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Master Thesis

Analyse qualitative des causes et circonstances de décès dans l'endocardite infectieuse à Staphylococcus aureus : étude de 57 dossiers de patients décédés

Abstract : Introduction - Staphylococcus aureus (SA) is the leading cause of infectious endocarditis (IE) and in comparison with other microorganisms, it provokes more serious infections with a higher mortality. Prognostic factors for SAIE are already known but they are not different from those reported for other IE and cannot to explain the excess of mortality. The main aim of this study was to inventory the causes of death of SAIE and second to identify new potential prognostic factors. Patients and methods - We conducted a retrospective qualitative study on all the patients who died during their hospitalization for SAIE in 2008 in 7 administrative regions of France. The qualitative analysis permitted to determine individually the final cause of death and to identify elements from patient characteristics, from the severity of the initial presentation, and from the care received. Then, those elements were selected and collected for each patient. Results - 57 patients were included. The mean age was 67,2 years (+/-16,1 Standard Deviation (SD)). The mean Charlson score was 2,5. The main final causes of death were cardiogenic choc, septic choc and neurologic causes (respectively 19, 17 and 15 patients). The other causes were acute respiratory distress syndrome (7), intraoperative death (4), hepatic insufficiency (3), final renal failure (3), mesenteric infarction (1), acute ischemia of a member (1) and slipping syndrome (1). The cause was composite in 10 cases. New elements related to the patient specificity were dependence (8 patients), pressure ulcer (8 patients) and malnutrition (20 patients). Another eight were treated by non-steroïdal anti- inflammatory drug before admission. About the gravity of the initial presentation, 18 patients had thrombocytopenia < 100 giga per liter. Eight patients had lactate over 2,5 mmol per liter. Respectively 24 (46%) and 12 patients (22,6%) needed vasopressive amines or dobutamine. During hospitalization, the empirical treatment was efficient in 40 patients on the 49 treated and included the optimal antibiotic in 11 cases. The mean time before starting documented antibiotic therapy was 5,2 days (+/-9,1 SD). The molecule and dose of this antibiotic therapy complied with the European standards in 27 cases. On the 35 patients who had an indication for cardiac surgery, only 16 patients undergo surgery. The main cause for lack of surgery was the poor condition of the patient (25,7%). Another surgery was indicated in 15 patient and it was neurosurgery in 33% of the cases. Respectively 17 and 19 patients presented a nosocomial infection or an iatrogenic complication during their hospitalization. It was drug toxicity in 14 cases and iatrogenic events in 12 cases, including skill complications, anticoagulant-linked hemorrhages. Conclusion - This qualitative study show that the main causes of death of the patient with SAIE are cardiogenic choc, neurologic causes and septic choc. It also highlight several potential prognostic factors that should be specifically studied: non-steroidal anti-inflammatory drugs, thrombocytopenia, concordance of antibiotic treatment to the microorganism and to recommendations, respect of surgical indication and occurrence of iatrogenic events.
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Master Thesis
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Mathilde Boutrou. Analyse qualitative des causes et circonstances de décès dans l'endocardite infectieuse à Staphylococcus aureus : étude de 57 dossiers de patients décédés. Médecine humaine et pathologie. 2018. ⟨dumas-02267721⟩



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