosa precoce em próteses valvares: experiência do Instituto Nacional de Cardiologia, 2006 – 2014
Endocardite infecciosa precoce em próteses valvares: experiência do Instituto Nacional de Cardiologia, 2006 – 2014
Data
2016
Autores
Brito, José Oscar Reis
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: Infecção em prótese é uma complicação possível da cirurgia de troca valvar e é uma das formas mais graves de endocardite infecciosa (EI), associada a alta taxa de morbimortalidade. Métodos: Estudo prospectivo observacional, tipo série de casos, com um componente retrospectivo por revisão de prontuários, entre 2006-2014, de pacientes adultos com EI precoce de prótese valvar (EIPPV) operados no Instituto Nacional de Cardiologia. Objetivos: Descrever o perfil epidemiológico, clínico e laboratorial dos pacientes com EIPPV, estimar a incidência de EIPPV e avaliar as condições de risco associadas a sua aquisição. Resultados: Ocorreram 22 casos no período, correspondendo a 9,9% dos 223 casos de EI. A incidência de EIPPV em relação ao número de cirurgias de trocas valvares no período foi de 22/ 2394 (0,9%). Eram do sexo masculino 10 (45,5%) e do feminino 12 (54,5%) pacientes. A média de idade foi de 46,9± 17,5 anos. EIPPV de menos de 2 meses ocorreu em 16/22 (72,7%). A apresentação foi aguda em 20 pacientes (90,9%). Valvopatia reumática ocorreu em 12 pacientes (54,5%) e 9 (40,1%) tinham prótese antes da 1a cirurgia. A comorbidade mais frequente foi insuficiência cardíaca congestiva em 11/22 (50%) e diabetes mellitus em 4/22 (18,2%). Enterococcus faecalis acometeu 5 (22,7%) e Staphylococcus epidermidis 3 (13,6%). No total de 26 próteses acometidas, 16 (61,5%) eram biológicas e 10 (38,5%), mecânicas. A posição mitral ocorreu em 16 (61,5%), a aórtica em 11 (42,3%) e mitral e aórtica em 4 (15,4%). Ecocardiograma transesofágico foi realizado em 21 dos 22 episódios (95,5%), mostrando vegetação (32%) e nova regurgitação valvar (29%) como achados mais frequentes. Embolizações à distância ocorreram em 9/22 pacientes (40,1%). Em relação ao tratamento realizado nos 22 pacientes com EIPPV, 10 (45,5%) foram submetidos à retroca valvar e os outros 12 (55,5%), ao tratamento clínico. Dos que foram re-operados, 6/10 (60%) faleceram e, dos que foram tratados de forma conservadora, não houve óbito. Conclusões: EIPPV afetou pacientes jovens, com predisposição reumática. A incidência anual foi semelhante à da literatura. A maior parte dos casos ocorreu em tempo inferior a 2 meses, de modo agudo. Nenhum caso teve S.aureus como etiologia, o que difere da literatura. A abordagem cirúrgica deve ser individualizada.
Introduction: Infection of prosthesis is a possible complication of cardiac valve surgery and is one of the most severe forms of infective endocarditis (IE), associated with high morbity and mortality. Methods: This is a prospective case series study, with a retrospective component due to data obtained from patients’ notes. Adult patients with early onset prosthetic valve endocarditis (EPVIE) admitted to Instituto Nacional de Cardiologia between 2006 and 2014 were included. Results: There were 22 episodes of EPVIE, corresponding to 9.9% of the 223 cases of IE in adults in the study period. The incidence of EPVIE in relation to all valve replacement surgery was 22/2394 (0.9%). There were 10 (45.5%) male and 12 (54.5%) female patients. Mean age was 46.9± 17.5 years. Acquisition of EPVIE in less than 2 months occurred in 16/22 (72.7%) of cases. Presentation was acute in 20 patients (90.9%). Previous rheumatic valve disease occurred in 12 (54.5%) and 9 (40.1%) had prosthesis before their 1st surgery. The most prevalent comorbidity was congestive heart failure, in 11/22 (50%), and diabetes mellitus in 4/22 (18.2%). Enterococcus faecalis affected 5 (22.7%) patients and Staphylococcus epidermidis 3 (13.6%). Of 26 affected prosthesis, 16 (61.5%) were biological and 10 mechanical (38.5%). The mitral position was involved in 16 (61.5%), the aortic in 11 (42.3%) and the mitral and aortic in 4 (15.4%). Transesophageal echocardiograms were done for 21 of the 22 episodes (95.5%), and showed vegetation (32%) and new valve regurgitation (29%) as the most frequent findings. Systemic embolization occurred in 9/22 patients (40.1%). New valve replacement surgery was done in 10/22 (45.5%) patients with EPVIE and conservative treatment alone was given to the other 12 (54.5%). Of the operated patients, 6/10 (60%) died, and of those treated conservatively, there were no deaths. Conclusions: EPVIE affected younger patients, with previous rheumatic valve disease. The annual incidence of EPVIE was similar to that reported in the literature. Most cases occurred less than 2 months after valve replacement surgery, with an acute presentation. None of the cases had S .aureus as the causative pathogen, which differs from what is published in the literature. Surgical indication must be done on an individual basis.
Introduction: Infection of prosthesis is a possible complication of cardiac valve surgery and is one of the most severe forms of infective endocarditis (IE), associated with high morbity and mortality. Methods: This is a prospective case series study, with a retrospective component due to data obtained from patients’ notes. Adult patients with early onset prosthetic valve endocarditis (EPVIE) admitted to Instituto Nacional de Cardiologia between 2006 and 2014 were included. Results: There were 22 episodes of EPVIE, corresponding to 9.9% of the 223 cases of IE in adults in the study period. The incidence of EPVIE in relation to all valve replacement surgery was 22/2394 (0.9%). There were 10 (45.5%) male and 12 (54.5%) female patients. Mean age was 46.9± 17.5 years. Acquisition of EPVIE in less than 2 months occurred in 16/22 (72.7%) of cases. Presentation was acute in 20 patients (90.9%). Previous rheumatic valve disease occurred in 12 (54.5%) and 9 (40.1%) had prosthesis before their 1st surgery. The most prevalent comorbidity was congestive heart failure, in 11/22 (50%), and diabetes mellitus in 4/22 (18.2%). Enterococcus faecalis affected 5 (22.7%) patients and Staphylococcus epidermidis 3 (13.6%). Of 26 affected prosthesis, 16 (61.5%) were biological and 10 mechanical (38.5%). The mitral position was involved in 16 (61.5%), the aortic in 11 (42.3%) and the mitral and aortic in 4 (15.4%). Transesophageal echocardiograms were done for 21 of the 22 episodes (95.5%), and showed vegetation (32%) and new valve regurgitation (29%) as the most frequent findings. Systemic embolization occurred in 9/22 patients (40.1%). New valve replacement surgery was done in 10/22 (45.5%) patients with EPVIE and conservative treatment alone was given to the other 12 (54.5%). Of the operated patients, 6/10 (60%) died, and of those treated conservatively, there were no deaths. Conclusions: EPVIE affected younger patients, with previous rheumatic valve disease. The annual incidence of EPVIE was similar to that reported in the literature. Most cases occurred less than 2 months after valve replacement surgery, with an acute presentation. None of the cases had S .aureus as the causative pathogen, which differs from what is published in the literature. Surgical indication must be done on an individual basis.
Description
Palavras-chave
Endocardite infecciosa, Próteses valvares, Cirurgia cardíaca, Infective endocarditis, Cardiac surgery, Prosthetic valve endocarditis, Nosocomial infection
Citação
Brito JOR. Endocardite infecciosa precoce em próteses valvares: experiência do Instituto Nacional de Cardiologia, 2006 – 2014. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2016