Impact of Multidisciplinary Endocarditis Team on management of infective endocarditis

Abstract

Infective Endocarditis (IE) is a complex, life-threatening disease. The aim of the present study was to evaluate the impact of the Endocarditis-Team on management of IE. This observational study conducted at a university hospital (2015‒22), included adult patients with IE. The study period was divided in two periods: before (pre-Endocarditis-Team; pre-ET) and after the establishment of the Endocarditis-Team (post-Endocarditis-Team; post-ET) on January 2018. Among 505 IE episodes (187 in pre-Endocarditis-Team, 318 in post-ET period), 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography was more commonly used in post-ET period (14% vs. 28%; p < 0.001). Overall, thirty-day and one-year mortality were 14% and 27%, respectively; no difference was observed between the two periods. In post-ET period, the administration of 4-weeks, rather than 6-weeks, of intravenous antimicrobial treatment was higher than in the post-ET period (15% vs. 45%; p < 0.001). Indication for surgery was present in 115 (61%) patients in pre-ET and in 153 (48%) in the post-ET period. In post-ET period, among patients with indication, valve surgery was more frequently performed (66% vs. 78%; p = 0.038). Such difference was due to a higher acceptance of operative indication by the cardiac surgeon (69% vs. 94%; p = 0.013). The observed increase in number of patients benefiting from cardiac surgery in the post-ET period led to a decrease of subsequent embolic events, since among patients with operative indication (n = 268), new embolic events after the establishment of the indication were more common in the pre-ET period compared to post-ET (23% vs. 12%; p = 0.033). After the implementation of the multidisciplinary Endocarditis-Team we observed several improvements in the general management of IE patients.