Abstract
BackgroundInfective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management. We aimed to define diagnosis parameters and delineate in-hospital management in patients with IE admitted in a tertiary hospital of Southern Italian.Materials and methodsFifty-six consecutive patients (42 males, 14 females; age range: 34-85 years) admitted for IE in the Infectious Diseases, Cardiac Surgery, and Cardiology units, between January 2011 and August 2017, were enrolled. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, and antimicrobial therapy were collected and analyzed. Any comments at the multidisciplinary team meetings were recorded in minutes of and approved.ResultsWe found 83.9% of patients with positive blood cultures. The four most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA: 21.3%), methicillin-sensitive Staphylococcus aureus (MSSA: 17%), Streptococci (14.9%), and Enterococci (14.9%). Both in the univariate and multivariate analysis, we observed a significant positive correlation between surgery and complications. Particularly in the univariate analysis only, surgery was positively correlated to males and C-reactive protein (CPR) at baseline. Also, considering the most common bacteria, it resulted in a positive correlation between surgery and MRSA and Streptococci spp. and between complications and MSSA. Finally, the male gender was positively correlated to MSSA and heart complications, major arterial embolism, septic pulmonary emboli, splenic infarction, and cerebral embolism.ConclusionsA blood culture test remains a critical factor for the diagnosis of IE and the antibiotic treatment of susceptible and emerging resistant bacteria. Male gender and heart complications are red flags for prompt operative management.
Highlights
In the last years, several efforts have been proposed to improve the management of infective endocarditis (IE) via international scientific groups [1,2]
We found 83.9% of patients with positive blood cultures
Considering the most common bacteria, it resulted in a positive correlation between surgery and methicillinresistant Staphylococcus aureus (MRSA) and Streptococci spp. and between complications and methicillin-sensitive Staphylococcus aureus (MSSA)
Summary
Several efforts have been proposed to improve the management of infective endocarditis (IE) via international scientific groups [1,2]. Despite these efforts and emerging methodologies to identify the pathogens, IE remains a challenging disease with a high fatality rate. The prevalence of hospital admission for IE disease varies across European countries [3]. Gouriet et al (2018) reported a tremendous epidemiologic disparity among Mediterranean countries regarding etiology and diagnosis [7]. Infective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management.
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