Pathology of Fatal Bacterial Endocarditis before and since the Introduction of Antibiotics

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Abstract
All 103 autopsied cases of proven bacterial endocarditis during the past thirty years at University Hospitals in Cleveland are reviewed. It is demonstrated that definite changes have occurred in the pathology of fatal endocarditis. These correlate well with the previously documented shift in bacterial etiology of this entity since the introduction of penicillin. There has been a reduction in mitral valve involvement by streptococcal organisms. However the changing etiology and introduction of antibiotics have not affected the attack rate on the aortic valve in these cases who succumb. Also, there has been an increase in right-sided valve involvement which appears to be correlated with the increasing incidence of non-strepto-coccal etiology since 1943. A reduction is noted in the occurrence of non-streptococcal vegetation on valves previously diseased by a rheumatic process, with a corresponding increase in the attack rate of these organisms on hearts with other underlying disease and in those previously normal. Twenty-two cases (21.2%) had at least one valve involved with vegetation but free of underlying disease. In this group there has been a significant increase in occurrence of non-streptococcal organisms since the advent of chemotherapy.