Outcomes In Infective Endocarditis Patients Research Articles

Infective Endocarditis in Belgium: Prospective Data in Adults from the ESC EORP European Endocarditis Registry.

(1) Background: infective endocarditis (IE) is a significant health concern associated with important morbidity and mortality. Only limited, often monocentric, retrospective data on IE in Belgium are available. This prospective study sought to assess the clinical characteristics and outcomes of Belgian IE patients in the ESC EORP European endocarditis (EURO-ENDO) registry; (2) Methods: 132 IE patients were identified based on the ESC 2015 criteria and included in six tertiary hospitals in Belgium; (3) Results: The average Belgian IE patient was male and 62.8 ± 14.9 years old. The native valve was most affected (56.8%), but prosthetic/repaired valves (34.1%) and intracardiac device-related (5.3%) IE are increasing. The most frequently identified microorganisms were S. aureus (37.2%), enterococci (15.5%), and S. viridans (15.5%). The most frequent complications were acute renal failure (36.2%) and embolic events (23.6%). Cardiac surgery was effectively performed when indicated in 71.7% of the cases. In-hospital mortality occurred in 15.7% of patients. Predictors of mortality in the multivariate analysis were S. aureus (HR = 2.99 [1.07-8.33], p = 0.036) and unperformed cardiac surgery when indicated (HR = 19.54 [1.91-200.17], p = 0.012). (4) Conclusion: This prospective EURO-ENDO ancillary analysis provides valuable contemporary insights into the profile, treatment, and clinical outcomes of IE patients in Belgium.

Abstract 11693: Comparison of In-Hospital Outcomes in Infective Endocarditis Patients With and Without Embolic Stroke

Introduction: Infective endocarditis (IE) is a critical condition that can lead to complications such as embolic stroke. This study aimed to compare the in-hospital outcomes between IE patients with and without embolic stroke. Methods: We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2020. We identified admissions with a principal diagnosis of IE, with embolic stroke as a secondary diagnosis. In-hospital outcomes, including mortality, length of stay, and total charge, were analyzed after adjusting for patients' demographics, hospital characteristics, and chronic comorbidities, including heart failure, hypertension, diabetes, chronic kidney disease, smoking, and hyperlipidemia. Results: A total of 62,200 admissions with IE were identified, of which 4,460 (7.2%) developed embolic stroke, with females accounting for 38% of the cohort. Patients who developed embolic stroke had a significantly higher risk of mortality (OR: 2.4, 95% CI: 1.8-3.1, P=0.000), longer length of stay (18 days, Coefficient: 5.8, 95% CI: 4.6-7.0, P=0.000), and higher total charge (285,285, Coefficient: 121,586, 95% CI: 98,119-145,054, P=0.000). Conclusion: Our study found that IE patients who experienced embolic stroke had significantly worse outcomes, including higher mortality rates, prolonged length of stay, and increased financial burden. These findings emphasize the need for targeted interventions and close monitoring for this high-risk subgroup to improve patient outcomes and resource utilization.

Evolving Patterns of Infective Endocarditis: Insights from a Tertiary Healthcare Institute in Western India

Abstract Context: Infective endocarditis (IE) is a dynamic disease with high morbidity and mortality despite advancements in diagnostics, antimicrobial therapy, and surgery. India faces a complex situation due to changing factors such as host characteristics, diagnostic techniques, antibiotics, and aggressive surgical approaches. Monitoring local epidemiology is crucial for prompt recognition and treatment. However, studies on IE trends in India are scarce and outdated. Aims: To investigate the clinical, microbiological, predisposing conditions, echocardiographic characteristics, and treatment outcomes of IE patients admitted to a Tertiary Care Academic Institute in Western India. Settings and Design: This retrospective observational study was done in a 2011-bedded tertiary care referral hospital in Western Maharashtra, between June 2019 and May 2023. The records of all adult patients (age >14 years) admitted during the study period with a definite diagnosis of IE, both native valve endocarditis and prosthetic valve endocarditis according to the modified Duke criteria, were included in the study. Baseline demographic data on age, sex, underlying heart disease, and predisposing conditions for bacteremia (infections, central venous catheters, surgeries, and invasive procedures) were collected. Subjects and Methods: The echocardiographic and microbiological findings, complications, treatment, and outcomes were noted. All blood cultures done for the diagnosis of IE were processed using standard methods to identify bacterial and fungal species and antimicrobial susceptibility profiles. For all the patients in this study, blood (5–8 mL per bottle) was collected in adult blood culture bottles using standard precautions and processed by a semiautomated blood culture system (BioMérieux, Marcyl̕ Etoile). Identification of causative organisms was performed by standard microbiological methods. Transthoracic and transesophageal echocardiography were performed to determine the location of vegetation, type of valve infected, and cardiac complications. Sample Size Calculation: Considering the Indian prevalence of IE to be 14.5% as observed by Gupta et al.,margin of error as 9%, and 95% of confidence level, the minimum required sample size calculated using WinPepi software (version: 11.65) for conducting the study was 59 patients. Statistical Analysis: Data was collected and entered into a database using Microsoft Excel. Data was represented as the frequency with percentage and Chi-square test (two-sample proportionality test) were applied for comparison of categorical variables. Quantitative data was summarized using mean and standard deviation and a two-sample t-test was applied to compare differences. P < 0.05 was considered statistically significant. Results: The mean age in the study was 44.1 ± 10.6 years with a female preponderance (male:female – 0.85:1). Rheumatic heart disease (RHD) (44.3%) was the most common underlying heart disease etiology, whereas 33% of patients did not have any cardiac disease. Blood culture was positive in 34.9% of episodes, with the most common organisms being Gram-positive Staphylococci (38%). Medical complications such as congestive heart failure (CHF) and acute kidney injury were seen in 41.2% of patients, followed by cerebrovascular accident and stroke in 20.6%. The majority of patients, 61.9%, had received antibiotics before referral to our center. Thirty-seven (58.7%) patients underwent definitive surgery for IE. The total in-hospital mortality rate was 12 (19.1%). In the univariate analysis, younger patients (<50 years) with CHF, diabetes mellitus, and Staphylococcus culture-positive IE were independent predictors of mortality. Conclusions: Over the past four decades, the landscape of IE in India has experienced noteworthy transformations. The disease profile of patients has shifted from predominantly older individuals with RHD to a rising number of younger patients with prosthetic valves or those without identified valvular conditions. Moreover, the yield of blood cultures has declined due to the increased utilization of antibiotics over the last two decades, although Staphylococcus species continue to be the most common organisms detected. Despite significant advancements in medical technology, the mortality rate remains unchanged. Our study provides compelling evidence to advocate for early surgical intervention, which holds the potential for improved outcomes.

Epidemiology, microbiology, and outcomes of infective endocarditis in atertiary center in Jordan.

Infective endocarditis (IE) is arelatively rare but serious and life-threatening disease with substantial mortality and morbidity despite progress in diagnostic and treatment techniques. The aim of this study is to investigate the epidemiology, clinical characteristics, microbiological profile, and outcomes of IE patients in atertiary care facility in Jordan, the Jordan University Hospital (JUH). This is aretrospective case series study which was conducted at JUH. Atotal of 23patients with either definite or possible IE according to the Modified Duke Criteria were included in the study. Medical records were reviewed, and relevant information was collected. Descriptive data analysis was performed. Our study identified atotal of 23patients with infective endocarditis; 65.2% were males, with amean age of 40.4years. The majority of patients had an underlying cardiac disease (60.9%), with the most common being congenital heart diseases (17.4%). The most commonly affected valves were the left-side heart valves, with the mitral valve (52.2%) being the most common followed by the aortic valve (34.8%). The most common organism detected in blood culture was Streptococcus viridans (21.7%) followed by methicillin-resistant Staphylococcus aureus. The most common complications among the patients were heart failure and septic shock, and the mortality rate among the patients was 13%. In patients with endocarditis, Streptococcus viridans is the most common culture-positive bacteria at JUH. One third of our patients needed surgical intervention and the mortality rate was 13%.

Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism-The Risk of Intermediate Deterioration.

Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1–7 days), intermediate (8–21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (n = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (p = 0.006), preoperative renal insufficiency (p = 0.019), age (p = 0.002), large vegetations (p = 0.018) as well as intermediate (p = 0.026), and late (p = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (p = 0.019) and increased age (p = 0.037)—but not operative timing—were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.

Characteristics, management, and outcome of infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry.

Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).

CHA2DS2-VASc Is Associated With In-Hospital Mortality in Patients With Infective Endocarditis: A Cross-Sectional Cohort Study.

Background and objectiveThe CHA2DS2-VASc score is a stroke risk stratification tool that is used in patients with atrial fibrillation (AF). Most of its clinical variables have been associated with poor outcomes in patients with infective endocarditis (IE). In this study, we aimed to determine its utility in predicting outcomes in IE patients.MethodsWe included 35,570 patients with IE from the National Inpatient Sample (NIS), 2009-2012. The CHA2DS2-VASc score was calculated for each patient. Hierarchical logistic regression was used to estimate the adjusted odds ratio for in-hospital mortality for CHA2DS2-VASc scores from 1 to 9, using a score of 0 as the reference score. All clinical characteristics were defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.ResultsThe mean age of the sample was 57.81 ±14 years. Higher CHA2DS2-VASc scores were associated with increased mortality, and the scores among the sample ranged from 0 for 8.1% to 8 for 21.7%. In the hierarchical logistic regression, after adjusting for age, sex, and relevant comorbidities, as the score increased, so did the odds for overall mortality.ConclusionIn patients with IE, the CHA2DS2-VASc score may serve as a risk assessment tool with which to predict outcomes. Further studies are needed to replicate these findings.

Post-surgical outcomes in infective endocarditis patients with liver disease: nationwide propensity-match analysis

Abstract Introduction Surgery remains the definitive treatment for persistent infective endocarditis (IE). Age, renal dysfunction and diabetes mellitus are few amongst the many associated with increased post-surgical mortality. Liver dysfunction is a common entity seen in patients with IE. Data on post-surgical sequelae in patients with IE and liver disease is lacking. Method We performed a retrospective cross-sectional analysis of all adult (age>18 years) admissions with a discharge diagnosis of acute or sub-acute IE using the 2016 National Inpatient Sample (NIS). IE patients undergoing valve replacement or repair were identified and divided into two groups based on the presence or absence of liver disease. Propensity score matching was performed to control for confounders such as diabetes, age, smoking among others. Odds of in-hospital mortality, cardiogenic shock, and acute kidney injury were calculated using multivariate logistic regression analysis. IE patients without liver disease undergoing valve surgery were selected as the reference population. Results We identified a total of 9,822 IE related admissions in the 2016 NIS. Amongst all IE admissions, 11.7% (n=1,158) had either valve replacement or repair surgery performed. After using propensity scores for 1 to 1 matching 16.8% of patients (n=195) who had concomitant liver disease were compared with 195 patients without liver disease. In-hospital mortality was significantly higher in patients with hepatic impairment (14.3% vs 0.51%, p=0.004). Patients with liver disease also had higher odds of concurrent cardiogenic shock (OR=9.35, 95% CI=3.01–29.15, p=0.001), acute kidney injury (OR=2.13, 95% CI=1.15–3.93, p=0.01), and thrombocytopenia (OR=2.29, 95% CI=1.13–4.61, p=0.02). Discussion The presence of liver disease in the setting of IE, in patients undergoing valvular surgery significantly increases the morbidity and mortality post-operatively. Functional status of the liver should be considered in addition to the commonly used tools for cardiac operative risk evaluation. Funding Acknowledgement Type of funding source: None

Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

BackgroundFew data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years.ResultsThe IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007).ConclusionThis Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

Early predictors of poor outcome in infectious endocarditis: A Tunisian cohort

Despite all improvements in diagnostic imaging modalities and therapeutic regimens, Infective endocarditis remains a lethal disease which is associated with a high mortality rate. The early identification of patients at risk of infective endocarditis complications is essential to improve prognosis. We aimed at identifying the predictive factors at admission for poor outcomes in infective endocarditis patients. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Three hundred forty patients were included in this study. The mean age of our patients was 37 ± 17.92 years. There were 56.4% men and 43.6% women. The third of the population had rheumatic heart disease. Cardiac surgery was performed in 76 patients (22.3%), and the overall in-hospital mortality rate was 25%. In the multivariable analysis, the independent predictors of death were: age > 60 years (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), and the vegetation length on diagnosis (OR 1.15, 95% CI 1.03–1.28). Also, heart failure, cardiogenic shock and embolic events during hospitalization were associated with a poor prognosis. Age, C-reactive protein, and the vegetation size were independent factors associated with and in-hospital mortality. Identifying the predictive factors of mortality in infective endocarditis may improve outcomes.

The effect of conscientious intelligence on the ability to manage patient expectations: Example from a university hospital

Infective endocarditis (IE) is still associated with severe complications and poor prognosis. The surgery of IE has various technical difficulties due to severe infection, inflammation of heart tissue, and systemic effects, so controversies continue about the optimal timing of operation. This study presents the treatment approaches, early and late-term outcomes of IE patients, who underwent surgery.This retrospective descriptive study is conducted with 46 patients (31males) operated between 2002-2018. The demographics and preoperative, intraoperative and postoperative data of patients were analyzed from the clinical database and patient records. Emergency surgery was performed to 15 (32.26%) patients.Numbers of patients with mitral valve, aortic valve, and prosthetic valve endocarditis were 14, 25, 7 respectively. Aortic valve replacement (AVR), mitral valve replacement (MVR), MVR + AVR and mitral valve repair were performed in 24, 12, 8 and 2 patients, respectively. Additionally, pericardial patch repair (periannular abscess or damage (n=12), aorta-right atrial fistulae (n=3)), debulking of associated tricuspid valve vegetation (n=2), tricuspid De Vega annuloplasty (n=3), Bentall operation (n=1) and aortic root enlargement (n=5) were performed. The mean follow-up period and mortality rates were 24.86 ± 38.98 months, 13.04% respectively. The mean survival and reoperation-free time were 179.02 ± 13.78 and 203 ± 10.09 months, respectively. Patients can be managed appropriately with early diagnosis, aggressive medical and surgical treatment via a multidisciplinary approach with customized management according to guidelines in terms of individual characteristics. In cases of worsening hemodynamic status, uncontrolled infection, large and mobile vegetations surgery should be performed as soon as possible.

Baseline C-reactive protein levels and prognosis in patients with infective endocarditis: A prospective cohort study

BackgroundEarly diagnosis and risk-stratification among infective endocarditis (IE) patients are limited by poor microbiological yield and inadequate characterization of vegetations. A simple tool that can predict adverse outcomes in the early phase of management is required. AimTo study the prognostic value of C-reactive protein (CRP) levels at admission and its role in predicting various clinical outcomes. MethodsIn a prospective study of consecutive IE patients diagnosed by modified Duke’s criteria, we measured the peak levels of CRP and erythrocyte sedimentation rate (ESR) in the first 3 days of admission and correlated it with in-hospital mortality, six-month mortality, embolic phenomena and the need for urgent surgery. Predefined laboratory-microbiological sampling protocols and antibiotic-initiation protocols were followed. Receiver-operating-characteristics curves were generated to identify a reliable cut-off for CRP in predicting various outcomes. ResultsOut of 101 patients who were treated, 85 patients had ‘definite’ IE. Blood cultures were positive in 55% (n = 39); and Staphylococcus species was the most common organism. Major complications occurred in 74.1% (n = 63) and in-hospital mortality was 32.9% (n = 28). Mean ESR and CRP levels were 102 ± 31 mm/h and 51 ± 20 mg/l, respectively. In multivariable analysis, high CRP levels were independently predictive of mortality, major complications, embolic events and need for urgent surgery. A CRP >40 mg/l predicted adverse outcomes with a sensitivity of 73% and specificity of 99%. ConclusionThe study shows that baseline CRP level in the first 3 days of admission is a strong predictor of short term adverse outcomes in IE patients, and a useful marker for early risk stratification.

Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis

Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE). The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients. Patients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes. Of the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; P=.006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; P<.001). ApoA-I (area under the curve, 0.671; P<.001) and HDL-C (area under the curve, 0.672; P<.001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I <0.90g/L and HDL-C <0.78mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P=.023) and HDL-C (increments of 1mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P=.015) were independently associated with long-term mortality. ApoA-I and HDL-C were inversely associated with adverse IE prognosis.

Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis

BackgroundDespite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE.MethodsA computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests.ResultsTwenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively.ConclusionIrrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results.

Characteristics of Infective Endocarditis in a Tertiary Hospital in East China.

The epidemiology, clinical presentation, and treatment of infective endocarditis (IE) has significantly changed over the past few years in developed countries. However, relevant data from developing countries are different and remain scarce. The objective of this study was to evaluate the clinical presentations, treatment and outcomes of IE patients in a tertiary hospital in East China over an 8-year period. This was a retrospective observational study of consecutive cases of definite or possible IE as per the modified Duke criteria between January 2008 and December 2015. A total of 135 definite and 39 probable IE cases were identified. The mean age was 47.8 ± 15.7 years, with a male preponderance (1.9: 1). Degenerative valve disease accounted for 30.5% cases of IE, followed by congenital heart disease (29.9%) and rheumatic heart disease (14.9%). Native cardiac valves were present in 93.7% of the IE patients. Echocardiography and blood culture were performed in all patients, of whom 55.2% were found to have large vegetations (≥10 mm) and the positive rate of blood culture was 60.3%. Streptococcus remained the chief causative agent that was identified in 61.9% of culture-positive patients. Glycopeptide antibacterials and cephalosporins were the most frequently used antimicrobial drugs for IE therapy. Seventy-six (43.7%) of the IE patients were surgically treated. The mortality rate during hospital stay was 10.9%. Our data reflected clinical and microbiological profile, and treatment of IE in a tertiary hospital located in the East China.

Early Operation for Endocarditis Complicated by Preoperative Cerebral Emboli Is Not Associated With Worsened Outcomes

Valve operations for patients presenting with infective endocarditis (IE) complicated by stroke are thought to carry elevated risk of postoperative complications. Our aim was to compare outcomes of IE patients who undergo surgical intervention early after diagnosis of septic cerebral emboli with outcomes of patients without preoperative emboli. All patients undergoing operations for left-sided IE between 1996 and 2013 at our institution were reviewed. Patients undergoing operations more than 14 days after embolic stroke diagnosis (n= 11) and those withpurely hemorrhagic lesions (n= 7) were excluded from the analysis. The study included 308 patients who were stratified according to the presence (STR, n= 54) or absence of a preoperative septic cerebral embolus (NoSTR, n= 254). Primary outcomes of interest were the development of a new postoperative stroke and 30-day mortality. Mean time to surgical intervention from stroke onset was 6.0 ± 4.1 days. Staphylococcus aureus(39% STR vs 21% NoSTR, p= 0.004) infection and annular abscess at operation (52% STR vs 27% NoSTR, p< 0.001) were more prevalent in STR patients. There wasno significant difference in 30-day mortality (9.3% STR vs 7.1% NoSTR, p= 0.57) or in the rate of new postoperative stroke (5 [9.4%] STR vs 12 [4.7%] NoSTR, p= 0.19) between groups. In addition, there was no difference in 10-year survival between groups (log-rank p= 0.74). Early surgical intervention in patients with IE complicated by preoperative septic cerebral emboli does not lead to significantly worse postoperative outcomes. Early surgical intervention for IE after embolic stroke warrants consideration, particularly in patients with high-risk features such as S aureus or annular abscess, or both.

Abstract 18110: Impact of Stroke Severity on Clinical Outcomes in Patients who had Infective Endocarditis With Cerebral Complications

Background: The treatment strategy in active infective endocarditis (IE) with cerebral complications still remains unclear. We sought to analyze the association of the neurological deficit level with the clinical outcomes in IE patients with stroke. Methods and Results: Clinical data were retrospectively reviewed in 141 consecutive patients with active left-sided IE with cerebral complications. To evaluate the severity of stroke, the National Institute of Health Stroke Scale (NIHSS) was assessed in all patients on admission. There were 116 (82%) patients with cerebral infarction including 9 hemorrhagic infarctions and 57 (40%) patients with cerebral hemorrhage. We divided the patients according to NIHSS; severe stroke group (NIHSS&gt;16: n=19) and non-severe stroke group (NIHSS≤16: n=122). Early surgery in the active phase (within 2 weeks after the initial diagnosis) was performed in 64 patients (6 severe stroke group and 58 non-severe stroke group), and the conventional treatment strategy was applied in 77 patients (13 severe stroke group and 64 non-severe stroke group). In the conventional treatment group, 37 patients (36 severe stroke group and 1 non-severe stroke group) underwent late surgical intervention. A mean follow-up period was 4.5 years. In-hospital death was significantly lower in non-severe stroke group (12% versus 53%, p&lt;0.001). In addition, the freedom rate from IE-related death was significantly higher in patients with non-severe stroke than those with severe stroke (84±4 % versus 37±13 % at 5-year, p&lt;0.001). Multivariate Cox proportional hazard analysis showed that NIHSS (HR=1.074; 95% CI 1.042-1.107: p&lt;0.001), logistic EuroSCORE (HR=1.026; 95% CI 1.010-1.042: p=0.002), conventional treatment (HR=3.478; 95% CI 1.477-8.193: p=0.004), and aortic valve involvement (HR=3.091; 95% CI 1.460-6.546: p=0.003) were significantly associated with IE-related mortality (p&lt;0.001). Conclusions: Severity of stroke was strongly associated with clinical outcomes in IE patients with cerebral complications. Therapeutic strategy for IE patients with stroke might have to be customized according to severity of neurological deficit.

Abstract 9421: The Role of B-type Natriuretic Peptide as a Prognostic Factor for Endocarditis at the Emergency Room

Background: Some prognostic factors for infective endocarditis (IE) are well established, but the role of B-type natriuretic peptide (BNP) at admission has not been well studied. Objective: The purpose of this study was to access the admission BNP value as a prognostic factor in patients with IE. Methods: Between July 2009 and January 2011, consecutive patients with IE admitted to the emergency room were prospectively enrolled. Patients were included if they met possible or definite Duke’s criteria for IE. The association between elevated BNP and in-hospital death was determined. Results: From 104 patients analyzed, 67 were male (48%), the mean age was 52.6±19.1 years. During follow-up, 32 (30.8%) patients died. In univariate analysis, staphylococcal infection (P&lt;0.001, HR 3.94; CI, 1.94-8.0), dyspnea at presentation (P=0.015, HR 2.41; CI, 1.20-4.86), sepsis at presentation (P=0.017, HR 2.34; CI, 1.16-4.72), left ventricular ejection fraction ≤ 55% (P&lt;0.001, HR 3.97; CI, 1.86-8.43), C-reactive protein (CRP) &gt; 120 mg/L, (P&lt;0.001, HR 4.04; CI, 1.91-8.55), creatinine &gt; 1 mg/dL (P=0.006, HR 2.92; CI, 1.26-6.76), and BNP &gt; 200 pg/mL (P&lt;0.001, HR 12.51; CI, 2.98-52.48) were associated with in-hospital mortality. In multivariate analysis, BNP values &gt; 200 pg/ml (P&lt;0.001, HR 2.41; CI, 1.20-4.86), staphylococcal infection (P=0.006, HR 2.89; CI, 1.39-6.02), dyspnea at presentation (P=0.003, HR 3.17; CI, 1.49-6.76), and CRP &gt; 120 mg/L, (P&lt;0.001, HR 3.86; CI, 1.76-8.46) were independent predictors of in-hospital mortality. Conclusion: As important as the classic prognostic factors, elevated BNP levels on admission were related to fatal outcomes in IE patients.