International Journal of Antimicrobial Agents 40 (2012) 145–150 Contents lists available at SciVerse ScienceDirect International Journal of Antimicrobial Agents jou rn al h om epa ge: h ttp://www.elsevier.com/locate/ijantimicag Management of Brucella endocarditis: results of the Gulhane study Suda Tekin Koruk a , Hakan Erdem b,∗ , Ibrahim Koruk c , Ays ¸ e Erbay d , Yasemin Tezer-Tekce e , Ali Rıza Erbay f , Saim Dayan g , Ozcan Deveci g , Asuman Inan h , Derya Ozturk Engin h , Rahmet Guner i , Nebahat Dikici j , Elif Doyuk-Kartal k , Behice Kurtaran l , Filiz Pehlivanoglu m , Oguz Resat Sipahi n , Aysun Yalci o , Mucahit Yemisen p , Sema Alp-Cavus q , Serap Gencer r , Gokhan Guzel s , Oral Oncul t , Mehmet Parlak u , Esra Kazak v , Necla Tulek w , Asim Ulcay b , Umit Savasci x a Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology (IDCM), Sanliurfa, Turkey b Kasımpas ¸ a Hospital, Department of IDCM, Istanbul, Turkey c Harran University, School of Medicine, Department of Public Health, Sanliurfa, Turkey d Bozok University, School of Medicine, Department of IDCM, Yozgat, Turkey e Turkiye Yuksek Ihtisas Training and Research Hospital, Department of IDCM, Ankara, Turkey f Bozok University, School of Medicine, Department of Cardiology, Yozgat, Turkey g Dicle University, School of Medicine, Department of IDCM, Diyarbakir, Turkey h Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey i Ataturk Training and Research Hospital, Department of IDCM, Ankara, Turkey j Selc ¸ uk University, Faculty of Selc ¸ uklu Medicine, Konya, Turkey k Osmangazi University, School of Medicine, Department of IDCM, Eskis ¸ ehir, Turkey l Cukurova University, School of Medicine, Department of IDCM, Adana, Turkey m Haseki Training and Research Hospital, Department of IDCM, Istanbul, Turkey n Ege University, School of Medicine, Department of IDCM, Izmir, Turkey o Ankara University, School of Medicine, Department of IDCM, Ankara, Turkey p Istanbul University, Cerrahpasa Medical School, Department of IDCM, Istanbul, Turkey q Dokuz Eylül University, School of Medicine, Department of IDCM, Izmir, Turkey r Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of IDCM, Istanbul, Turkey s Cumhuriyet University, School of Medicine, Department of IDCM, Sivas, Turkey t Gulhane Haydarpasa Hospital, Department of IDCM, Istanbul, Turkey u Ataturk University, School of Medicine, Department of IDCM, Erzurum, Turkey v Uludag School of Medicine, Department of IDCM, Bursa, Turkey w Ankara Training and Research Hospital, Department of IDCM, Ankara, Turkey x Military Hospital, IDCM Service, Sarikamis, Turkey a r t i c l e i n f o Article history: Received 22 February 2012 Accepted 12 April 2012 Keywords: Brucellosis Endocarditis Therapy Mortality a b s t r a c t Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke’s criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients. © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. ∗ Corresponding author. Present address: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Servisi, Kasımpas ¸ a Asker Hastanesi, Kasımpas ¸ a, Istanbul, Turkey. Tel.: +90 532 784 2024. E-mail address: hakanerdem1969@yahoo.com (H. Erdem). 0924-8579/$ – see front matter © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. http://dx.doi.org/10.1016/j.ijantimicag.2012.04.009