What is the morbidity and mortality of endocarditis with modern day management (and how many relapse)?

Despite progress in management, morbidity and mortality remain major problems for the patient with endocarditis, both during the acute phase and as the result of long term complications after a bacteriological cure. Improvements in microbiological diagnosis, types of antibiotic treatment and timing of surgical intervention have improved the outlook for some patients but the impact has been minor with some of the more invasive pathogens. The infection can relapse and vegetations can be reinfected. Healed vegetations may leave valvular function so compromised that surgery is required.

In 140 patients with acute infective endocarditis, 48 (34%) required valve replacement during treatment.1 Heart failure occurred in 46 patients. During the active disease, 22 patients (16%) died. Medical treatment alone cured 80 patients. Relapse occurred in 3 (2.7%) of 112 patients all within one month of discharge. Recurrence was observed in 5 (4%) patients between 4 months and 15 years after the first episode. In the follow up period, another 16 patients died of cardiac causes, most within five years. Of 34 patients with late prosthetic valve endocarditis, 27 (79%) survived their hospital admission but 11 had further surgery during the next five years, usually following cardiac failure.2 In another study, 91 (70%) of 130 patients survived hospitalisation for native valve endocarditis and 17 of 60 initially treated medically required surgery during a mean 9 year follow up.3 During follow up, 29 (22%) patients died, 13 from cardiac causes.