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JAC Advance Access originally published online on January 13, 2005
Journal of Antimicrobial Chemotherapy 2005 55(2):234-239; doi:10.1093/jac/dkh527
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JAC vol.55 no.2 © The British Society for Antimicrobial Chemotherapy 2005; all rights reserved

Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization

Arlo Upton1, Dragana Drinkovic1, Sudha Pottumarthy1, Teena West2 and Arthur J. Morris1,3,*

Departments of 1 Clinical Microbiology and 2 Biostatistics, Auckland District Health Board, Auckland, and 3 Microbiology Laboratory, Diagnostic Medlab, Panmure, PO Box 14743, Auckland, New Zealand

* Corresponding author. Tel: +649-571-4093; Fax: +649-571-4091; Email: amorris{at}dml.co.nz

Objectives:

To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization.

Patients and methods:

Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to {alpha}-haemolytic streptococci; 15 due to ß-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery.

Results:

For {alpha}-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1–20) and 16 (4–58) days of treatment, respectively, P < 0.001. For ß-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received ≤4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received ≤8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received ≤4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with ß-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative.

Conclusions:

Our findings support current treatment guidelines for endocarditis caused by {alpha}-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.

Keywords: {alpha}-haemolytic streptococci , ß-haemolytic streptococci , Streptococcus anginosus , Streptococcus pneumoniae , surgery


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