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Editorial |

Evaluating and Optimizing Outcomes of Surgery for Endocarditis

David T. Durack, MB, DPhil
JAMA. 2003;290(24):3250-3251. doi:10.1001/jama.290.24.3250.
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The mortality rate for infective endocarditis remains high—too high. In the preantibiotic era, death was inevitable for anyone unfortunate enough to develop this disease. Penicillin changed this dismal picture. By 1951, based on more than 1000 cases of endocarditis compiled from several reports, Hunter1 estimated that the overall cure rate was about 70%. A half-century later, despite the advent of valve replacement surgery and the development of many more antibiotics, the "global cure rate" for infective endocarditis remains about the same. For example, Hasbun et al2 recently reported a 6-month survival rate of 74% among 513 patients with endocarditis in the United States. Similarly, for 208 patients in England the cure rate at 6 months was 73%.3 Mortality in a large tertiary-care hospital in the United States was about 35%.4 When more favorable rates have been reported, for example from France by Hoen et al,5 the follow-up period often was relatively short. The mortality for patients who have been microbiologically "cured" continues to increase over years.68 In sum, it appears that little progress has been made.

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