A Clinical Survey of Infective Endocarditis

Kim, Kyung Hyo; Sul, Jun Hee; Lee, Seung Kyu; Chin, Dong Sik; Cho, Seung Yun; Lee, Woong Ku; Cho, Bum Koo

Abstract

Since the first report on infective endocarditis by Rokitansky in 1985, this subject has been extensively dealt with in the world literature. Nowadays by use of echocardiography, there has been a high discovery rate of vegetation, and thus made it a valuable tool in diagnosis, treatment, and the evaluation of the patient. However in Korea, there have been only a few case reports and even fewer studies on infective endocarditis. This study is a clinical analysis of 87 infective endocarditis cases, which were admitted and treated at the department of Pediatrics and Internal medicine, diagnosed as infective endocarditis, during the period from january 1975 through February 1984. 1) The mean age was 24.8 years and male to female ratio was 1.49:1. 2) Annual incidence showed no increment during the period and it was 1:2500. 3) Underlying heart diseases consisted of rheumatic heart disease(52.3%), congenital heart disease(39.7%), no underlying heart disease(8%), previous infective endocarditis(4.6%), and prosthetic valve endocarditis(3.4%). 4) Frequent clinical manifestations on admission were high fever, heart murmur, congestive heart failure and frequent laboratory findings were positive blood culture results, anemia, positive C-reactive protein, and hematuria. 5) Blood culture was positive in 75.9% and the most common infecting organism was alpha-streptococcus, which represented 42.4% of total positive cases. S. aureus and S. epidermidis were next common and these three organisms consisted of 71.2% Culture positivity was not significantly related to the type and incidence of complications. 6) Antibiotics sensitivity of the major isolated organisms were performed. Alpha-streptococcus was sensitive to almost all antibiotics except Tetracycline. Group D-streptococcus was sensitive to Chloramphenicol and Cephalosporin. S. aureus and S. epidermidis showed same results, which showd sensitivity to Chloramphenicol, Cephalosporin and Methicillin and resistence to penicillin. 7) Echocardiography was performed in 55 cases and showed vegetation in 58.2%. Complications related to the echocardiographic identification of the vegetations showed difference only in the mortality rate, which was greater by 3 times in the positive cases than in the negative. 8) Peripheral embolizations occurred in 29.9% of cases, and by far the mostcommon site was the brain, where 63% of the embolism was localized. 9) Sufficient duration of hospitalization(4-6 weeks) and judicious antibiotics administration was done in 43.7%. The initial response to therapy was noted in 48.5% of total febrile cases. 10) The mortality rate of the cases was 13.8% of the patients died. However, as many patients were discharged against advice because of socio-economic factors, precise therapeutic results of these cases could not be obtained.