Significado de la fiebre persistente o recurrente durante el tratamiento de la endocarditis infecciosa

patients with infective endocarditis (ie) were studied to assess incidence, clinical features and mortality in a population with either persistent (pf) or recurrent fever (rf) during treatment. a sample of 81 patients was evaluated. of these, 46 patients (56.8%) had fever during treatment: 35 had pf and 16 had rf (group 1). this group was compared with 35 patients with ie without fever (group 2). age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. the aortic and tricuspid valve compromise, and staphylococcus aureus as etiologic agent were more frequent in group 1 (although not significantly). however, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with mrsa (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in group 1(p<0.05). the most common causes of pf were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). on the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with rf. the overall mortality was 39.5%, distributed as follows: 52.2% of group 1 and in 22.9% of group 2 (p=0.007). the presence of comorbidities, major vessel embolization, heart failure, mrsa infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in group 1(p<0.05). we propose an evaluation method during the treatment of patients affected by this type of fever.