Infective endocarditis: a Hunter New England perspective.

Abstract

Infective endocarditis (IE) is a severe infection conferring significant morbidity and mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner. To evaluate the presentation, treatment and outcomes of patients with IE in the Hunter New England Local Health District (HNELHD). A total of 112 patients with definite IE admitted to hospitals within the HNELHD between 2011 and 2015 was retrospectively analysed. The mean age of patients was 56.8 (standard deviation 20.3) and 62.5% were male. The most common valve affected was the mitral valve, in 41% of patients, and the most common organism was Staphylococcus aureus, in 47.7% of patients. A history of IE was present in 10% of patients and 19.6% presented with prosthetic valve IE. Survival among patients treated surgically was 100% at 30 days, 92% at 1 year and 83% at 3 years, versus 82% at 30 days, 65% at 1 year and 51% at 3 years for those not operated (P = 0.004). Valve type, organism and Australian Standard Geographical Classification remoteness area did not have a statistically significant effect on mortality (P-value 0.095, 0.456 and 0.186, respectively). Factors associated with improved survival by univariate analysis included surgery and multidisciplinary team review. IE in the HNELHD affects a relatively young cohort of patients and is associated with a high mortality. Outcomes could be improved by implementation of a multidisciplinary team approach and inpatient cardiac surgery.