Twelve-year review of recurrent native-valve infective endocarditis: a disease of the modern antibiotic era.

Recurrent cases of native-valve endocarditis have been seen for only the past four decades. In a review of the English-language literature over the past 12 years, 281 cases of recurrent infective endocarditis were found. Males were more than three times more commonly identified than females. Intravenous drug use was a designated risk factor for endocarditis in 43% of patients. Compared with patients with other risk factors for endocarditis, patients with intravenous drug use were significantly more likely (P less than .005) to suffer a recurrent bout of native-valve endocarditis within 12 months after the primary (or previous) episode. A greater variety of organisms were isolated from patients with recurrent endocarditis than from those with primary endocarditis. Valvular involvement was evenly distributed among the aortic, mitral, and tricuspid valves for both primary and recurrent episodes of infection. While complications of recurrent native-valve endocarditis were relatively common, the mortality rate associated with the recurrences was less than 30%.