Determinants of Disease Outcome in Patients with Drainage of Aortic Root Abscess Caused by Infective Endocarditis
Patients with infective endocarditis (IE) were studied to assess incidence, clinical features and mortality in a population with either persistent (PF) or recurrent fever (RF) during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8%) had fever during treatment: 35 had PF and 16 had RF (Group 1). This group was compared with 35 patients with IE without fever (Group 2). Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly). However, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with MRSA (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in Group 1 (p<0.05). The most common causes of PF were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). On the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with RF. The overall mortality was 39.5%, distributed as follows: 52.2% of Group 1 and in 22.9% of Group 2 (p=0.007). The presence of comorbidities, major vessel embolization, heart failure, MRSA infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in Group 1 (p<0.05). We propose an evaluation method during the treatment of patients affected by this type of fever.