0031: Performance of systematic search for present and potential portals of entry of infective endocarditis

Abstract

Infective endocarditis (IE) is a severe disease, with an in-hospital mortality around 20%. 10% of the patients will have another episode of IE. Thus, looking for and treating the portal of entry of IE is particularly important. Yet, literature on this topic is nonexistent. Since January 2005, we have been prospectively enrolling patients hospitalized for certain IE (Duke-Li criteria) in the International Collaboration on Endocarditis database. Since then, we have been systematically looking for and treating the portal of entry of the present IE episode and potential portals of entry of a new IE episode. Among 444 patients hospitalized in our institution between 2005 and 2011, 318 were included in the present study (exclusion of patients who died during hospitalization; some medical charts unavailable for technical reasons). Portal of entry of the present IE episode was identified in 238 patients (74%). Distribution of identified portals of entry was: cutaneous: 44% (healthcare-associated: 21%; community-acquired: 13%; IV drug use: 9%); oral / dental: 29%; gastrointestinal: 22%; genitourinary: 3%; ENT: 2%; respiratory: 1%. Potential portals of entry were: continuation of IV drug use in 21 patients and a cutaneous disease in 2 patients; oral / dental infective foci in 66 / 125 patients with stomatologic examination; colonic lesions (polyps, diverticulosis, adenocarcinoma) in 32 / 80 patients in whom colonoscopy was performed because they were ≥50 years old or they had a familial history of colonic polyposis; genitourinary lesions (prostatic cancer or hyperplasia, urethral stenosis...) in 32 / 52 patients with genitourinary examination; ENT lesions (sinusitis, otomastoidosis...) in 6 / 180 examinations. In conclusion, systematic search for the portal of entry of IE was successful in as many as ¾ of patients. Systematically searching for a potential oral / dental, gastrointestinal or genitourinary portal of entry of a new IE episode was also successful in a lot of patients.