Outcome and Treatment of Bartonella Endocarditis

Raoult, Didier MD, PhD
Fournier, Pierre-Edouard MD, PhD
Vandenesch, François MD, PhD
Mainardi, Jean-Luc MD, PhD
Eykyn, Susannah J. FRCP, FRCS, FRCPath
Nash, James MD
James, Edward MD
Benoit-Lemercier, Catherine MD
Marrie, Thomas J. MD

From the Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseille, France; (Drs Raoult and Fournier); Laboratoire de Microbiologie, Hôpital Edouard Herriot, Lyon, France; (Dr Vandenesch); Service de Microbiologie, Hôpital Georges Pompidou (Dr Mainardi), and Laboratoire de Microbiologie, Hôpital Bichat (Dr Benoit-Lemercier), Paris, France; Department of Infection, St Thomas' Hospital (Dr Eykyn), and Microbiology Department, St Bartholomew's Hospital (Dr James), London, England; Public Health Laboratory Service, William Harvey Hospital, Willesborough, Ashford, England; (Dr Nash); and Department of Medicine, University of Alberta, Edmonton (Dr Marrie).

Corresponding author and reprints: Didier Raoult, Md, PhD, Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille CEDEX 05, France (e-mail: [email protected]).

We thank Fabrice Bruneel, MD, Chantal Roure, MD, Maryse Archambaud, MD, and Lionel Deforges, MD, for providing clinical material.

Accepted for publication May 7, 2002.

Archives of Internal Medicine 163(2):p 226-230, January 27, 2003.

Background

Endocarditis caused by Bartonella species is a potentially lethal infection characterized by a subacute evolution and severe valvular lesions.

Objectives

To evaluate the outcome of patients with Bartonella endocarditis and to define the best antibiotic regimen using the following measures: recovery, relapse, or death.

Methods

We performed a retrospective study on 101 patients who were diagnosed in our laboratory as having Bartonella endocarditis between January 1, 1995, and April 30, 2001. Bartonella infection was diagnosed using immunofluorescence with a 1:800 cutoff, polymerase chain reaction amplification of DNA, and/or culture findings of Bartonella species from whole blood, serum, and/or valvular biopsy specimens. A standardized questionnaire was completed by investigators for each patient.

Results

Twelve of the 101 patients died and 2 relapsed. Patients receiving an aminoglycoside were more likely to fully recover (P = .02), and those treated with aminoglycosides for at least 14 days were more likely to survive than those with shorter therapy duration (P = .02).

Conclusion

Effective antibiotic therapy for Bartonella endocarditis should include an aminoglycoside prescribed for a minimum of 2 weeks.