Evaluation of Perioperative Data in Patients with Infective Endocarditis Due to Antibiotic-Resistant Strains, Operated with the Use of Hyperthermic Perfusion

Abstract

Objectives. Due to reduction of terms of in-hospital treatment and increased range of community-acquired medical interventions risk of infective endocarditis (IE) due to antibiotic-resistant microorganisms increases. Surgical treatment of IE due to antibiotic resistant strains requires complex approach including the terms of surgical intervention, rational etiotropic antibiotic therapy, adequate materials for intracardiac reconstructions, hyperthermic per-fusion during bypass and careful perioperative management.
 The objective of the study was to describe the influence of antibiotic resistance on clinical course and results of surgical treatment in patients with infective endocarditis, operated with the use of hyperthermic perfusion.
 Materials and methods. Clinical data of 227 consequent patients with active infective endocarditis, operated from 01/01/2016 to 01/11/2018 were analyzed. The mean age was 48.7 ± 15.5 years. Gram-positive microorganisms were identified in 210 (92.5%) cases. Among them vancomycin-resistant strains composed – 46 (22.1%)cases. Gram-negative cultures were found in 17 (7.5%) cases. In this group the rate of carbapenem-resistant strains reached 47.1% (8 cases). Patients were operated with the use of total controlled hyperthermic perfusion (TCHP). Comparative analysis of perioperative data was carried out.
 Results. The group of patients with IE due to antibiotic-resistant strains (N = 54) was characterized by a higher frequency of redo interventions for replacement of infected valves – 7 (12.9%) cases, intracardiac abscesses – 13 (24.1%) cases, and lower frequency of valve-repair procedures – 5 (9.2%) cases, indicating a significant degree of initial degradation of the valve (p < 0.05). Despite the absence of influence of the duration of aortic cross-clamping time, the total bypass time in the antibiotic-resistant group was significantly higher (p = 0.021). Analysis of hemodynamic status of patients revealed that the dose and duration of sympatho-mimetic administration were significantly higher in the group of patients with resistant microorganisms: dobutamine – 3.7 ± 0.6 ?g/kg/min and 113.2 ± 2.1 hours; norepinephrine – 0.09 ± 0.01 ?g/kg/min and 12.3 ± 2.1 hours respectively (p < 0.001). Surgical interventions in patients with IE due to antibiotic-resistant strains, had higher frequency of postoperative heart failure – 30.8% cases (p = 0.002) and hospital mortality – 5,8% (p = 0.017) cases.
 Conclusions. Application of TCHP allowed to decrease hospital mortality to 5.8% in surgical treatment of patients with IE, caused by antibiotic-resistant strains of microorganisms.