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Some inveterate lumpers still regard treatment of intravascular prosthetic infections as Osier once viewed the therapy for natural endocarditis, ie, "useless and hopeless in the majority of cases." This "splitter oriented" book puts such lumpers to shame. First, it distinguishes vascular graft infections from those of prosthetic heart valves. (The graft infections are usually external, do not communicate with the vascular compartment, and thus are not often associated with positive venous blood cultures.)
Second, after emphasizing the differences between natural endocarditis and prosthetic valve endocarditis (PVE), it subdivides PVE into early (less than 60 days from implantation) and late PVE. Early PVE is more lethal and has a different microbiological spectrum. Third, it suggests that the mortality for either type of PVE can be lowered by prompt surgical intervention. Medical therapy alone now seems appropriate only for late-onset, uncomplicated PVE due to Streptococcus viridans. Always clinically relevant, the authors present
Marty A. Infections of Prosthetic Heart Valves and Vascular Grafts: Prevention, Diagnosis, and Treatment. JAMA. 1977;238(16):1766–1767. doi:10.1001/jama.1977.03280170060036
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