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Infectious Diseases in Clinical Practice:
Special Article: Review of Literature: General Infectious Diseases

Outcome and Treatment of Bartonella endocarditis

Section Editor(s): Trenholme, Gordon M.

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Editor’s Note:

This section of IDCP features summaries of publications relevant to the practice of general infectious diseases. In most cases, a comment is provided from the editor concerning interpretation, impact, or further relevant information on the topic reviewed. This represents a modification of selected entries in the “What’s News” section of the Johns Hopkins website for ID (reprinted from www.hopkins.id.edu, with permission).

John G. Bartlett, John Hopkins University School of Medicine, Baltimore, MD.

Outcome and Treatment of Bartonella endocarditis

Raoult D et al.

Arch Intern Med. 2003;163:226

The authors report the results from 4 reference laboratories (Lyon, Paris, London, and Edmonton) for Bartonella endocarditis detected between 1995 and 2001 in France, England, and Canada. The diagnostic criteria for endocarditis were the Duke criteria; the diagnostic criteria for Bartonella was culture or positive results with Bartonella DNA from valve tissue or blood (61 cases) or IgG titers of 31:800 by IFA (Clin Diagn Lab Immunol. 2002;9:795). The species could be detected in the 61 cases established by culture or PCR: 49 were B. quintana and 12 were B. henselae. The major antibiotic regimens were aminoglycosides combined with betalactam agents; other commonly used agents with or without aminoglycosides were doxycycline and fluoroquinolones. The best results were achieved when patients received aminoglycoside for at least 14 days. Characteristics of the patients are summarized in the following table:

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Comment: For most clinicians, Bartonella will present as culture-negative endocarditis. Many are treated with betalactams plus aminoglycoside, and that would appear appropriate providing the aminoglycoside is continued for a sufficient duration. It is noteworthy that, as emphasized by the author, the antibiotic experience with Bartonella at other anatomic sites provides no useful information for treatment of Bartonella endocarditis.

© 2002 Lippincott Williams & Wilkins, Inc.