Abstract
Background: Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of antimicrobial therapy and the temporal incidence of stroke in patients with IE and to determine if this time course differs from that shown for embolic events in previous studies. Methods: Prospective incidence cohort study involving 61 tertiary referral centers in 28 countries. Case report forms were analyzed from 1437 consecutive patients with left-sided endocarditis admitted directly to participating centers. Results: The crude incidence of stroke in patients receiving appropriate antimicrobial therapy was 4.82/1000 patient days in the first week of therapy and fell to 1.71/1000 patient days in the second week. This rate continued to decline with further therapy. Stroke rates fell similarly regardless of the valve or organism involved. After 1 week of antimicrobial therapy, only 3.1% of the cohort experienced a stroke. Conclusions: The risk of stroke in IE falls dramatically after the initiation of effective antimicrobial therapy. The falling risk of stroke in patients with IE as a whole precludes stroke prevention as the sole indication for valvular surgery after 1 week of therapy.
Original language | English (US) |
---|---|
Pages (from-to) | 1086-1094 |
Number of pages | 9 |
Journal | American heart journal |
Volume | 154 |
Issue number | 6 |
DOIs | |
State | Published - Dec 2007 |
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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In: American heart journal, Vol. 154, No. 6, 12.2007, p. 1086-1094.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis
T2 - An analysis from the ICE Prospective Cohort Study (ICE-PCS)
AU - Dickerman, Stuart A.
AU - Abrutyn, Elias
AU - Barsic, Bruno
AU - Bouza, Emilio
AU - Cecchi, Enrico
AU - Moreno, Asuncion
AU - Doco-Lecompte, Thanh
AU - Eisen, Damon P.
AU - Fortes, Claudio Q.
AU - Fowler, Vance G.
AU - Lerakis, Stamatios
AU - Miro, Jose M.
AU - Pappas, Paul
AU - Peterson, Gail E.
AU - Rubinstein, Ethan
AU - Sexton, Daniel J.
AU - Suter, Fredy
AU - Tornos, Pilar
AU - Verhagen, Dominique W.
AU - Cabell, Christopher H.
N1 - Funding Information: David Gordon, MBBS, FRACP, FRCPA, PhD, Uma Devi, MD (Flinders Medical Centre, Adelaide, Australia); Denis Spelman, MD (Alfred Hospital, Amiens, France); Jan TM van der Meer, MD, PhD (University of Amsterdam, Amsterdam, The Netherlands); Carol Kauffman, MD, Suzanne Bradley, MD, William Armstrong, MD (Ann Arbor VA Medical Center, Ann Arbor, MI); Efthymia Giannitsioti, MD, Helen Giamarellou, MD, PhD (Attikon University General Hospital, Athens, Greece); Stamatios Lerakis, MD FAHA, FACC, FASE, FCCP (Emory University, Atlanta, GA); Ana del Rio, MD, Asuncion Moreno, MD, Carlos A. Mestres, MD, PhD, FETCS, Carlos Paré, MD, Cristina Garcia de la Maria, MD, Elisa De Lazzario BSc, Francesc Marco, MD, Jose M Gatell, MD, José M. Miró, MD, PhD, Manel Almela, MD, Manuel Azqueta, MD, Maria Jesús Jiménez-Expósito, MD, Natividad de Benito, MD, Noel Perez, MD (Hosp. Clinic-IDIBAPS: University of Barcelona, Barcelona, Spain); Benito Almirante, MD, Nuria Fernandez-Hidalgo, MD, Pablo Rodriguez de Vera, MD, Pilar Tornos, MD, Vicente Falcó, MD Xavier Claramonte, MD, Yolanda Armero, MD (Hospital Universitari Vall d'Hebron, Barcelona, Spain); Nisreen Sidani RN, MSN, Souha Kanj-Sharara, MD, FACP, Zeina Kanafani, MD, MS (American University of Beirut Medical Center, Beirut, Lebanon); Annibale Raglio, MD, DTM&H, Antonio Goglio, MD, Fabrizio Gnecchi, MD, Fredy Suter, MD, Grazia Valsecchi, MD, Marco Rizzi, MD, Veronica Ravasio, MD (Ospedali Riuniti di Bergamo, Bergamo, Italy); Bruno Hoen, MD, PhD, Catherine Chirouze, MD, Efthymia Giannitsioti, MD, Joel Leroy, MD, Patrick Plesiat, MD, Yvette Bernard, MD (University Medical Center of Besançon, Besançon, France); Anna Casey, Peter Lambert, BSc,PhD,DSc, Richard Watkin, MRCP, Tom Elliott, BM, BS, B Med Sci, PhD, DSc, FRCPath (Queen Elizabeth Hospital, Birmingham, UK); Mukesh Patel, MD, William Dismukes, MD (University of Alabama at Birmingham, Birmingham, AL); Angelo Pan, MD, Giampiero Caros, MD (Spedali Civili–Università di Brescia, Brescia, Italy); Amel Brahim Mathiron Christophe Tribouilloy, MD, PhD, MD, Thomas Goissen, MD (South Hospital Amiens, Bron Cedex, France); Armelle Delahaye, Francois Delahaye, MD, MPH, FESC, Francois Vandenesch, MD, PhD (Hopital Louis Pradel, Bron Cedex, France); Carla Vizzotti, MD, Francisco M. Nacinovich, MD, Marcelo Marin, MD, Marcelo Trivi, MD, Martin Lombardero, MD (Instituto Cardiovascular, Buenos Aires, Argentina); Claudia Cortes, MD, José Horacio Casabé, MD (Instituto de Cardiología y Cirugía Cardiovascular, Buenos Aires, Argentina); Javier Altclas, MD, Silvia Kogan, MD (Sanatorio Mitre, Buenos Aires, Argentina); Liliana Clara, MD, Marisa Sanchez, MD (Hospital Italiano, Buenos Aires, Argentina); Anita Commerford, MD, Cass Hansa, MD, Eduan Deetlefs, MD, Mpiko Ntsekhe, MD, Patrick Commerford, MD (Groote Schuur Hospital, Cape Town, South Africa); Dannah Wray, MD, MHS, Lisa L. Steed PhD, Preston Church, MD, Robert Cantey, MD (Medical University of South Carolina, Charleston, SC); Arthur Morris, MD, FRCPA, David Holland, MD, David Murdoch, MD, DTM&H, FRACP, FRCPA, FACTM, Katherine Graham, MD, Kerry Read, MD, Nigel Raymond, MD, Paul Bridgman, MD, Richard Troughton, MD, Selwyn Lang, MD, Stephen Chambers, MD (Canterbury Health Laboratories, Christchurch, New Zealand); Despina Kotsanas BSc (Hons), Tony M. Korman, MD (Southern Health, Clayton, Australia); Gail Peterson, MD, Jon Purcell BS, Paul M. Southern, Jr, MD (UT-Southwestern Medical Center, Dallas, TX); Manisha Shah, MD, Roger Bedimo, MD, MS (Dallas VA Medical Center, Dallas, TX); Arjun Reddy, Donald Levine, MD, Gaurav Dhar, MD (Wayne State University, Detroit, MI); Alanna Hanlon-Feeney, Margaret Hannan, MD, BCh BAO, MSc, MRCPath, FRCPI, Sinead Kelly, MD (Mater Hospitals, Dublin, Ireland);Andrew Wang, MD, Christopher H. Cabell, MD, MHS, Christopher W. Woods, MD, MPH, Daniel J Sexton, MD, Danny Benjamin, Jr, MD, MPH, PhD, G Ralph Corey, MD, Jay R McDonald, MD, Jeff Federspiel, John J Engemann, MD, L Barth Reller, MD, Laura Drew RN, BSN, LB Caram, MD, Martin Stryjewski, MD, MHS, Susan Morpeth MBChB, Tahaniyat Lalani, MD, Vance Fowler, Jr, MD, MHS, Vivian Chu, MD (Duke University Medical Center, Durham, NC); Bahram Mazaheri, PhD, Carl Neuerburg, Christoph Naber, MD (University Essen, Essen, Germany); Eugene Athan, MD, Margaret Henry, BSc (Hons), PhD, Owen Harris, MD (Barwon Health, Geelong, Australia); Eric Alestig, MD, Lars Olaison, MD, PhD, Lotta Wikstrom, Ulrika Snygg-Martin, MD (Sahlgrenska Universitetssjukhuset/Östra, Goteborg, Sweden); Johnson Francis, MD, DM, K Venugopal, MD, DM, Lathi Nair, MD, DM, Vinod Thomas, MD, DM (Medical College Calicut, Kerla, India); Jaruwan Chaiworramukkun, MD, Orathai Pachirat, MD, Ploenchan Chetchotisakd, MD, Tewan Suwanich, MD (Khon Kaen University, Khon Kaen, Thailand); Adeeba Kamarulzaman, MBBS, FRACP, Syahidah Syed Tamin, MD (University of Malaya Medical Center, Kuala Lumpur, Malaysia); Manica Mueller Premru, MD, PhD, Mateja Logar, MD, PhD, Tatjana Lejko-Zupanc, MD, PhD (Medical Center Ljublijana, Ljublijana, Slovenia); Christina Orezzi, John Klein, MD (St. Thomas' Hospital, London, UK); Emilio Bouza, MD, PhD, Mar Moreno, MD, PhD, Marta Rodríguez-Créixems, MD, PhD, Mercedes Marín, MD, Miguel Fernández, MD, Patricia Muñoz, MD, PhD, Rocío Fernández, Victor Ramallo, MD (Hospital General Universitario Gregorio Marañón, Madrid, Spain); Didier Raoult, MD, PhD, Franck Thuny, MD, Gilbert Habib, MD, FACC, FESC, Jean-Paul Casalta, MD, Pierre-Edouard Fournier, MD (Faculté de Médecine de Marseille, Marseille, France); Natalia Chipigina, PhD, Ozerecky Kirill, MD, Tatiana Vinogradova, MD, PhD, Vadim P. Kulichenko, PhD (Russian Medical State University, Moscow, Russia); OM Butkevich, PhD (Learning Medical Centre of Russian Presidential Affairs Government, Moscow, Russia); Christine Lion, MD, Christine Selton-Suty, MD, Francois Alla, MD, PhD, Hélène Coyard, Thanh Doco-Lecompte, MD (CHU Nancy-Brabois, Nancy, France); Diana Iarussi, MD, Emanuele Durante-Mangoni, MD, PhD, Marie Françoise Tripodi, MD, Riccardo Utili, MD (II Università di Napoli, Naples, Italy); A Sampath Kumar, MD, Gautam Sharma, MD (All India Institute of Medical Sciences, New Delhi, India); Stuart A. Dickerman, MD (New York University Medical Center, New York, USA); Alan Street, Damon Peter Eisen, MBBS, MD, FRACP, Emma Sue McBryde, MBBS, FRACP, PhD, Leeanne Grigg (Royal Melbourne Hospital, Parkville, Australia); Elias Abrutyn, MD (Drexel University College of Medicine, Philadelphia, PA); Christian Michelet, MD, PhD, Pierre Tattevin, MD, Pierre Yves Donnio, PhD (Pontchaillou University, Rennes, France); Claudio Querido Fortes, MD (Hospital Universitario Clementino Fraga Filho/UFRJ, Rio de Janeiro, Brazil); Jameela Edathodu, MRCP, Mashael Al-Hegelan, MD (King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia); Bernat Font, MD, Ignasi Anguera, MD, PhD, Joan Raimon Guma, MD (Hospitál de Sabadell, Sabedell, Spain); M Cereceda, MD, Miguel J. Oyonarte, MD, Rodrigo Montagna Mella, MD (Hospital Clinico Universidad de Chile, Santiago, Chile); Patricia Garcia, MD, Sandra Braun Jones, MD (Hosp. Clínico Pont. Universidad Católica de Chile, Santiago, Chile); Auristela Isabel de Oliveira Ramos, MD (Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil); Marcelo Goulart Paiva, MD, Regina Aparecida de Medeiros Tranchesi, MD (Hospital 9 de Julho, São Paulo, Brazil); Lok Ley Woon, BSN, Luh-Nah Lum, BSN, Ru-San Tan, MBBS, MRCP (National Heart Centre, Singapore, Singapore); David Rees, MD, Pam Kornecny, MD, Richard Lawrence, MD, Robyn Dever, MD (St. George Hospital, Sydney, Australia); Jeffrey Post, MD, Phillip Jones, MD, Suzanne Ryan MHSc, GCDM (The University of New South Wales, Sydney, Australia); John Harkness, MD, Michael Feneley, MD (St. Vincent's, Sydney, Australia); Ethan Rubinstein, MD, LL.B, Jacob Strahilewitz, MD (Tel Aviv University School of Medicine, Tel Aviv, Israel); Adina Ionac, MD, PhD, Cristian Mornos, MD, Stefan Dragulescu, MD, PhD (Victor Babes University of Medicine and Pharmacy, Timisoar, Romania); Davide Forno, MD, Enrico Cecchi, MD, Francesco De Rosa, MD, Massimo Imazio, MD, FESC, Rita Trinchero, MD (Maria Vittoria Hospital, Torino, Italy); Franz Wiesbauer, MD, Rainer Gattringer, MD (Vienna General Hospital, Vienna, Austria); Ethan Rubinstein, MD, LLB, Greg Deans, MD (University of Manitoba, Manitoba, Winnipeg, Canada); Arjana Tambic Andrasevic, MD, PhD, Bruno Barsic, MD, PhD, Igor Klinar, MD, Josip Vincelj, MD, PhD, FESC, Suzana Bukovski, MD, Vladimir Krajinovic, MD (Univ. Hospital for Infectious Diseases, Zagreb, Croatia). ICE Coordinating Center, Durham, NC Christopher Cabell, MD, MHS, Judy Stafford, MS, Khaula Baloch, BA, Paul Pappas, MS, Thomas Redick, MPH, Tina Harding, RN, BSN. ICE Steering Committee A W Karchmer, MD, Arnie Bayer, MD, Bruno Hoen, MD, PhD, Christopher H Cabell, MD, MHS, Daniel J Sexton, MD, David T. Durack, MD, D Phil, FACP, FRCP, FRACP, Elias Abrutyn, MD, Ethan Rubinstein, MD, LLB, G Ralph Corey, MD, José M. Miró, MD, PhD, Phillipe Moreillon, Susannah Eykyn, Vance Fowler, Jr, MD, MHS, Lars Olaison, MD, PhD. ICE Publications Committee Arnie Bayer, MD, Bruno Hoen, MD, PhD, Christopher H Cabell, MD, MHS, David Murdoch, MD, DTM&H, FRACP, FRCPA, FACTM, Elias Abrutyn, MD, Eugene Athan, MD, José M. Miró, MD, PhD, G Ralph Corey, MD, Paul Pappas, MS, Vance Fowler, Jr, MD, MHS.
PY - 2007/12
Y1 - 2007/12
N2 - Background: Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of antimicrobial therapy and the temporal incidence of stroke in patients with IE and to determine if this time course differs from that shown for embolic events in previous studies. Methods: Prospective incidence cohort study involving 61 tertiary referral centers in 28 countries. Case report forms were analyzed from 1437 consecutive patients with left-sided endocarditis admitted directly to participating centers. Results: The crude incidence of stroke in patients receiving appropriate antimicrobial therapy was 4.82/1000 patient days in the first week of therapy and fell to 1.71/1000 patient days in the second week. This rate continued to decline with further therapy. Stroke rates fell similarly regardless of the valve or organism involved. After 1 week of antimicrobial therapy, only 3.1% of the cohort experienced a stroke. Conclusions: The risk of stroke in IE falls dramatically after the initiation of effective antimicrobial therapy. The falling risk of stroke in patients with IE as a whole precludes stroke prevention as the sole indication for valvular surgery after 1 week of therapy.
AB - Background: Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of antimicrobial therapy and the temporal incidence of stroke in patients with IE and to determine if this time course differs from that shown for embolic events in previous studies. Methods: Prospective incidence cohort study involving 61 tertiary referral centers in 28 countries. Case report forms were analyzed from 1437 consecutive patients with left-sided endocarditis admitted directly to participating centers. Results: The crude incidence of stroke in patients receiving appropriate antimicrobial therapy was 4.82/1000 patient days in the first week of therapy and fell to 1.71/1000 patient days in the second week. This rate continued to decline with further therapy. Stroke rates fell similarly regardless of the valve or organism involved. After 1 week of antimicrobial therapy, only 3.1% of the cohort experienced a stroke. Conclusions: The risk of stroke in IE falls dramatically after the initiation of effective antimicrobial therapy. The falling risk of stroke in patients with IE as a whole precludes stroke prevention as the sole indication for valvular surgery after 1 week of therapy.
UR - http://www.scopus.com/inward/record.url?scp=36249004321&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=36249004321&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2007.07.023
DO - 10.1016/j.ahj.2007.07.023
M3 - Article
C2 - 18035080
AN - SCOPUS:36249004321
SN - 0002-8703
VL - 154
SP - 1086
EP - 1094
JO - American heart journal
JF - American heart journal
IS - 6
ER -