Abstract 362: Presentation, Management, and Outcomes of Infective Endocarditis at a Tertiary Medical Center

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Background: Infective endocarditis (IE) has historically caused significant morbidity and mortality, but there are few descriptions of contemporary cohorts of IE patients. Methods: We conducted a retrospective cohort study of adult patients admitted to a single tertiary medical center with diagnosis of IE between 2007-2011. Using medical record abstraction and administrative databases, we collected demographic data, comorbidities and clinical data indicating IE severity, management and outcome. Results: We identified 180 hospitalizations with a primary or secondary discharge diagnosis of IE and clinical criteria confirming IE diagnosis; 66% were male and 79% were white. Mean patient age was 60 years (SD=18 years) and 29% (52 of 180) of patients were admitted to critical care or step down unit. Risk factors for IE were common: 9% (17 of 180) had previous history of IE, 25% (45 of 180) had prosthetic valve IE, 17% (30 of 180) had intra cardiac devices, 12% (21 of 180) had long term central lines and 14% (25 of 180) were intravenous drug users. Half of the sample had an infected native mitral valve (90 of 180) and 40% had an infected native aortic valve (72 of 180). Nearly all patients (93%: 173 of 180) had at least 2 sets of blood cultures drawn before starting antibiotics. The most common microorganism detected in blood culture was Staphylococcus aureus (41%: 69 of 180), followed by Streptococcus.viridans (17%: 29 of 180). Cultures were negative for 4% (7 of 180). Infectious disease consultation was completed in 83% (150 of 180) and cardiac surgery consultation in 45% (81 of 180) of patients. Echocardiography was performed in 89% (161 of 180) of patients, transthoracic in 69% (125 of 180), and transesophageal in 56% (100 of 180). Among patient who had echocardiography, 17% (28 of 180) had a left ventricular ejection fraction of <50%; 52% (94 of 180) had insufficiency of the infected valve. Perivalvular abscess was reported in 8.9% (16 of 180) and valve perforation in 11% (19 of 180). The median length of stay was 13 days (interquartile range 9-21days), inpatient mortality rate was 15% (27 of 180; 95% CI: 11.2%-21.2%), and 6-month readmission rate was 10.5% (19 of 180; 95% CI: 6.0%-15.1%). Conclusions: In a single academic medical center, IE patients presented with high degree of acuity and found to have frequent complications in echocardiogram. Despite recent advances in medical, surgical, and critical care, many patients had a long hospitalization with relatively high inpatient mortality and readmission rate.