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Arch Intern Med. 2009 Jul 27;169(14):1290-8. doi: 10.1001/archinternmed.2009.192.

Dramatic reduction in infective endocarditis-related mortality with a management-based approach.

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Laboratoire de Microbiologie, Centre National de la Recherche Scientifique, Unite Mixte de Recherche 6236, Institut Fédératif de Recherche 48, Université de la Méditerranée, 13385 Marseille CEDEX 5, France.



Despite improvements in medical and surgical therapy, infective endocarditis (IE) is still associated with a severe prognosis and remains a therapeutic challenge. We aimed to evaluate the impact of a standardized diagnostic and therapeutic protocol on mortality and to correlate the outcome with compliance with our management-based protocol.


We conducted an observational before-after study that included 333 consecutive patients treated for IE at a referral center from 1991 to 2006, which was divided into 2 periods: period 1 (1991-2001), before implementation of our therapeutic protocol (n = 173), and period 2 (2002-2006), after implementation of our protocol (n = 160). Our protocol was created by a multidisciplinary task force including a sampling of biological specimens, the use of only 4 antimicrobial agents, a standardized duration of treatment, standardized surgical indications, and 1 year of close follow-up. Because our protocol was based on a local consensus by physicians and surgeons, it was not possible to randomize the study.


The 1-year mortality significantly decreased from 18.5% during period 1 to 8.2% during period 2 (hazard ratio, 0.41; 95% confidence interval, 0.21-0.79 [P = .008]). After multivariable analysis, the management during period 2 remained a strong protective factor (adjusted hazard ratio, 0.26; 95% confidence interval, 0.09-0.76 [P = .01]). During period 2, we observed a statistically significantly better compliance in antimicrobial therapy and fewer cases of renal failure. Deaths by embolic events and multiple organ failure syndrome also significantly decreased during period 2.


A dramatic reduction in mortality was observed during this study, suggesting that a management-based approach has a significant impact on IE outcome.

[Indexed for MEDLINE]

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