Abstract
We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008–2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37–5.29)), enterococci (OR: 3.01 (95% CI: 1.51–6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05–5.36)), and surgical treatment (OR: 0.23 (0.1–0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65–5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04–2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies.
Highlights
Recurrent infective endocarditis (IE) is a feared complication that is associated with increased mortality [1,2]
This study represents the largest cohort of patients with IE and examines the clinical profile of recurrent endocarditis
The large number of subjects in our national cohort allowed us to identify clinical factors associated with recurrent IE in general, and for relapses and reinfections separately
Summary
Recurrent infective endocarditis (IE) is a feared complication that is associated with increased mortality [1,2]. Despite current therapies and prophylactic measures to prevent further episodes of IE, about 5–10% of patients eventually develop this condition [1,3,4,5]. Recurrent episodes of IE are classified as relapse or reinfection depending on the etiology and pathogenesis. Reinfection is associated with new episodes of bacteremia in patients, where a condition predisposing to the development of IE may be present [7]. Episodes of IE recurrences caused by a different microorganism than the previous one are usually considered as reinfections. On the other hand, when the new episode is caused by the same species, there is an inclination to consider it a relapse
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