Bacterial endocarditis. II. A prospective study with clinical, laboratory and therapeutic observations.

In a prospective study 31 cases of proved and 10 of highly suspected bacterial endocarditis were analysed. Valve incompetence was the usual consequence but stenosis occurred in 3 cases, all fatal. Congestive heart failure developed in two-thirds. Secondary manifestations were common and as often caused by alpha-streptococci as by other bacteria. Initial antibiotic treatment was mainly applied according to a fixed schedule, generally with continuous intravenous infusion, followed by oral therapy. In 10 patients, the infection was still active after 6 weeks of therapy. Therefore, we now use intermittent injections or infusions for at least 4--6 weeks. Within a year, 9 patients died from uncontrolled infection together with congestive heart failure, and 1 from heart failure and active chronic endocarditis. In 4, myocardial abscesses or inflammations were found. All 10 had underlying factors or advanced stages of the disease. Of 18 patients with alpha-streptococci or enterococci none died from endocarditis, as against 10 of 23 with other or unknown bacteria. Follow-up yielded valuable information on one-third of the patients. The mortality during the initial hospital stay was 22%, after 1 year 24% and after 5 years 39%.