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Changing Etiology of Bacterial Endocarditis in the Antibacterial Era: Experiences at Boston City Hospital 1933-1965

MAXWELL FINLAND, M.D., M.A.C.P.; and MILDRED W. BARNES, M.S.
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Supported in part by grants 5R1-AI-00023 and 2T1-AI-00068, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

Presented March 21, 1969, at the National Symposium on Bacterial Endocarditis held at The Royal College of Physicians, London. The results of some of these studies (based on the material for the years 1935 to 1957) were first presented in May 1959 at the annual meeting of the Association of American Physicians and later published (FINLAND M: Occurrence of serious bacterial infections since the introduction of antibacterial agents. JAMA 170:2181-2197, 1959).

▸Requests for reprints should be addressed to Dr. Maxwell Finland, Boston City Hospital, Boston, Mass. 02118


Boston, Massachusetts


Ann Intern Med. 1970;72(3):341-348. doi:10.7326/0003-4819-72-3-341
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During 12 selected years from 1933 to 1965, 337 patients were documented as having bacterial endocarditis at Boston City Hospital, 43 of them with 2 organisms and 10 with 3 in their blood, or heart valves, or both. Streptococcus viridans was the most frequent organism found and occurred in every year and Pneumococcus and Staphylococcus aureus in each year but one. The finding of Staph. aureus, gram-negative bacilli (not Salmonella or Shigella), Enterococcus, and Staph. epidermidis appeared to be related to extensive usage of antimicrobials and was predominantly nosocomial. Only two patients with Enterococcus and one in whom Staph. epidermidis was found were seen before 1947. Rheumatic valvular disease was present in more than two thirds of the patients with S. viridans or Staph. epidermidis but in only one third or less of those with other organisms. Staph. aureus, Enterococcus, and gram-negative bacilli more often affected patients over 60 and S. pyogenes and S. viridans, those under 40 years old.

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