Profile Of Infective Endocarditis Research Articles

Unexpected Infective Endocarditis: Towards a New Alert for Clinicians.

Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.

Trend in Infective Endocarditis in Bulgaria: Characteristics and Outcome, 17-Years, Single Center Experience.

Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. This study is retrospective, single-centered, and includes 270 patients diagnosed with IE for the period 2005-2021. We compared two periods, 2005-2015 (n = 119) and 2016-2021 (n = 151), to find the characteristics changes. The study included 177 (65.5%) male patients. In the second period, there is a significant increase in age from 62 (44-73) to 67 (53-75), (p = 0.023); in the Charlson comorbidities index (CCI) from 3 (1-4) to 4 (2-6), (p = 0.000); in cases with chronic kidney diseases (CKDs) from 15 (12.6%) to 55 (36.9%), (p = 0.001); coronary arterial diseases (CADs) from 20 (16.85%) to 44 (29.1%), (p = 0.018); and atrial fibrillation (AF) from 13 (10.9%) to 36 (23.8%), (p = 0.006). Ejection fraction decreased significantly in the second period from 63 (56-70) to 59 (51-66), (p = 0.000). Almost half of the patients 123 (45.6%) had no known predisposing cardiac condition, and 125 (46.3%) had an unknown port of entry. IE was community-acquired in 174 (64.4%), healthcare-associated in 72 (26.7%), and injection-drug-use-related IE in 24 (8.9%). The study population included 183 (67.8%) native valve IE, 85 (31.5%) prosthetic IE, and 2 (0.74%) intracardiac-device-related IE. The hemocultures were positive in 159 (59.6%), and the most frequent pathogenic agent was staphylococci-89 (33.3%) (Staphylococcus aureus-44 (16.5%) and coagulase negative staphylococci-45 (16.8%)). Only 54 (20%) of patients underwent early surgery. The all-cause 30-day mortality rate was 67 (24.8%). There is no significant difference between the two periods in terms of the characteristics listed above. The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions, and entry door. The most common pathogen was the Staphylococcus spp. The 30-day mortality rate remains high.

Comparative analysis of infective endocarditis in hemodialysis versus non-hemodialysis patients in Iran: implications for clinical practice and future research.

In hemodialysis (HD) patients, there is a larger frequency of mortality and morbidity associated with infective endocarditis (IE) as opposed to the general population. Despite the increased burden of IE in the HD population, optimal strategies for prevention and management still need to be clarified. Elucidating the distinguishing features and outcomes of IE in HD patients is crucial to guide clinical decision-making and improve prognosis in this high-risk group. However, the details of IE characteristics, specifically in HD patients in the Middle East, are limited. To compare the clinical characteristics and short-term outcomes of IE between HD and non-HD patients. A retrospective analysis was carried out on 139 patients with infective endocarditis who were referred to a tertiary cardiovascular center in Iran from 2006 to 2018. The participants were split into HD (n = 34) and non-HD (n = 105) groups. Data pertaining to demographic characteristics, comorbidities, microbiological findings, occurrence of complications, therapeutic interventions, and mortality rates during hospital stay were gathered. Diabetes, hypertension, and congestive heart failure were observed more frequently in HD patients. HD patients were more likely than non-HD patients to have involvement of the right valve (41.2% vs. 20.9%), larger vegetation, and extracardiac emboli. In-hospital mortality was 41.2% for HD patients versus 14.3% for non-HD patients. Mortality remained high after valve surgery in HD patients (38.2% vs. 10.5% in non-HD). HD patients exhibited a distinct clinical profile of IE with worse short-term outcomes, including higher mortality.

Cardiac complications as a major predictor of in-hospital death in infective endocarditis using machine-learning algorithm analysis

Abstract Introduction Despite advances in diagnostic and therapeutic strategies, infective endocarditis (IE) remains associated with devastating outcomes with substantial mortality rate. In patients who develop cardiac complications, an early aggressive therapeutic strategy regarding surgical intervention may be warrant. The epidemiologic profile of IE has been changed, which highlights the need for studies with risk stratification of patients hospitalized with IE. Purpose The study aim is to investigate variables strongly associated with in-hospital death and define groups of patients at different risk profile based on values of explanatory variables. Methods A prospective cohort including 349 consecutive patients with IE admitted to a quaternary hospital. The diagnosis was based on the modified Duke criteria and modified European Society of Cardiology criteria from 2015. Data regarding predisposing conditions, laboratory, imaging results, treatment, and outcomes were described. The primary endpoint was in-hospital mortality due to any complication related to IE. Cardiac complications were defined as development or worsening heart failure, prosthesis rupture or perivalvular extension of infection. In-hospital death was analyzed through conditional inference trees and the composed nodes were discriminated in groups with different risks of death and by logistic regression model. Results The median age was 55 years, 59% of patients had native valve, 23.5% prosthetic valve and 35.5% intracardiac device-related IE. Rheumatic heart disease corresponded to 25%, 18% presented diabetes and 13.5% had chronic kidney disease as predisposing conditions. The main causative microorganism was Staphylococcus aureus (19%) and average C-reactive protein (CRP) at diagnosis was 72mg/L. During treatment, 123 (35%) had cardiac complications, 73 (21%) neurological complications, and 45 (13%) suffered embolic events. A total of 105 (47%) patients underwent cardiac surgery. The overall in-hospital mortality was 35.5%. On multivariable analysis, the independent predictors of death were increasing age, high CRP, neurologic and cardiac complications (Figure 1), with C statistic of the model 0.76 (CI 95% 0.70-0.82). According to the decision-tree analysis (Figure 2), patients with cardiac complications, CRP >71mg/L and age >43 years-old had 83.8% mortality rate, whereas those without cardiac or neurologic complications and CRP ≤51 had 7.1% in-hospital death. Among all predictors, cardiac complications showed the strongest association with the primary endpoint. Conclusions Cardiac and neurologic complications, elevated age and high CRP were independently associated with death. The machine-learning algorithm demonstrated that cardiac complications were the most important risk factor for in-hospital death. Early identification of patients who are at high risk of death can offer opportunity for more aggressive monitoring and approach to improve IE outcome.Logistic regression modelDecision-tree analysis

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

The Clinical Course of Infective Endocarditis and Independent Predictors of In-Hospital Mortality

Introduction: Despite advances in prevention, medical, and surgical treatment, the global prevalence of infective endocarditis (IE) has been gradually rising over the last two decades. However, the profile of IE varies by continent, geographic region, and hospital type. In this study, we aimed to investigate the epidemiological and clinical features of IE and to determine the factors predicting in-hospital mortality. Patients and Methods: This retrospective study was carried out at a single tertiary health care hospital in Türkiye. A total of 104 consecutive patients (>18 years old) who were hospitalized with IE between January 2016 and August 2021 were included. Modified Duke criteria were used to diagnose IE. Demographic information (age and gender), underlying heart diseases, comorbidities, causative microorganisms, blood culture results, echocardiographic findings, cardiac and extracardiac complications, surgical requirements, and in-hospital mortality were all examined. Results: The study included 104 IE cases (mean age: 57.2 ± 15.9 years; 59.6% males). Fifty-six patients (53.9%) had native valve IE, 37 patients (35.6%) had prosthetic valve IE, and four patients (3.8%) had devicerelated IE. Blood cultures were negative in 62 cases (59.6%). Staphylococcus aureus was the most common responsible microorganism in 17 patients [methicillin-sensitive Staphylococcus aureus in 13 (12.5%), methicillin-resistant Staphylococcus in four (3.8%)]. The overall in-hospital mortality rate was 30.8%. White blood cell count (OR= 1.002, 95% CI= 1.001-1.003) creatinine (OR= 1.45, 95% CI= 1.08-2.00), acute renal failure (OR= 8.60, 95% CI= 2.27-37.81), and cerebrovascular accidents (OR= 4.58, 95% CI= 1.21-18.85) were independent predictors of in-hospital mortality. Conclusion: In line with developed countries, the epidemiology and causative pathogens of IE in Türkiye have been changing. Investigating these epidemiological and clinical changes may serve as a basis for strategies to be developed for the prevention and treatment of IE.

Influence of the healthcare pathway on the outcome of patients with infective endocarditis.

To determine the prognosis of patients treated for infective endocarditis (IE) according to their healthcare pathway. To assess how the ESC guidelines are implemented concerning the performance of transoesophageal echocardiography, the use of antibiotic therapy, and the performance of valve surgery; and to compare the epidemiological profile of IE according to the type of centres in which the patients are hospitalized. In a prospective multicentric study including 22 hospitals in the South-East of France, 342 patients were classified into three groups according to their healthcare pathway: 119 patients diagnosed and taken care entirely in a reference centre or hospital with cardiac surgery [Referral Center (RC) group], 111 patients diagnosed and initially taken care in a non-RC (NRC), then referred in a centre including cardiac surgery [transferred to the Referral Center (TRC) group] and 112 patients totally taken care in the NRC (NRC group). One-year mortality was 26% (88 deaths) and was not significantly different between Groups 1 and 2 (20 vs. 21%, P = 0.83). Patients in the NRC group had a higher mortality (37%) compared with patients in the RC and TRC groups (P < 0.001). ESC guidelines were not implemented similarly depending on the healthcare pathway (P = 0.04). Patients in the NRC group were significantly older (P < 0.001) and had more comorbidities (P < 0.001) than patients treated in referral centres. Prognosis of patients with IE is influenced by their healthcare pathway. Patients treated exclusively in NRC have a worse prognosis than patients treated in referral or surgical centres.

Comorbidity and Prognosis in Octogenarians with Infective Endocarditis.

Background. Infective endocarditis (IE) in older patients is associated with a high morbidity, mortality, and functional impairment. The purpose of this study was to describe the current profile of IE in octogenarians and to analyze the prognostic impact of baseline comorbidities in this population. Methods. Patients ≥ 80 years and definite IE from the Spanish IE Prospective Database were included. The effect of Charlson Comorbidity Index (CCI) on in-hospital and 12-month mortality was analyzed. Results. From 726 patients, 357 (49%) had CCI ≥ 3 and 369 (51%) CCI < 3. A total of 265 patients (36.6%) died during hospital admission and 338 (45.5%) during 1-year follow-up. CCI ≥ 3 was an independent predictor of in-hospital and 1-year mortality (odds ratio 1.46, 95% confidence interval 1.07–1.99, p = 0.017; hazard ratio 1.34, 95% confidence interval 1.08–1.66, p = 0.007, respectively). Surgical management was less common in patients with high comorbidity (CCI ≥ 3 68 [19.0%] vs. CCI < 3 112 ((30.4%) patients, p < 0.01). From 443 patients with surgical indication, surgery was only performed in 176 (39.7%). Patients with surgical indication treated conservatively had higher mortality than those treated with surgery (in-hospital mortality: 147 (55.1%) vs. 55 (31.3%), p < 0.001), (1-year mortality: 172 (64.4%) vs. 68 [38.6%], p < 0.001). Conclusion. About half of octogenarians with IE had high comorbidity with CCI ≥ 3. CCI ≥ 3 was a strong independent predictor of in-hospital and 1-year mortality. Our data suggest that the underperformance of cardiac surgery in this group of patients might have a role in their poor prognosis.

Changing profile of infective endocarditis during 31-year time course in a tertiary care hospital

Aim: Infective endocarditis (IE), infection of the endocardial surface of heart, may cause mortality up to 30% despite advancements in medical care. Epidemiology of IE and profile of causative organism has changed in the last years. We aimed to investigate the changing profile of IE over a 31-year period in a tertiary care hospital &#x0D; Material and Method: Medical records of 290 patients treated with the diagnosis of IE between 1974 and 2005 were re-evaluated according to Modified Duke criteria. Forty seven cases were classified as rejected cases. &#x0D; Results: Of the 243 patients 109 was female (44.8%) and 134 male (55.2%). The mean age of the patients was 38±16.4 years (Table). The mean age of the patients showed an increasing trend throughout the time (p&lt; 0.001) ; it was 29 years between 1974- 1980 but increased to 54 years in 2001-2005 period. Rheumatic valvular disease (RVD) was the most frequent underlying heart disease (60%) but showed a declining trend especially in the last years. S. aureus was the most common pathogen in all the time periods (15.2%). Blood cultures were negative in 90 (43%) patients. But the percentage of blood culture negativitiy decreased significantly from 63% in 1981-1985 periods to 28% in 2001-2005 period. (p: 002). Mitral valve was the most common affected valve (52, 44%). Surgery was performed in 74 of the 243 cases (30.5%). In-hospital mortality rate was 30.6. Mortality rate was significantly lower in patients who underwent surgery compared to ones who did not (19.2% vs. 35.8%, p&lt; 0.005). Mortality rate was also lower in patients with community acquired infection compared to ones with nosocomial infection (27% vs 45%). Embolic events, nosocomial infections and surgery were independent risk factors for mortality. &#x0D; Conclusion: The mean age of IE population is increasing, RVD disesase is less commonly seen as an underlying heart and S. aureus is the most common pathogen. These findings are compatible with the reports from developed countries. Surgery displays a protective effect on the prognosis of IE

Influence of the health-care pathway on the outcome of patients with infective endocarditis: Should all patients be treated in referral centers?

Mortality in infective endocarditis (IE) remains high. Few studies have compared the prognosis and management of patients with IE according to their health-care pathway (HCP) To determine the prognosis of patients treated for IE according to their HCP. To assess how the ESC guidelines are implemented concerning the performance of transesophageal echocardiography, the use of antibiotic therapy, and the performance of valve surgery; and to compare the epidemiological profile of IE according to the type of centers in which patients are hospitalized. In a prospective multicentric study including 22 hospitals in the South-East of France, patients with a diagnosis of IE were classified in 3 groups according to their HCP: patients diagnosed and entirely managed in a reference center or hospital with cardiac surgery (group 1), patients initially taken care in a non-referral center, then referred in a center including cardiac surgery (group 2) and patients totally managed in non-referral centers (group 3). Primary endpoint was death from all cause at one-year follow-up. Between 2014 and 2017, 342 patients were consecutively included: 119 in group 1, 111 in group 2 and 112 in group 3. One-year mortality was 26% (88 deaths) and was not significantly different between groups 1 and 2 (20% vs. 21%, P = 0.83). Patients in group 3 had a higher mortality (37%) compared to patients in groups 1 and 2 ( P < 0.001). Belonging to group 3 was a predicitive factor of one-year mortality in multivariate analysis (HR 2.56; IC95% 1.44–4.55, P = 0.001). ESC guidelines were not implemented similarly depending on the HCP ( P = 0.04). Patients in group 3 were significantly older ( P < 0.001) and had more comorbidities ( P < 0.001) than patients treated in referral centers ( Fig. 1 ). Prognosis of patients with IE is influenced by their HCP. Patients treated in non-referral centers have a worse prognosis than patients treated in referral or surgical centers.

Clinical and Microbiological Characteristics of Infective Endocarditis at a Cardiac Center in Saudi Arabia

BackgroundInfective endocarditis (IE) is a serious disease with complex pathology and significant mortality. Little information is known regarding clinical and microbiological characteristics in Saudi Arabia. This study surveyed these characteristics at a Cardiac Center in Riyadh, Saudi Arabia over a period of 5 years.MethodsThis retrospective study was done on all infective endocarditis (IE) patients admitted to Prince Sultan Cardiac Center between January 1, 2015, and December 31, 2019. Clinical characteristics, microbiological results, management, and outcomes were assessed.ResultA total of 340 cases of infective endocarditis were identified over the study period.Most patients (64%) were 50 years old or above, and 67% were males. Fever was the most common clinical presentation, and a murmur was audible in a fifth of patients. Blood cultures were positive in 177 (52%) cases. The most common organisms were Staphylococcus aureus, coagulase negative Staphylococcus and viridans group Streptococcus. Most common microbiological organisms causing native valve endocarditis were viridans group Streptococcus (32%) followed by methicillin-susceptible Staphylococcus aureus (21%), and for prosthetic valve endocarditis they were coagulase negative Staphylococcus (32%) followed by methicillin-susceptible Staphylococcus aureus (23%), the most common causes of culture negative endocarditis were Q-fever and brucellosis. Predisposing cardiac conditions were present in 127 (37%) patients, most commonly rheumatic heart disease and congenital heart disease. Surgical intervention was done in 26% of cases, with an overall in-hospital mortality rate of 6.76%.ConclusionWe demonstrate the epidemiological, clinical, and microbiological profile of infective endocarditis in a tertiary care cardiac center in Saudi Arabia. It gives information concerning the prevalence of responsible organisms. This information will be helpful in assessing patients with suspected IE and in planning management of cases knowing the relative frequency of types of microorganisms encountered.

Microbiological and Clinicoepidemiological Profile of a Series of Patients with Infective Endocarditis at a Center in Eastern Nepal

Background The microbiological and clinicoepidemiological profile of infective endocarditis (IE) has undergone significant change over time. The pattern of IE studied at local level provides broader vision in understanding the current scenario of this disease. This study aimed to depict the overall picture of IE and its changing profile by evaluating the microbiological and clinicoepidemiological features in the context of a tertiary care center of eastern Nepal. Methods The descriptive study was conducted from September 2017 to August 2018 among IE patients presenting to B. P. Koirala Institute of Health Sciences, Nepal. Detailed history and clinical manifestations of patients were noted. Microorganisms isolated from the blood culture were processed for identification by standard microbiological methods, and susceptibility testings were done. Each patient was assessed daily during hospital stay. Results Ten definite and 7 possible endocarditis cases were studied. The mean age was 41.4 ± 15.85 (17–70) years with predominance of male (4.7 : 1). Rheumatic heart disease (41.1%) was the most common underlying heart disease observed followed by injection drug user endocarditis (23.5%). All the cases had native valve endocarditis. Aortic valve was the most common valve involved (35.3%) followed by mitral, tricuspid, and pulmonary valves. Blood culture positivity was 53%. Staphylococcus aureus was the major causative agent responsible for 23.5% of the cases followed by Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. Mortality of 2 cases (11.8%) was associated with S. aureus and P. aeruginosa. Majority of patients developed acute kidney injury (35.3%) and congestive cardiac failure (23.5%). Conclusion IE patients in our center exhibited differences from the west in terms of age at presentation and predisposing factors but held similarity in terms of commonly isolated microorganisms. The changing patterns of IE, etiological agents, and their antimicrobial susceptibility observed in this study may be helpful for clinicians in formulating a new empirical antibiotic treatment protocol.

A narrative review of diagnosis of infective endocarditis—imaging methods and comparison

The profile of infective endocarditis (IE) has changed over the past few decades. The modified Duke’s criteria is currently employed for diagnosis of IE. Emphasis on imaging modalities however, have been increasing due to the variety of presenting symptoms leading to diagnostic conundrums. This wide range of diagnostic tools must be adapted to permit localization of the infectious field which may involve multiple valves on either side of the heart. The availability of such diagnostic tools is also variable in different centres. The use of echocardiography has long been the default position, however the lack of specificity and sensitivity especially in prosthetic valve endocarditis has been highlighted throughout the literature. We therefore aimed to look at the different imaging modalities available and the strengths and weaknesses of each of these modalities to enhance the diagnostic yield and allow timely intervention for this condition. We highlight the role of the different forms of echocardiography, multi-detector computed tomography (MDCT), Nuclear Medicine, Magnetic Resonance Imaging and identify the special indications such as right sided infective endocarditis (RSIE) and cardiac implantable electronic device (CIED) endocarditis. Input from a specialist heart team is essential to ensure timely diagnosis and care are afforded. The role of alternative imaging techniques such as nuclear medicine in determining timing of cardiac surgery should be evaluated further by randomised trials.

Age-related characteristics of infective endocarditis: prospective data from the Euro-Endo registry

Abstract Introduction The profile of infective endocarditis (IE) is continuously evolving over time, and this may probably be partly due to increasing age of the patients. Methods All data were collected from the EURO-ENDO registry, which is a one-year prospective international multicentre observational survey on patients with definite or possible IE included between 2016 and 2018. Subjects were stratified into 3 groups according to their age at index hospitalization. Results Among the 3113 patients included, 1670 patients (54%, Young group) were &amp;lt;65, 1068 (34%, Medium group) between 65 and 80 and 375 (12%, Old group) ≥80 years old. The most striking age-related differences were (old group vs others) (table 1) 1) the higher comorbidity burden and Charlson index; 2) the lower rate of embolic events on admission and under therapy; 3) the higher rate of Enterocci and digestive streptococci; 4) the lower rate of surgery during acute IE despite a theoretical indication; 5) the higher in-hospital and 1-year mortality. With regards to surgery, young and medium age were predictive of more frequent performance of surgery as compared to old age (Young: OR 4.33, 95% CI [3.09–6.06], Medium: 3.62, [2.57–5.10], p&amp;lt;0.001). In multivariable analysis, age per se was not predictive of in-hospital and 1yr FU mortality, but lack of surgical procedures when indicated (27% of the old group), was strongly predictive. Conclusion This is the largest contemporary registry showing the strong influence of age on the demographic, clinical, therapeutic, and prognostic profile of IE. Non-performance of surgical procedures when indicated is frequent in old patients and is a strong predictor of mortality while age per se is not. Endocarditis Teams should take these results into account when considering surgery in elderly patients. Funding Acknowledgement Type of funding source: Other. Main funding source(s): EORP grant

A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018

BackgroundInfective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years.MethodsMedical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018.ResultsA Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality.ConclusionsOur study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.

Infective endocarditis in children: profile in a 6 years experience from Dr.Mohammad Hoesin Hospital, Palembang, Indonesia

Infective endocarditis (IE) is an inflammation or infection in the endocardium. Cardiac abnormalities represent a predisposing for the development of IE. The aim of this study is to describe the profile of IE from Mohammad Hoesin Hospital. A retrospective study was conducted from January 2011 to December 2017. Forty six children were diagnosed with IE, 67,4% of patients with aged > 5 years old. The nutritional status was 69.6% wasting and 30.4% normal. Congenital Heart Disease (CHD) was the predominant underlying heart condition (60,9%), followed by Rheumatic Heart Disease (RHD) 37% and without cardiac abnormalities (2,1%). The infective agents were identified in 50% cases, and the most frequent causative agents were Staphylococcus aureus (21.7%), followed by Staphylococcus epidermidis (10.9%), Streptococcus viridans (6.5%), Enterococcus faecalis (4.3%), Streptococcus bovis (1%), Staphylococcus haemoliticus (1%). The following complications were common: heart failure (65.2 %), pneumonia (17.4%), anemia (4.3%), pericardial effusion (4.3%) respectively.The most empirical antibiotics were ampicillin and gentamicin (82.6%) and only 1 patient underwent surgery for IE. The overall death was4.3%. The conclusion of this study is IE mostly occurs in CHD and the most organism is Staphylococcus aureus.

127The increasing incidence and changing profile of infective endocarditis in Spain: a population-based study (2003-2014)

127The increasing incidence and changing profile of infective endocarditis in Spain: a population-based study (2003-2014)

CHANGING SPECTRUM OF INFECTIVE ENDOCARDITIS: REVIEW OF 707 PATIENTS OVER 26 YEARS

Background: In the last decades the clinical and epidemiological profile of infective endocarditis (IE) has considerably changed. The aim of this study is to assess the temporal variations of IE and to identify factors related to in-hospital mortality in a large cohort of patients observed over a 26

345 - Is that the profile of infective endocarditis has changed in Tunisia?

345 - Is that the profile of infective endocarditis has changed in Tunisia?

Guidelines for the prevention, diagnosis, and treatment of infective endocarditis in adults: The Task Force for the Prevention, Diagnosis, and Treatment of Infective Endocarditis in Adults of Chinese Society of Cardiology of Chinese Medical Association, and of the Editorial Board of Chinese Journal of Cardiology

The pathogenesis of infective endocarditis (IE) is a complex process which can include tissue damage to the valves during bacteraemia, pathogen adherence leading to the formation of non-bacterial thrombotic vegetations, platelet aggregation at sites of tissue damage, and a variety of biological interactions between pathogens and host matrix molecules (e.g. platelets).1,2 In the past few decades, the incidence of IE has increased significantly, which may be the result of an aging population, delayed diagnosis of valvular heart disease, and even new methods of valve implantation, including transcatheter therapies. The incidence of IE of the right heart has also increased due to the prevalence of intravenous drug use. Overall, the epidemiological profile of IE in China remains inadequately characterized, and the precise epidemiology differs between geographic location and study populations. For example, in Europe, the incidence of IE is reported to be 3–10 episodes/100 000 person-years and increases with age—the peak incidence being 14.5 episodes/100 000 person-years in patients between 70 and 80 years of age, with a male : female ratio of ≥2 : 1. Over the course of the 20th century, due to effective antibiotic treatment, the major cause of IE has changed from rheumatic valve disease, which mainly affects young adults, to a variety of other aetiologies. In many locations, the most common pathogen of IE has changed from Streptococcus to Staphylococcus . In the USA, staphylococcal infection has become the most prevalent, and, in China, case reports show that Streptococcus and Staphylococcus are the most common pathogens.3–6 Despite advances in its management, IE is still considered a severe disease with a high mortality rate and poor prognosis. This consensus is …