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JAC Advance Access published online on January 13, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh527
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JAC © The British Society for Antimicrobial Chemotherapy 2005; all rights reserved
Received September 15, 2004
Revised October 31, 2004
Accepted November 9, 2004

Original article

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

Arlo Upton 1, Dragana Drinkovic 1, Sudha Pottumarthy 1, Teena West 2, and Arthur J. Morris 3*

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

* To whom correspondence should be addressed.
Arthur J. Morris, E-mail: amorris{at}dml.co.nz


  Abstract

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.

Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to {alpha}-haemolytic streptococci; 15 due to {beta}-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.

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 {beta}-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 {beta}-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative.

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; {beta}-haemolytic streptococci; Streptococcus anginosus; Streptococcus pneumoniae; surgery.
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