Infective endocarditis in a community hospital.

Recent reviews from major university centers of infective endocarditis have stressed an increase in unusual infections owing to virulent pathogens. This article compares the 40 episodes of infective endocarditis at a community hospital complex with the recent literature. It was observed that the majority of infecting microorganisms were penicillin-susceptible streptococci similar to those seen in the early antibiotic era. An older patient population was encountered, but overall mortality was low. Streptococcus bovis was a frequent cause of both natural and prosthetic valve infections. Symptoms lasting longer than two months were associated with vegetations demonstrated by echocardiography and high morbidity. Clinical features in this series that significantly correlated with a poor prognosis were height of fever at admission, the failure of fever to resolve within one week of appropriate therapy, the degree of peripheral leukocytosis, gross hematuria, and CNS signs. Conservative parenteral treatment closely monitored by serum bactericidal levels was employed. No relapses occurred among patients surviving initial therapy.