0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Right-sided Endocarditis in Intravenous Drug Users: Prognostic Features in 102 Episodes

Susan R. Hecht, MD; and Marvin Berger, MD
[+] Article and Author Information

Requests for Reprints: Susan R. Hecht, MD, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003.

Current Author Addresses: Drs. Hecht and Berger: Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;117(7):560-566. doi:10.7326/0003-4819-117-7-560
Text Size: A A A

Objective: To describe the clinical, laboratory, and echocardiographic findings in a large group of patients with right-sided endocarditis and to determine whether any of these findings is predictive of prognosis.

Design: Retrospective survey of medical records to evaluate the course of hospitalization with follow-up on 6-month survival. Review of two-dimensional echocardiograms by an observer blinded to clinical information.

Setting: Large, metropolitan, voluntary hospital.

Patients: One hundred twenty-one intravenous drug users with clinical and bacteriologic evidence of 132 episodes of endocarditis. The presence of a right-sided valvular vegetation detected by two-dimensional echocardiography was required for entry into the study.

Measurements and Results: Staphylococcus aureus was the most common infecting organism (82%, 108 of 132). Vegetations involved the tricuspid valve in 127 episodes, the pulmonic in 4, and both in 1; they ranged in size from 0.4 to 4.3 cm (mean, 1.5 ± 0.7 cm). Vegetations greater than 1.0 cm were present in 106 cases (80%). Among patients with isolated native right-sided endocarditis who reached a definite end point in treatment, mortality was 7% (7 of 98). Vegetations greater than 2.0 cm were associated with a significantly higher mortality compared with vegetations of 2.0 cm or less (33% compared with 1.3%, P < 0.001).

Conclusions: Overall, right-sided endocarditis has a favorable prognosis. Although complications and prolonged fever are common, most cases respond to medical therapy. Our findings suggest that vegetation size may be an important predictor of outcome and that vegetations greater than 2.0 cm are associated with increased mortality.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)