INFECTIVE ENDOCARDITIS, 1970-1979 - A STUDY OF CULTURE-POSITIVE CASES IN ST THOMAS HOSPITAL

Abstract

Episodes (93) of culture-positive endocarditis occurred in 88 patients from 1970-1979. Streptococci caused 2/3 of the cases, with Streptococcus mitior and S. sanguis most common. Among the Group D streptococci, S. bovis was much more common than S. faecalis. Staphylococci accounted for 1/4 of the episodes. Streptococcal endocarditis was most common in the elderly; staphylococcal endocarditis occurred at all ages. Degenerative heart disease was the underlying cardiac factor in nearly 1/2 the streptococcal cases, but staphylococci most often affected normal heart valves. When prosthetic valves were infected, endocarditis of early onset was staphylococcal, but that of late onset was streptococcal. Narcotic abuse was a common cause of staphylococcal endocarditis, second only to surgical wound infection following valve replacement. Streptococci affected the mitral and aortic valves equally but the staphylococci more usually involved mitral or tricuspid valves. The overall mortality was 36% but was much higher for staphylococcal than streptococcal endocarditis.