Incidence Of Infective Endocarditis Research Articles

#1916 Infective endocarditis in young female hemodialysis patient: a case report and literature review

Abstract Background and Aims Infective endocarditis (IE) in hemodialysis patient is one of major infective and cardiovascular complications with high morbidity and mortality. Compared to general population, incidence of IE among hemodialysis (HD) patients is 50-60 times higher. Despite the devastating implications, there is no particular preventive measures of IE for HD patients. Previous studies revealed leading risk factors for IE in HD population including use of central venous catheters (CVCs), first 6 months period of renal replacement therapy (RRT), aortic valve disease, and previous endocarditis. Case Summary We report a case of IE in a 21-year-old female hemodialysis patient using AV fistula for the past 16 months with no prior history of heart valve disease, previous endocarditis, and IV drug abuse. Patient presented with fever of 38.5°C, dyspnea, and cough since three days before admission. Physical examination revealed grade 5 pansystolic murmur with punctum maximum at apex. Vegetation on the anterior mitral leaflet (AML) was first detected through trans-thoracal echocardiography. Patient was treated with ceftriaxone and vancomycin for 14 days, followed by oral antibiotics in outpatient setting after clinical resolution. Conclusion This case provides insight of the occurrence of IE in relatively young patient in the absence of well-known risk factors, making strict prevention, prompt diagnosis and treatment are of the utmost importance. Possible pathophysiological mechanisms for IE in HD patients are bacteremia from repeated vascular manipulation and valvular calcification that compromises valve to colonization. Therefore, besides infection prevention, managing the progression of valvular calcification among HD patients remains an issue to be addressed in future studies.

Infective Endocarditis in North Africa and the Middle East, 1990‒2019: Updates from the Global Burden of Disease Study 2019.

Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.

Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures

The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007. To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures. PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023. Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included. Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis. The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis. Of 11 217 records identified, 30 were included (1 152 345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci-infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis. While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.

Diferencias regionales en la epidemiología y los resultados de la endocarditis infecciosa en España. Un estudio poblacional contemporáneo

Introduction and objectivesOur aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]). MethodsWe conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed. ResultsA total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions. ConclusionsWe found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.

КЛИНИЧЕСКИЙ СЛУЧАЙ УСПЕШНОГО 120-ДНЕВНОГО КОМПЛЕКСНОГО ЛЕЧЕНИЯ ИНФЕКЦИОННОГО ЭНДОКАРДИТА МИКСОМАТОЗНО-ИЗМЕНЕННОГО МИТРАЛЬНОГО КЛАПАНА, ОСЛОЖНЕННОГО КАРДИОГЕННЫМ И СЕПТИЧЕСКИМ ШОКОМ С ПОЛИОРГАННОЙ НЕДОСТАТОЧНОСТЬЮ

Annotation. Estimated incidence of infectious endocarditis (IE) is 13.8 cases per 100.000 subjects per year while mortality as high as 0.87 death cases per 100.000 patients demonstrating upstroke trend in majority countries in the world over past 30 years. Imaging positive for IE is among major diagnostic criteria of which transthoracic echocardiography is recommended as the first-line imaging modality in suspected IE. Negative, non-diagnostic or inconclusive results of echocardiography make diagnosis of IE challenging followed by treatment delays and poor outcomes. Within current clinical case we discuss the experience of diagnosis and successful treatment of IE of mitral valve with mixomatous degeneration and rupture of chordae tendineae that challenged vegetations detection and delayed surgical treatment followed by development of complications as cardiogenic and septic shock with multiple organ failure.

Regional differences in infective endocarditis epidemiology and outcomes in Spain. A contemporary population-based study

Introduction and objectivesOur aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]). MethodsWe conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed. ResultsA total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions. ConclusionsWe found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.

Publication Trends on Infective Endocarditis: Comprehensive Bibliometric Analysis and Visualization Between 1892 and 2022.

In recent years, studies reported that the incidence of infective endocarditis (IE) has increased despite the decrease in rheumatic heart diseases, great advances in medical and surgical treatment methods, and prophylactic antibiotic therapies. However, there is no bibliometric analysis based on the visual mapping method in the literature. In the study, we aimed to analyze the hot topics in IE, the distribution of publications in terms of country, institution, journal, author, and their relationships by assessing IE articles published in the 130 years between 1892 and 2022. Publications before 2023 were analyzed using the keywords 'infective' and 'endocarditis' in the Scopus database. Approximately 25% of the publications on IE were from the USA followed by Japan, France, and the UK. A total of 116 keywords were used at least 15 times and the keywords were categorized into 9 clusters by the VOSviewer program. The keywords used more than 100 times except 'infective endocarditis' were 'echocardiography,' 'mortality,' 'surgery,' 'Staphylococcus aureus,' 'cardiac surgery,' 'epidemiology,' and 'prognosis' 247, 191, 152, 142, 130, 122, and 119 times, respectively. To the best of our knowledge, the study is the most comprehensive study globally on IE with the widest time range including the visual mapping method. Since our study reveals the changes in the literature related to infective endocarditis, we think that it will be a guide in planning new research studies. We believe that periodic repetition of bibliometric analyses and keyword mapping studies will contribute to the quantitative and qualitative development of scientific productivity globally.

NatIonal Danish endocarditis stUdieS – Design and objectives of the NIDUS registry

AimsThe National Danish endocarditis stUdieS (NIDUS) registry aims to investigate the mechanisms contributing to the increasing incidence of IE and to discover risk factors associated to the course, treatment and clinical outcomes of the disease. MethodsThe NIDUS registry was created to investigate a nationwide unselected group of patients hospitalized for infective endocarditis (IE). The National Danish healthcare registries have been queried for validated IE diagnosis codes (International Classification of Disease, 10th edition (ICD-10): DI33, DI38, and DI398). Subsequently, a team of 28 healthcare professionals, including experts in endocarditis, will systematically review and evaluate all identified patient records using the modified Duke Criteria and the 2015 European Society of Cardiology (ESC) modified diagnostic criteria. The registry will contain all cases with definite or possible IE found in primary data sources in Denmark between January 1, 2016, and December 31, 2021. We will gather individual patient data, such as clinical, microbiological, and echocardiographic characteristics, treatment regimens, and clinical outcomes. A digital data collection form will be used to the gathering of data. A sample of approximately 4,300 individual patients will be evaluated using primary data sources. Conclusion and perspectivesThe NIDUS registry will be the first comprehensive nationwide IE registry, contributing critical knowledge about the course, treatment, and clinical outcomes of the disease. Additionally, it will significantly aid in identifying areas in which future research is needed.

Sex Differences in Infective Endocarditis: A Systematic Review.

Despite the advancement in medicine, there is still a lack of understanding of the sex disparities in disease onset, progression, treatment, and outcome. In some life-threatening acute conditions, despite most patients with these illnesses being males, females have a significantly higher chance of mortality. This can be due to the differences in disease progression or healthcare disparities in managing the illness between the sexes. Treatment of illnesses tends to be more conservative for women without an explanation, but this disparity is due to the healthcare provider. Infective endocarditis (IE) is an acute life-threatening condition where bacteria latch onto and seed damaged endocardium, with some preliminary information reporting differences between the sexes. This paper aims to evaluate the sex disparities in the incidence, age, comorbidities, etiology, risk factors, manifestations, treatment, and outcomes of IE. From 2003-2023, 21584 articles were found that focused on the sex differences in IE and, through PRISMA guidelines, were narrowed down to 34 publications. There are significant differences between the sexes in IE, such as a significantly higher incidence of IE in males, who also tend to be older and have their native aortic valves involved, compared to younger females who have their mitral valve involved. Comorbidities also vary between the sexes; females tend to have atrial fibrillation, chronic kidney disease, psychiatric disorders, and taking immunosuppressants compared to males who suffer from chronic liver disease, underlying valve disease, and peripheral artery disease, contributing to the ease of developing IE. While the most common microorganism leading to IE is Staphylococcus aureus, females were more likely to have culture-negative IE, and men were more likely to be infected with Streptococcus viridans. Major manifestations in IE are fever and vegetation along the closure of the valves in the heart, where females were more likely to have vegetation on the mitral and aortic valves. At the same time, males were more likely to have it on the tricuspid valve. On par with sex disparities in health, females usually took longer to seek medical help than males despite the advancement of symptoms and deterioration. Females were also treated conservatively through antibiotic management, whereas males were more likely to advance to surgical treatment, leading to a longer hospital stay. While there was no true difference in the in-hospital mortality rate, the 30-day and 1-year mortality were significantly increased in females. These differences provide a range of starting points for various research to further educate physicians on sex disparities, such as why males have a higher incidence of infective endocarditis and determining whether it's hormones and basic metabolites, possibly limiting those who develop the infection. Another important point is treating females with IE; the antibiotic doses are standard, but whether they advance to surgical treatment is mostly up to the provider. Some providers deny surgical treatment despite all indications, but it could also be females denying surgery as they tend to leave against medical advice. This review is crucial in developing the next steps to sex disparity in IE, which may lead to better outcomes for males and females.

Utility of Echocardiogram in Neutropenic Patients with Gram Positive Bacteremia: A Retrospective Study

Introduction: Hemato-oncology patients are vulnerable to bloodstream infections (BSI) due to their immunocompromised and neutropenic state, and the common use of intravascular catheters. The risk of infective endocarditis (IE) among non-neutropenic patients with gram positive bacteremia is substantial, however the risk is considered to be lower among neutropenic patients, though data is limited. We aimed to evaluate the incidence of IE among neutropenic hemato-oncology patients' cohort, and to explore the yield of echocardiogram in this specific population. Methods: A single center, retrospective study. Between 01/2007 and 12/2019, hospitalized patients in the Hematology department consisting of the hemato-oncology and bone marrow transplantation units were included, if they had positive blood cultures for specific organisms known to cause IE while neutropenic. Patient characteristics, results and timing of blood cultures and echocardiogram obtained during hospitalization were collected. Results: Two hundred seventy-four patients had positive blood cultures with pathogens known to be associated with IE. Overall, 340 isolates have been identified. After excluding 57 coagulase negative staphylococcus (CONS) isolates which were suspected as a contamination (identified in a single collection), 241 patients were included with 283 isolates. CONS were the most commonly isolates found, followed by streptococcus viridans, comprising 31.4% (89) and 24.3% (69) of isolates, respectively. Trans thoracic echocardiography (TTE) was performed in 108 (45%) patients overall, of which 14 (5.8%) had additional trans esophageal echocardiogram (TEE). Only one case of IE was diagnosed in our series, of a forty-seven-year-old female patient with a diagnosis of multiple myeloma in relapse after autologous stem cell transplantation. The patient presented with a stroke caused by septic emboli, fever and streptococcus viridans bacteremia. Lab works showed neutropenia of 0K/micl and thrombocytopenia of 8K/micl. TTE and TEE failed to demonstrate valvular pathology consistent with IE in this case. Valvular vegetations have not been identified on TTE nor on TTE in any other case as well. Conclusion In our experience, the yield of echocardiogram in hemato-oncological neutropenic patients with gram positive bacteremia is extremely low, owing to reduced probability of IE in this population, and thus could be avoided in most cases.

Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study

Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI. In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE. Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p=0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p=0.15). Consistent findings were found in 712 propensity score-matched patients. Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI. The funder had no role in the study design, data management, or writing.

Regional differences in infective endocarditis epidemiology and outcomes in Spain. A population-based study

Abstract Introduction Population-based studies of infective endocarditis (IE) provide nationwide representative information of the disease, with a lower risk of selection and referral bias. Purpose Our aim was to describe the contemporary epidemiological profile of IE in Spain, and to evaluate regional variations in the incidence, characteristics and outcomes of IE in the different Spanish regions (autonomous communities, AC). Methods Retrospective population-based study to analyse the incidence, epidemiological and clinical characteristics and outcomes of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile among the 17 Spanish AC were also evaluated. Results A total of 9008 episodes were identified during the study period. Mean age was 69.5 (14.6) years, and 66.1% of the patients were male. 52.6% of episodes were treated at referral centers. Direct standardized incidence of IE in the study period was 5.77 (95% CI: 5.12-6.41) cases per 100000 person-years. 26.8% of episodes were prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. The most frequently isolated microorganisms were staphylococci (33.3%; 19.0% Staphylococcus aureus and 14.3% coagulase-negative staphylococci), followed by gram-negative (21.0%) and streptococci (20.8%). Culture-negative IE accounted for 20.7% of episodes. 38.6% of patients developed heart failure during hospitalization, and 27.5% had acute renal failure. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of episodes treated in high-volume referral centres. In-hospital mortality was 25.1%. The standardized incidence of IE in Spain in the period 2016-2019 was 5.77 (95% CI: 5.12-6.41) cases per 100000 person-years. Standardized incidence rates (cases per 1000000 person-years) and risk-adjusted in-hospital mortality rates of infective endocarditis among AC are shown at Figure 1, were significant differences were found. In a multilevel logistic regression analysis, cardiogenic shock (OR 5.95, CI 4.98-7.9) and septic shock (OR 4.54, CI 3.78-5.44) were associated with the highest odds ratio for in-hospital mortality, whereas Streptococci viridans was associated with the lowest (OR 0.44, CI 0.37-0.52). Irrespectively of the AC, patients treated at high-volume centres (> 22 episodes per year) had a slightly lower risk-adjusted mortality (22.7±4.1 vs 23±3.6) p<0.001) (Figure 2, blue dots represent low-volume hospitals, red dots represent high-volume hospitals). Conclusions We found relevant and statistically significant differences in standardized incidence rates of IE, and risk-adjusted in-hospital mortality rates among regions. Regardless of the AC, patients treated in high-volume centres (>22 episodes per year) had a slightly lower risk-adjusted mortality.Figure 1Figure 2

Mitral valve replacement versus repair and long-term risk of infective endocarditis: a nationwide study

Abstract Background There is a paucity of data regarding mitral valve (MV) repair versus MV replacement and the associated risk of infective endocarditis (IE). Further research is needed to optimise patient selection and determine the importance of using prophylactic antibiotics. Purpose To examine the long-term risk of IE in patients undergoing MV repair, compared with a matched population of patients undergoing MV replacement as well as the background population. Methods All patients undergoing MV repair from 2000 to 2020 with no history of IE were identified using Danish nationwide registries. Those patients were matched to patients undergoing MV replacement in a 1:1 ratio as well as the background population in a 1:4 ratio based on age, sex, and year of procedure. The Aalen-Johansen estimator and multivariable Cox regression models were used to examine the long-term risk of IE. Results After matching, the study population included 1,797 patients undergoing MV replacement, 1,797 undergoing MV repair, and 7,188 matched controls from the background population. The median age of the study population was 67.8 years (percentile[p]25-p75: 57.8-74.7), and 45.1% were females. Patients with MV replacement were significantly more comorbid, compared with patients with MV repair and the control group, which included ischaemic heart disease, heart failure, atrial fibrillation, stroke, diabetes, chronic renal disease, and chronic obstructive pulmonary disease. During a median follow-up of 7.7 years (p25-p75: 4.0-13.5), 134 (7.5%) with MV replacement, 57 (3.2%) patients with MV repair, and 27 (0.38%) in the control group were hospitalised with IE. The median follow-up time from date of procedure to IE admission was 3.5 years (p25-p75: 0.82-7.1) in the MV replacement group, 2.4 years (p25-p75: 0.61-6.6) in the MV repair group, and 8.2 years (p25-p75: 5.3-12.4) in the control group. In patients with MV replacement, MV repair, and the control group, the 1-year cumulative incidences of IE (Figure) were 7.5% (95% CI: 6.3-8.7%), 3.2% (95% CI: 2.4-4.1%), and 0.38% (95% CI: 0.25-0.54%), respectively. The 10-year cumulative incidences of IE (Figure) were 9.4% (95% CI: 7.9-11.1%), 3.9% (95% CI: 3.0-5.0%), and 0.56% (95% CI: 0.38-0.82%) in patients with MV replacement, MV repair, and the control group, respectively. After multivariable adjustment, MV replacement was associated with an increased 10-year rate of IE, compared with MV repair (hazard ratio 2.4 [95% CI: 1.8-3.3]), while the control group was associated with a lower 10-year rate, compared with MV repair (hazard ratio 0.14 [95% CI: 0.085-0.23]). Conclusion In this nationwide study, MV replacement was associated with a twofold increased 10-year rate of infective endocarditis, while matched controls from the background population were associated with a significantly lower 10-year rate of infective endocarditis, compared with MV repair.Figure

One-year outcome of elderly patients with endocarditis: a retrospective observational study

Abstract Background The incidence of infective endocarditis (IE) is rising in general population, especially in elderly, where it is associated with high morbidity and mortality. Health care procedures, degenerative heart valve diseases and intracardiac electronic devices are the main risk factors for IE in elderly population. Cardiac surgery is largely underused in these patients and the few available observational studies seem to confirm the positive outcome of surgery. Purpose The aim of the present study is to assess differences in survival between elderly patients affected by endocarditis treated with a conservative strategy or cardiac surgery. Methods We conducted a retrospective observational study of 143 elderly patients (age ≥ 70 years old) affected by endocarditis with at least one year of follow-up who were hospitalized between 2016 and 2022. The primary endpoint was the difference in one-year all-cause mortality between patients treated with a conservative strategy or cardiac surgery. The secondary endpoint was one-year mortality for sepsis or septic shock. The cumulative probability of survival was calculated using the Kaplan-Meier estimator. The log-rank test was used to compare between-group differences in survival and cox regression was used in the uni and multivariate analysis, a p<0.05 was considered significant. Results Between 2016 and 2022, 242 patients have been diagnosed with IE. Between them, 143 patients were at least 70 years old (59%). Cardiac surgery was performed in 16 patients, while 127 were treated with medical therapy alone. Patients treated with cardiac surgery were younger (74y vs 80y, p=0.005) and had higher prevalence of severe valvular heart disease (69% vs 23%, p< 0.001). The primary endpoint of one-year all-cause mortality occurred in 80 patients in the conservative strategy group and in 5 patients treated with surgery (p=0.015); the secondary endpoint occurred in 42 patients in conservative strategy group, while no patients treated with surgery died for sepsis or septic shock (p=0.006). Finally, surgery was associated with better one-year survival (HR 0.34, 95% CI 0.14 - 0.85). Conclusions IE in elderly patients is an emerging clinical matter since its incidence is rising but mortality has not significantly decreased. Current clinical guidelines do not give specific indication for elderly, who are generally excluded from surgery due to the high risk carried by age and comorbidities. Few previous studies have analyzed the best treatment strategy in this cohort of patients, but data from observational studies shows a better outcome among those undergone surgery. The result of our work confirmed that elderly patients with IE treated with cardiac surgery have better one-year survival and lower rate of death for all causes, sepsis or septic shockKaplan Mayer Curve For One-Year Survival

Abstract 17886: Temporal Trends, Healthcare Resource Utilization and In Hospital Outcomes of Infective Endocarditis Following Transcatheter Edge-to-Edge Repair Using Mitraclip Among Elderly Patients With Severe Mitral Regurgitation: A National Perspectives

Introduction: Procedural proficiency combined with the careful selection of patients with severe mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, may have influenced the incidence and outcomes of infective endocarditis (IE) following mitral Transcatheter edge-to-edge repair (TEER). Objective: To assess the temporal trends, healthcare resource utilization (HRU), and in-hospital outcomes of IE post-TEER. Methods: We used the National inpatient sample registry to identify all patients aged > 65 with definite IE post-TEER between 2016 and 2020. Temporal incidence trends, in-hospital mortality, length of stay, and discharge disposition were analyzed. Results: During the study period, there were an estimated 71 cases of endocarditis among patients 65 years and older following mitral TEER, representing 355 discharges (1.0% of TEER-associated discharges) nationally. The temporal trend of the incidence of IE is shown in Figure 1. Relative to its absence, the occurrence of IE following TEER was associated with a 30.3% increased risk of HRU (Patient Average Treatment effect - PATE estimate = 0.303; 95% confidence interval (CI) =0.214 - 0.391; P<0.001); a 13.2% increased risk of AKI (PATE estimate = 0.132; 95% confidence interval (CI) =0.033 - 0.232; p=0.009) and a 6.2% increased risk of in-hospital mortality (PATE estimate = 0.062; 95% confidence interval (CI) =0.008 - 0.117; p=0.025) Conclusions: Among elderly patients with severe symptomatic mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, the incidence of TEER-associated IE appears to be trending downwards. The occurrence of TEER-associated IE confers small but significant high HRU, complication rates, including AKI and in-hospital mortality, compared to those without IE. High-fidelity studies are needed to elucidate these findings.

Abstract 12161: Trends in Age, Sex and Racial Differences in the Incidence of Infective Endocarditis in Florida and New York

Introduction: How the incidence of infective endocarditis (IE) changed in various demographic subgroups of the United States along with the worsening opioid epidemic over the last decade is unknown. Methods: This retrospective cohort study used data from the 2005-2018 State Inpatient Databases of Florida and New York. Cases of incident IE were combined with census data to compute age, sex- and race-specific incidence. Joinpoint regression was used to quantify the annualized percentage change (APC) in incidence over time. Results: Of 98,221 incident IE admissions, 70.0% were Non-Hispanic White (NHW) and 60.6% were ≥ 65 years old (yo). The average annual age and sex-standardized incidence of IE in cases/100,000 population was 19.2 (95%CI 18.7-19.6) but this varied by age, sex, and race. Incidence was ≈20% higher in men (20.9 [95%CI 20.2-21.7]) compared to women (17.5 [95%CI 16.8-18.2]) and increased with age in both sexes. Incidence was higher in Black: 22.5 (95%CI 21.0 - 23.9) vs NHW: 20.0 (95%CI 19.3 - 20.6), Hispanic: 13.2 (95%CI 12.3 -14.1) and Asian/Pacific Islander patients: 5.9 (95%CI 4.7 - 7.1). The age and sex-standardized incidence did not change over time (APC 0.5%, p=0.646). However, incidence increased in women 18-44 (APC 11.0%, p<0.001), men 18-44 (APC 7.3, p<0.001) and men 45-64 yo (APC 1.5%, p=0.002) but declined in women ≥ 65 yo(APC -2.8, p=0.049). Most of this increased incidence occurred in NHW women and men 18-44, NHW men 45-64 and Hispanic Men 18-44 yo (Figure 1). Incidence did not change over time in other age/sex groups. Prevalence of opioid use disorder increased by >2-fold in all age/sex groups over time but the pace of increase was faster in NHW women and men 18-44 yo compared to other races of similar demography (p-for-time interaction <0.001). Conclusions: Over the last decade, among residents of Florida and New York, incidence of IE increased in several demographic groups, but the most prominent rise was among young NHW patients, especially young NHW women.

Abstract 17840: Impact of Age and Sex on Mortality Trends of Infective Endocarditis in High-Income Countries

Introduction: Incidence of infective endocarditis may relate to a variety of background conditions which may vary depending on age groups and sex in a country. Its national trends in each age group and sex among high-income countries are still unclear. Hypothesis: We hypothesized that mortality from infective endocarditis is without sex differences and has improved in all age groups in both sexes among high-income countries. Methods: The WHO mortality database was analyzed to determine trends in mortality from infective endocarditis in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2021. Age-standardized and age-specific (≤49, 50-64, 65-79, ≥80 years) mortality rates per 100,000 persons in either sex were compared by using male-to-female ratio. Trends were analyzed using joinpoint regression. Results: Age-standardized mortality rates ranged from 0.40 (95%CI, 0.38, 0.42) in Japan to 1.29 (95%CI, 1.23, 1.35) in France in the most recent year and showed increasing trends in all studied countries except for Japan with decreasing trends and the USA with constant trends. During the studied periods, age-standardized mortality was male-dominant in all countries (p<0.0001). In age-specific analysis, three age groups (≤49, 50-64, 65-79 years) showed male dominancy in all countries while age group ≥80 years showed no sex difference except for France. Different mortality trends were identified between the sexes. In the USA, female mortality rates showed increasing trends in the age group ≤49 years while there were decreasing trends in the other three age groups. Male mortality rates showed constant trends in age groups ≤49 and 50-64 years while there were decreasing trends in the age group 65-79 and ≥80 years. Conclusions: Mortality from infective endocarditis was male-dominant in age groups less than 80 years old in all studied high-income countries. The different mortality trends between sexes among age groups need to be contextualized.

Abstract 15466: Social Determinants of Health Vulnerabilities Among Patients With Substance Use Disorder and Infective Endocarditis

Introduction: Data indicate that the incidence of infective endocarditis (IE) is rising among patients with substance use disorder (SUD) and is linked with increased mortality. However, the social determinants of health (SDOH) vulnerabilities associated with IE in this population has not been well characterized. Aims: To examine the SDOH associated with IE among patients with SUD. Methods: Using our electronic medical records, we identified patients with concurrent diagnosis of IE and SUD from 2017 until May 2023. Socio-demographics and SDOH including unstable housing (identified using diagnosis codes, residential address test, and natural language processing of clinical notes documenting homelessness and shelter referrals) were identified. A multivariable regression model was conducted to identity independent risk factors associated with IE among patients with SUD. Results: Among 26,918 patients admitted with an SUD encounter, 1,422 (5.3%) had an IE encounter. Patients with IE were younger (37 vs 43 years, P<0.001), mostly white (96% vs 87.7%, P<0.001), Medicaid enrollees (84.2% vs 58.6%, P<0.001), and had less than high school education (10.6% vs 8.1%, P=0.005). They were more likely to reside in rural areas (58.1% vs 44.8%) and have unstable housing (28.6% vs 16.3%). Patients with IE had higher prevalence of smoking (83.5% vs 67.3%) as well as cardiac, dental, mental and other health conditions. Certain socio-demographics and SDOH were independently associated with IE on multivariable regression (Figure). Conclusions: Patients with SUD and IE have distinct socio-demographics and SDOH characteristics. Incorporating these factors into future risk prediction tools could better help identifying SUD patients who are at risk to implement targeted techniques which have been proven to lower the risk of infection.

Infective endocarditis of the aortic valve in an 85-year-old man due to translocation of the intestinal flora

Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.

Mitral Kapak Replasmanında Sütür Tekniklerinin Karşılaştırmalı Değerlendirilmesi: Klinik Sonuçlar Üzerindeki Etkisi

Background: This study aimed to compare the outcomes of mitral valve replacement (MVR) using the intermittent simple suture technique versus the horizontal matrix suture technique with pledgeted in terms of paravalvular leakage and infective endocarditis. Methods: A retrospective analysis was conducted on 422 patients who underwent MVR between 2019 and 2023. Patients were divided into two groups based on the suture technique used: group B (simple suture technique) and group P (horizontal matrix suture technique with pledgeted). Propensity score matching was performed to balance the groups, resulting in 62 case pairs for comparative analysis. Results: There were no intraoperative mortalities, and the duration of cardiopulmonary bypass and cross-clamp time did not significantly differ between the two groups. No significant differences were observed in terms of total hospitalization time, early mortality, cerebrovascular events, and arrhythmias. Postoperative echocardiography revealed minimal paravalvular leakage in both groups, with non-serious leakage observed in 4 patients in group B and 2 patients in group P. The incidence of infective endocarditis was 1 in group B and 2 in group P. Hemolysis indicators showed higher mean values in the simple suture technique group, although not statistically significant. Conclusions: The study findings suggest that there is no significant difference in the incidence of paravalvular leak and infective endocarditis between the intermittent simple suture technique and the horizontal matrix suture technique with pledgeted. Both techniques can be safely employed in MVR.