Infective endocarditis in Jerusalem. A comparative analysis of native and prosthetic valve endocarditis.

Thirty patients with prosthetic valve endocarditis (PVE) and 62 patients with native valve endocarditis (NVE) observed during a concurrent period of time (1970-80) were analyzed. Patients with PVE were also compared with 697 patients who underwent cardiac valve replacement in the same period, in an attempt to uncover risk factors for PVE. In the operated patients the overall incidence of endocarditis was 4.3%. There were several significant differences between the NVE and PVE groups. Atrial fibrillation was more prevalent in the PVE group (33.4 vs. 11.5%, P less than 0.05), while infection with gram-positive organisms was more prevalent in the NVE patients (79 vs. 47%, P less than 0.01). The outcome of combined medical and surgical treatment showed a much higher mortality rate (50 vs. 6.4%, P less than 0.01) in the PVE group. Staphylococcal endocarditis resulted in 16% mortality in NVE vs. 100% in the PVE group (P less than 0.01). Careful surveillance may hopefully lead to early detection, treatment and better outcome of PVE.