Outcome Of Infective Endocarditis Research Articles

Trends in the Clinical Characteristics and Outcome of Infective Endocarditis: ANationwide Study From 2016 to 2021.

Infective endocarditis (IE) is still a fatal disease, and given its rarity, ongoing updates to patient characteristics and outcomes of IE are essential for providing precision diagnoses and effective treatments. This study sought to examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Using the Japan nationwide administrative database, we identified patients with IE in Japan from 2016 to 2021. A total of 17 407 patients with IE (37.8% women; median age, 72 [interquartile range, 59-81] years) were identified. The incidence of IE increased from 2.02 per 100 000 population in 2016 to 2.59 per 100 000 population in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (odds ratio [OR], 1.34 [95% CI, 1.29-1.40]), heart failure (OR, 1.37 [95% CI, 1.18-1.59]), cerebrovascular complications (OR, 1.78 [95% CI, 1.59-1.99]), renal failure (OR, 2.36 [95% CI, 2.06-2.70]), and sepsis (OR, 2.79 [95% CI, 2.48-3.13]), were independently associated with an increased in-hospital mortality rate. In contrast, cardiac surgery (OR, 0.47 [95% CI, 0.41-0.55]), and a higher number of total cardiac surgeries (OR, 0.77 [95% CI, 0.65-0.92]) independently predicted a lower in-hospital mortality rate. The characterization and comprehensive analysis of IE in Japan provides valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

Early Surgical Outcomes in Infective Endocarditis Before and During COVID-19 Pandemic.

Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, which may have affected the outcomes of patients requiring urgent procedures. This study aimed to evaluate the impact of the pandemic on surgical outcomes of IE patients in Southern Germany. This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 (n=84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, n=94). Preoperative status and postoperative in-hospital complications were analyzed and compared between groups. The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 vs. 8 days, p = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% vs. 68.1%, p = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% vs. 33%; Class IV: 22.6% vs. 11.7%, p = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown (p < 0.05). However, in-hospital survival rates did not differ significantly between the groups. The COVID-19 pandemic and related lockdown measures were associated with delayed diagnoses and worse perioperative outcomes for surgical IE patients, highlighting the need for improved management strategies during public health crises.

Abstract 4124769: Temporal Changes in Clinical Characteristics and Oucomes of Infective Endcarditis: A Report from JROAD-DPC Study

Background: Despite advances in medical science and patient care, infective endocarditis (IE) is still a serious and life-threatening disease. Considering the recent shifts in predisposing clinical backgrounds of cardiovascular disease, such as an aging population and increased usage of prosthetic valves and cardiovascular implantable electronic devices, ongoing updates to patient characteristics and outcomes of infective endocarditis (IE) are essential for providing precision diagnoses and effective treatments. Objective: To examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Methods: Observational study of using a nationwide Japanese administrative database (JROAD-DPC), that is operated by the Japanese Circulation Society. IE was identified based on the code of the International Classification of Diseases, Tenth Revision. The study outcomes were in-hospital mortality and IE-compatible complications (heart failure, cerebrovascular episodes, renal failure, and sepsis). Results: Between the years 2016 and 2021, a total of 17,407 IE patients (37.8% female; median age 72 (IQR, 59-81) years) were identified in JROAD-DPC database. The incidence of IE increased from 2.02 per 100,000 population (2,534 cases) in 2016 to 2.59 (3,183 cases) in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. Notably, the proportion of patients older than 80 years rose from 25.4% to 30.8%. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (OR, 1.34; 95% CI, 1.29 to 1.40; &lt;.001), heart failure (OR, 1.37; 95% CI, 1.18 to 1.59; P&lt;.001), cerebrovascular complications (OR, 1.78; 95% CI, 1.59 to 1.99; P&lt;.001), renal failure (OR, 2.36; 95% CI, 2.06 to 2.70; P&lt;.001), and sepsis (OR, 2.79; 95% CI, 2.48 to 3.13; P&lt;.001), were independently associated with increased in-hospital mortality. In contrast, cardiac surgery (OR, 0.47; 95% CI, 0.41 to 0.55; P&lt;.001), and a higher number of total cardiac surgeries (OR, 0.77; 95% CI, 0.65 to 0.92; P&lt;.004) independently predicted a lower in-hospital mortality. Conclusions: The characterization and comprehensive analysis of IE in Japan provide valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

Mechanical thrombectomy is associated with worse outcomes in infective endocarditis: a retrospective cohort study

Abstract Background Acute Ischaemic stroke (AIS) is a common complication in infective endocarditis (IE) and associated is with high mortality. There is a paucity of data evaluating mechanical thrombectomy (MT) in patients with AIS secondary to IE. Our retrospective cohort study aimed to quantify the efficacy and safety of MT in this patient population. Methods The National Inpatient Sample (NIS) was utilised. We obtained data from 2004 – 2019. We included all patients who had AIS and IE. We excluded patients who received thrombolysis. Those who received mechanical thrombectomy were compared to those who did not. Odds ratios were calculated using logistic regressions. We adjusted for multiple confounders. Outcomes included inpatient mortality, long length of stay (&amp;gt; 4 days), discharge status (normal vs ‘other’) and intracranial haemorrhage. Results The sample population consisted of 22,6390 patients (mean age 69, 52.3% female). ME was performed on 496 (2.2%). Patients with IE who received MT had a greater odds of death compared to those who did not (OR 1.91 95% CI 1.00 – 3.67). In addition, they had a greater odds of intracranial bleeding (OR 4.47 95% CI 2.78 – 7.20). Length of stay and neurological outcome did the significantly differ. We performed a sub-analysis, which included patients who had received thrombolysis in addition to MT. This did not modify the results for mortality and intracranial bleeding outcomes. Conclusion Mechanical thrombectomy was associated with increased mortality and intracranial bleeding in patients who have AIS associated with IE. While acknowledging the limitations of observational data, we therefore advise caution when considering mechanical thrombectomy in this patient population.

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p &amp;lt;0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p &amp;lt;0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p &amp;lt;0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Infective Endocarditis Outcomes in Congestive Heart Failure Patients.

The aim of this study is to analyze the difference in hospital outcomes for infective endocarditis (IE) admissions with and without comorbid congestive heart failure (CHF). The National Inpatient Sample (NIS) was the database we used to find and sort patient data from inpatient hospitalizations. We then used logit probit regression to analyze the association between patients admitted for IE with and without CHF and their all-cause mortality rates. After collecting our sample population, we used propensity score matching to create our comparative cohorts of IE patients which were then analyzed to determine if there was an association between inpatient hospital outcomes and the presence of CHF. Among the patients admitted for IE, there was a statistically significant association between comorbid CHF diagnoses and an increase in all-cause mortality during hospital admission. The proportion of mortality was 7.8% during the hospitalization for IE admissions with comorbid CHF, while the proportion was 4.16% for the subset of IE admissions without comorbid CHF. The association of comorbid CHF and all-cause mortality during the hospital stay for IE admissions was significant with an odds ratio of 3.197 (2.089-4.891) after adjusting for age, sex, race, income, and other comorbidities. The association between the requirement for either temporary or continuous pacing during the hospital stay and co-existing CHF diagnosis in IE admissions was also significant with an odds ratio of 2.86 (1.720-4.761). Among the propensity-matched cohort analysis, there was a significantly higher proportion of IE admissions with co-existing CHF needing pacing (either temporary or continuous), 5.74% (3.96%-8.25%) compared to the IE cohort without comorbid CHF: 1.48% (0.71%-3.09%). With the results of our analyses proving a significant association between the presence of CHF and adverse in-hospital outcomes in IE admissions, it calls for further prospective and real-world studies to analyze the finer aspects of the association. This becomes important for clinicians in stratifying at-risk patients for a higher level of care and prognostication aspects of the treatment. Our study results prove a causative association between the presence of CHF and heart block in IE admissions. This could be useful for clinicians in planning appropriate management plans in the event of initial signs of bradycardia and hypotension developing in this patient population.

Outcomes in infective endocarditis among adults with CHD: a comparative national study.

Given increased survival for adults with CHD, we aim to determine outcome differences of infective endocarditis compared to patients with structurally normal hearts in the general population. We conducted a retrospective cross-sectional study identifying infective endocarditis hospitalisations in patients 18 years and older from the National Inpatient Sample database between 2001 and 2016 using International Classification of Disease diagnosis and procedure codes. Weighting was used to create national annual estimates indexed to the United States population, and multivariable logistic regression analysis determined variable associations. Outcome variables were mortality and surgery. The primary predictor variable was the presence or absence of CHD. We identified 1,096,858 estimated infective endocarditis hospitalisations, of which 17,729 (1.6%) were adults with CHD. A 125% increase in infective endocarditis hospitalisations occurred for adult CHD patients during the studied time period (p < 0.001). Adults with CHD were significantly less likely to experience mortality (5.4% vs. 9.5%, OR 0.54, CI 0.47-0.63, p < 0.001) and more likely to undergo in-hospital surgery (31.6% vs. 6.7%, OR 6.49, CI 6.03-6.98, p < 0.001) compared to the general population. CHD severity was not associated with increased mortality (p = 0.53). Microbiologic aetiology of infective endocarditis varied between groups (p < 0.001) with Streptococcus identified more commonly in adults with CHD compared to patients with structurally normal hearts (36.2% vs. 14.4%). Adults with CHD hospitalised for infective endocarditis are less likely to experience mortality and more likely to undergo surgery than the general population.

Infective Endocarditis Among Women Who Inject Drugs

In the US and Canada, women comprise approximately one-third of people who inject drugs (PWID); however, clinical characteristics and outcomes of injection drug use complications in women are poorly described. To identify clinical characteristics and outcomes of infective endocarditis (IE) among women who inject drugs (WWID). This is a retrospective cohort study of PWID with definite IE (per 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria) admitted from April 5, 2007, to March 15, 2018, at 5 tertiary-care hospitals in London, Ontario, and Regina, Saskatchewan, Canada. Data were analyzed from June 1, 2023, to August 2, 2024. Descriptive analyses were conducted for baseline characteristics at index hospitalization and stratified by sex. The primary outcome was the difference in 5-year survival between female and male PWID with IE. The secondary outcome was 1-year survival. Multivariable time-dependent Cox proportional hazards regression analyses were conducted for variables of clinical importance to evaluate 5-year mortality. Of 430 PWID with IE, 220 (51.2%) were women; of 332 non-PWID with IE, 101 (30.4%) were women. WWID with IE were younger than men (median [IQR] age, 31.5 [27.0-38.5] vs 38.5 [31.0-49.0] years), and 11 of 220 (5.0%) were pregnant at index hospitalization, although only 12 of 220 (5.5%) had contraceptive use documented. Women had a larger proportion of right-sided IE than men (158 of 220 women [71.8%] vs 113 of 210 men [53.8%]). WWID living in urban areas had higher mortality than WWID in rural areas (adjusted hazard ratio [aHR], 2.70; 95% CI, 1.15-6.34; P = .02). Overall mortality was lower among PWID referred for substance use disorder counseling in centers with inpatient services compared with centers with only outpatient referrals (aHR, 0.29; 95% CI, 0.17-0.51; P < .001). Overall mortality was lower with right-sided heart disease for both women (aHR, 0.44; 95% CI, 0.27-0.71; P < .001) and men (aHR, 0.22; 95% CI, 0.10-0.50; P < .001) and was higher with congestive heart failure for both women (aHR, 2.32; 95% CI, 1.29-4.18; P = .005) and men (aHR, 1.73; 95% CI, 1.07-2.79; P = .02). In this cohort of PWID with IE, women were overrepresented. Reasons for women's disproportionately high IE incidence need further study. Inpatient substance use disorder services, contraception counseling, and enhanced social support for WWID living in urban areas need to be prioritized.

Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study

BackgroundAortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.MethodsBetween January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.ResultsThe mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36–5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43–2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).ConclusionsIn this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

Infective endocarditis outcomes at a tertiary hospital in Western Australia: a retrospective cohort study from 2016 to 2021.

Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner. To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH). A single-centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021. Eighty-four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve-month mortality was 16.7%, with significantly increased mortality in those treated non-surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non-surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery. IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.

Occurrence and Outcome of Infective Endocarditis after Surgical Compared to Transcatheter Pulmonary Valve Implantation in Congenital Heart Disease.

Background: Conflicting data exist on the occurrence and outcome of infective endocarditis (IE) after pulmonary valve implantation. Objectives: This study sought to assess the differences between transcatheter pulmonary valve implantation (TPVI) and surgical pulmonary valve replacement (SPVR). Methods: All patients ≥ 4 years who underwent isolated pulmonary valve replacement between 2005 and 2018 were analyzed based on the data of a major German health insurer (≈9.2 million insured subjects representative of the German population). The primary endpoint was a composite of IE occurrence and all-cause death. Results: Of 461 interventions (cases) in 413 patients (58.4% male, median age 18.9 years [IQR 12.3-33.4]), 34.4% underwent TPVI and 65.5% SPVR. IE was diagnosed in 8.0% of cases during a median follow-up of 3.5 years. Risk for IE and all-cause death was increased in patients with prior IE (p < 0.001), but not associated with age (p = 0.50), sex (p = 0.67) or complexity of disease (p = 0.59). While there was no difference in events over the entire observational time period (p = 0.22), the time dynamics varied between TPVI and SPVR: Within the first year, the risk for IE and all-cause death was lower after TPVI (Hazard Ratio (HR) 95% CI 0.19 (0.06-0.63; p = 0.006) but increased over time and exceeded that of SPVR in the long term (HR 10.07 (95% CI 3.41-29.76; p < 0.001). Conclusions: Patients with TPVI appear to be at lower risk for early but higher risk for late IE, resulting in no significant difference in the overall event rate compared to SPVR. The results highlight the importance of long-term specialized care and preventive measures after both interventions.

Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience.

Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death. A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1-3.4, p = 0.03 and HR 2.1, 95% CI 1.2-3.6, p = 0.01, respectively) and Kaplan-Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4-13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4-22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9-1, p < 0.05), abscess (HR 3.5, 95% CI 1.2-10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5-14.1, p < 0.01) were independently associated with the all-cause death endpoint. IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint.

Clinical Characteristics and Outcome of Infective Endocarditis among Intravenous Drug Abusers after 6 months

Clinical Characteristics and Outcome of Infective Endocarditis among Intravenous Drug Abusers after 6 months

Changing Paradigms in Epidemiology, Microbiology, and Outcomes of Infective Endocarditis

Changing Paradigms in Epidemiology, Microbiology, and Outcomes of Infective Endocarditis

Characteristics and outcomes of infective endocarditis in South Africa: A retrospective cohort study

Background: Infective endocarditis (IE) remains a disease with significant morbidity and mortality for a predominantly young group of patients in South Africa. There is a paucity of data assessing contemporary outcomes of IE in South Africa, limiting our ability to institute strategies to improve the outcome of patients with IE in South Africa. Methods: A retrospective cohort of patients with IE was established from healthcare records for the period of 1 January 2017 - 31 December 2018. A profile of clinical, laboratory, microbiologic, echocardiographic, surgical, and morbidity and mortality data was compiled for each patient. Results: A total of 75 patients with definite IE were included in this study. The mean age was 39.6 years with a male preponderance (68%). Mortality at 6 months (all cause) was 34.7% and embolic complications were common, especially cerebral embolism (21%). Rheumatic heart disease (RHD) was present in 28% of the cohort. A high rate of blood culture negative IE (BCNIE) was present (62.7%). In patients with a positive blood culture, Staphylococcus aureus (43%) and the viridans group of streptococci (32%) were the most common causative organisms. Conclusion: IE in South Africa remains a disease with a significant mortality rate despite the young age of the patients affected. The high rate of BCNIE is a likely contributor to the associated adverse outcomes. Some of the features of IE in South Africa have evolved to resemble a profile of disease similar to cohorts from high-income countries with a Staphylococcal predominance and a reduction in underlying RHD as predisposing risk factor.

Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short- and Long-Term Outcomes.

Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020. We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests. Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043). In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Sex differences in characteristics, microbiology, management, and outcomes in infective endocarditis

Abstract Background Infective endocarditis affects male patients more frequently, yet female sex has been associated with higher mortality rate in prior smaller studies. Unselected nationwide studies on sex differences in infective endocarditis are sparse and may help identify sex-related and universal prophylactic strategies. Purpose To investigate sex related differences in patient characteristics, practice patterns and outcomes in patients with infective endocarditis. Methods Between 2010–2020, we identified and characterized all patients with infective endocarditis according to sex. We used data from the Danish national registries including microbiological data, and outcome. Frailty was assessed by the sum of cardiovascular and non-cardiovascular comorbidities in each patient using the Hospital Frailty Risk Score. Mortality was compared in unadjusted analyses using Kaplan-Meier estimates for 90-day mortality following hospital admission and 5-year mortality following hospital discharge. In adjusted analyses, Cox regression was used for comparison of 90-day and 5-year mortality. Results We identified 6,259 patients with infective endocarditis including 2,047 (32.7%) female patients and 4,212 (67.3%) male patients. Female patients were older (median age 75.0 years (IQR 64.3–82.2 vs. 71.7 years (IQR 61.7–78.9) and more frail (Intermediate frailty: 36.5% vs. 33.1%, High frailty: 11.4% vs. 9.2%, p&amp;lt;0.001). Female patients had lower education level, lower income and were more likely to live alone. Female patients had less cardiovascular comorbidity than male patients such as ischemic heart disease (25.2% vs. 34.8%), congestive heart failure (20.3% vs. 24.0%), prior myocardial infarction (7.8% vs. 14.3%), prosthetic heart valve (16.5% vs. 20.3%), and CIED (12.2% vs. 18.7%) (p&amp;lt;0.01). Staphylococcus aureus was the most common microorganism in both sexes (34.6% vs. 28.8%), but fewer female patients had Enterococcus species than male patients (10.5% vs. 18.1%). Female patients were less often surgically treated (14.0% vs. 21.2%). The cumulative 90-day incidences of mortality from hospital admission were 30.9% (95% CI 28.9%–32.9%) in females and 23.6% (95% CI 22.3%–24.9%) in males (Figure 1). The cumulative 5-year incidences of mortality from hospital discharge were 59.8% (95% CI 57.4%–62.0%) in female patients and 53.0% (95% CI 51.3%–54.6%) in male patients. In adjusted analysis, female sex was associated with increased 90-day mortality (adj. HR 1.22, 95% CI 1.10–1.36), but no difference was found in 5-year mortality (adj. HR 1.02, 95% CI 0.93–1.12). Conclusion In infective endocarditis, female sex is associated with an increased 90-day mortality despite adjusting for age and frailty. However, this association is not found in long-term mortality. Female patients differ from male patients with lower prevalence of Enterococcus infective endocarditis and lower rates of surgery. Further research is needed to understand why these differences persist.

Abstract 12736: Prevalence, Characteristics, and Outcomes of Infective Endocarditis in Patients With Liver Disease in the United States

Introduction: Infective endocarditis (IE) is common in patients with liver disease. Data regarding IE in liver disease are limited. Hypothesis: We analyzed IE admissions to determine inpatient outcomes among patients with liver disease in the United States. Methods: We used the 2017 National Readmission Database to identify index admission of adults with IE, based on the International Classification of Disease, 10th revision codes. The primary outcome was 30-day readmission. Secondary outcomes were mortality and predictors of hospitalization readmission. Results: We identified 40,413 IE admissions. Figure 1 presents prevalence of variables associated with liver disease in this cohort. Patients who were readmitted were more likely to have a history of hepatitis C virus (19.4% vs 12.3%, p &lt; 0.001), hyponatremia (25% vs 21%, p &lt; 0.001), and thrombocytopenia (20.3% vs 16.3%, p &lt;0.001). After adjusting for age, hypertension, heart failure, diabetes mellitus, and end stage renal disease, hyponatremia (odds ratio (OR): 1.25; 95% confidence intervals [CI]: 1.17 to 1.35; p &lt; 0.001) and thrombocytopenia (OR: 1.16; 95% CI: 1.08 to 1.24; p &lt; 0.001) correlated with higher odds of 30-day readmission. Mortality was higher among patients with hyponatremia (29% vs 22%, p &lt; 0.001), thrombocytopenia (29% vs 17%, p &lt; 0.001), coagulopathy (12% vs 5%, p &lt; 0.001), cirrhosis (6% vs 4%, p &lt; 0.001), ascites (7% vs 3%, p &lt;0.001), liver failure (18% vs 3%, p &lt; 0.001), and portal hypertension (3% vs 1.5%, p &lt; 0.001) (Figure 2). Conclusions: Important liver disease related variables correlate with higher risks of hospital readmission and mortality in patients with IE. Targeting such variables may improve outcomes in this patient population.

Contemporary Outcomes and Predictors of Inpatient Mortality for Infective Endocarditis Occurring in Renal Transplant Recipients in the United States

Renal transplant (RT) recipients are susceptible to infections because of immunosuppression. The literature regarding the epidemiology and outcomes of infective endocarditis (IE) in RT recipients is limited. We analyzed the National Inpatient Sample in the United States to study IE in RT and identify risk factors for inpatient mortality and IE development in RT patients. All patients ≥18years who had IE with and without RT between 2007 and 2019 were identified from the National Inpatient Sample. The demographics, co-morbidities, length of stay, hospital costs, and mortality of IE patients with RT were compared with IE patients without RT. Predictors of inpatient mortality for RT recipients with IE were analyzed. Between 2007 and 2019, there were 777,245 hospitalizations for IE, of which 3,782 had RT. The IE in RT cohort was younger than the general IE population and had higher proportions of males, non-White races, and Hispanic ethnicity, and higher burden of co-morbidities, but similar inpatient mortality rates. On multivariate analysis, Staphylococcal IE (adjusted odds ratio [aOR]2.26, 95% confidence interval [CI] 1.2 to 4.3, p=0.015), stroke (aOR6.4, 95% CI 2.7 to 15.3, p<0.001), anemia (aOR2.3, 95% CI 1.3 to 4.0, p=0.004), and shock (aOR6.3, 95% CI 3.3 to 11.9, p<0.001) were associated with greater inpatient mortality, whereas Streptococcal endocarditis (aOR0.37, 95% CI 0.1 to 0.9, p=0.038) was associated with lower inpatient mortality. In conclusion, RT patients with IE were younger and had more severe co-morbidities compared with IE patients without RT. Staphylococcal IE, presence of shock and stroke worsened the prognosis in these patients.