Distant embolisation in infective endocarditis: characteristics and outcomes.

Abstract

Infective endocarditis is asevere and potentially lethal cardiac disease. Recognition of the clinical features of endocarditis, such as distant embolisation, and adequate treatment should be initiated promptly given the grim perspective of upcoming virulent pathogens. We report on our registry-based experience with outcomes of consecutive patients with infective endocarditis with distant embolisation. We aimed to describe the patient characteristics of infective endocarditis complicated by distant organ embolisation and the safety aspects of continuing endocarditis treatment at home in these patients. From November 2018 through April 2022, 157consecutive patients were diagnosed with infective endocarditis. Of them, 38patients (24%) experienced distant embolisation, either in the cerebrum (n = 18), avisceral organ (n = 5), the lungs (n = 7) or the myocardium (n = 8). Pathogens identified in blood cultures were predominantly streptococcal variants (43%), with only one culture-negative endocarditis case. Of the 18patients with cerebral embolisation, 12had neurological complaints and most often discrete abnormal findings on neurological examination. Six of the 8cardiac embolism patients experienced chest pain before admission. Visceral organ and pulmonary embolism occurred silently. Of the 38patients with distant embolisation, 17could be discharged earlier by providing antibiotic treatment at home without complications. This registry-based single-centre experience showed an incidence of distant embolisation in daily care of 24%. Cerebral and coronary embolisation provoked symptoms, while visceral emboli remained silent. Pulmonary emboli may present with inflammatory signs. Distant embolisation was not in itself acontra-indication for outpatient endocarditis@home treatment.