Klebsiella endocarditis: report of two cases and review.

The rarity of endocarditis due to Klebsiella species limits its recognition and awareness of its often malignant course. We describe two recent cases of Klebsiella pneumoniae endocarditis and review the clinical context and outcomes of 48 other cases reported in the literature. At our hospital, endocarditis complicated only one of 86 consecutive episodes of bacteremia due to Klebsiella species. In 22 series of endocarditis that we reviewed, Klebsiella species caused < or =1.2% of cases of native valve endocarditis and up to 4.1% of cases of prosthetic valve endocarditis. Valves were replaced in 44% of these cases, and the mortality rate was 49% in cases for which outcome was specified. Valve replacement may be associated with improved survival. We conclude that Klebsiella species are a rare but ominous cause of complicated bacterial endocarditis that requires careful evaluation during the entire course of therapy.