Journal Article

Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization

Arlo Upton, Dragana Drinković, Sudha Pottumarthy, Teena West and Arthur J. Morris

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 55, issue 2, pages 234-239
Published in print February 2005 | ISSN: 0305-7453
Published online February 2005 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh527
Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization

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  • Medical Oncology
  • Critical Care

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Objectives:

To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization.

Patients and methods:

Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to α-haemolytic streptococci; 15 due to β-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery.

Results:

For α-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1–20) and 16 (4–58) days of treatment, respectively, P < 0.001. For β-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received ≤4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received ≤8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received ≤4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with β-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative.

Conclusions:

Our findings support current treatment guidelines for endocarditis caused by α-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.

Keywords: α-haemolytic streptococci; β-haemolytic streptococci; Streptococcus anginosus; Streptococcus pneumoniae; surgery

Journal Article.  3949 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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