Risk Of Infective Endocarditis Research Articles

Infective endocarditis in an adult with undiagnosed tetralogy of Fallot: a case report of a rare presentation.

Unrepaired tetralogy of Fallot (TOF) is uncommonly diagnosed in adulthood and only 3% of patients survive to reach the age of 40 without surgical repair. If unrepaired, these patients are at risk for infective endocarditis (IE). In this report, we present a case of a middle-aged, previously healthy female whose only complaint was unexplained fever. Echocardiography led to the discovery of undiagnosed TOF complicated with IE with a vegetation on the right ventricular (RV) side of the ventricular septal defect (VSD) which was appropriately managed with antibiotics. In rare cases of acyanotic TOF where there is a lesser degree of right ventricular outflow tract obstruction (RVOTO), patients may survive into adulthood and can be asymptomatic till becoming initially presented with complications such as infective endocarditis.

Abstract 4138345: Incidence and Predictors of Infective Endocarditis in Bacteremic Patients

Background: Infective endocarditis (IE) is a serious disease, with a high mortality rate.There has been a shift in the composition of organisms causing infective endocarditis. We aimed to provide a contemporary incidence of IE among bacteremic patients stratified by bacterial pathogens. We also sought to evaluate the predictors of IE in bacteremic patients. Methods: We included patients at a large quaternary centre in Canada. All bacteremias during the period from 2014 to 2016 were identified and data was collected on the following variables – patient demographics, organism, comorbidities, pre-disposing factors, clinical findings, pertinent biochemistry, performance of echocardiography, and diagnosis of IE. Diagnosis of IE was made using the modified Duke’s criteria. Logistic regression was used to identify predictors of IE. Results: There were 1,708 patients with bacteremia included in this analysis. The mean age was 64.5±17.0 years old; 39.7% were females and 77.4% were community acquired bacteremia. In addition, 47.0% had hypertension, 29.9% had diabetes mellitus, 17.5% had chronic kidney disease and 25.2% were immunosuppressed. There were 102 (6.0%) patients with confirmed infective endocarditis (IE). The proportion of bacteremic patients who developed IE was 13.2% in 281 patients with methicillin-sensitive Staphylococcus aureus, 5.4% in 56 patients with methicillin-resistant S. aureus, 2.4% in 292 patients with S. epidermidis, 9.9% in 121 patients with Streptococcus viridans group, 16.5% in 91 patients with Enterococcus, 1.3% in 303 patients with Escherichia coli, 38.5% in 13 in patients with Streptococcus bovis, and 9.5% in 21 patients with Propionibacterium acnes. Predictors of IE were intravenous drug use (odds ratio [OR]=8.64, 95% confidence interval [CI] 3.50- 21.3; p<0.0001), prosthetic heart valve (OR= 2.10, 95% CI 1.01- 4.39; p=0.049), structural heart disease (OR= 12.2, 95% CI 3.35- 44.67; p= 0.0002) and community acquired bacteremia (OR= 2.06, 95% CI 1.11- 3.82; p=0.02). CONCLUSIONS: Methicillin-sensitive Staphylococcus aureus is the commonest cause overall of IE followed by viridans group streptococcus. Streptococcus bovis and Enterococcus bacteremia have the highest incidence of IE. Knowledge of the incidence rates of IE among various pathogens may guide diagnostic testing such as pursuing more advanced imaging procedures for patients with increased risk of IE.

Risk of Infective Endocarditis in Patients with Spinal Surgical Site Infection and Staphylococcus aureus Bacteremia.

Context: Surgical site infection (SSI) is responsible for significant morbidity, prolonged hospital stays, and increased costs. Infectious endocarditis (IE) is a rare but serious complication of bacteremia, particularly that resulting from Staphylococcus aureus SSI. The VIRSTA score predicts the risk of IE and determines the priority of transthoracic echocardiography (TTE) in patients with S. aureus bacteremia. The aim of the study was to (1) assess the performance of the VIRSTA score and (2) determine the usefulness of TTE in S. aureus bacteremia related to spinal SSI. Materials and Methods: We carried out a retrospective study of consecutive patients with spinal SSI and S. aureus bacteremia at two university hospitals in France (Bordeaux and Tours) from January 2009 to January 2023. We collected the patients' clinical and surgical characteristics at baseline, VIRSTA score items, TTE results, and medicosurgical management. The associations of these parameters with IE were assessed using the chi-square test and logistic regression models. Results: Of 82 patients with spinal SSI and S. aureus bacteremia, only 1 (1.21%) developed IE. Thirteen patients did not benefit from TTE during hospitalization and were considered free of IE after clinical follow-up. Diabetes mellitus (p < 0.04) and the presence of severe sepsis or septic shock (p < 0.03) were significantly associated with the presence of IE in this population. Conclusions: Incidence of IE in patients with spinal SSI and S. aureus bacteremia is low. The VIRSTA score has high sensitivity but is not accurate for identifying patients at high risk for IE and systematic performance of TTE is complex and not useful in this setting. Level of Evidence: IV.

Risk of infective endocarditis in patients with mitral valve prolapse: Systematic review with meta-analysis

AimsInfective endocarditis (IE) is a serious heart valvular condition. While mitral valve prolapse (MVP) has been associated with an increased risk of IE, the magnitude of this association remains poorly quantified. This systematic review aimed to better estimate the risk of developing IE among MVP patients compared with the general population. MethodsMEDLINE, Cochrane Library (CENTRAL) and Web of Science databases were searched electronically to find all the relevant cohort and case-control studies. Pooled estimates of odds ratios (ORs) and 95 % confidence intervals (CIs) were derived by random effects meta-analysis. Heterogeneity was assessed using the I2 test. ResultsA total of six studies were considered eligible, and the obtained results showed that MVP patients had a higher risk of IE when compared to the general population (OR 7.83, 95 % CI 5.11, 12.02; I2 = 0 %). Posterior analysis according to the risk of bias and study design didn't show any significant variations in the direction and magnitude of the effect. ConclusionThe magnitude of increased risk of IE of 7-fold warrants further attention for patients with MVP. Further contemporary studies and prophylaxis studies should be considered.

Atopic dermatitis increases the risk of infective endocarditis in prosthetic heart valve patients – A retrospective study

Atopic dermatitis increases the risk of infective endocarditis in prosthetic heart valve patients – A retrospective study

Impact of mandatory preoperative dental screening on infective endocarditis in patients undergoing surgical valve replacement

Abstract Background Guidelines recommend preoperative dental screening (PDS) prior to surgical valve replacement (SVR) to reduce risk of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations. Purpose Investigate the effect of mandatory PDS on risk of IE in patients undergoing SVR. Methods A total of 1,207 patients undergoing SVR in Western-Denmark from 2020 to 2022 were included in this observational study. Patients were considered based on two applied PDS practices: mandatory PDS (MPDS), and no routine referral PDS (NPDS). Outcome data were retrieved from Danish registries and adjudicated using medical records. The primary endpoint was incidence of IE. Secondary endpoints were all-cause mortality, and the composite endpoint of IE and all-cause mortality. Key endpoints were also analyzed in a propensity score-matched (PSM) population. Results Of 805 patients in the MPDS, 93% (n=751) underwent subsequent PDS, compared to 5% (n=21) among 402 patients in the NPDS. Patients in the MPDS were older with higher rates of coexisting co-morbidities. During a median follow-up of 2.6 years (interquartile range 1.9-3.2 years), 3.3% (n=40) developed IE. The yearly incidence IE rate was higher in MPDS compared with NPDS (1.5% vs. 0.7%; p=0.08). All-cause mortality rate was higher in the MPDS (2-year mortality of 6.2% vs 2.3%, p=0.02) as well as the composite endpoint (p&amp;lt;0.01). Differences in IE rates, all-cause mortality, but not composite endpoint were abolished in 370 propensity score-matched patients. Conclusion Risk of IE was low regardless of PDS practice. MPDS prior to surgery did not alter the risk of IE or all-cause mortality in patients undergoing left-sided SVR in Denmark.Kaplan-Meier plot

Increased risk of infective endocarditis following transurethral resection of the prostate (TUR-P)

Abstract Background Transient bacteremia is a well-known complication of transurethral resection of the prostate (TUR-P). Still, the associated risk of bacteremia and subsequent infective endocarditis (endocarditis) after TUR-P has been sparsely examined. Purpose To examine the risk of bacteremia and infective endocarditis following TUR-P. Methods We identified all patients who underwent TUR-P between 2010-2020 with ICD-10 codes from Danish nationwide registries. Patients were compared to an age-matched cohort of males from the general population (1:1 match-ratio). We defined a 6-month exposure window following TUR-P and examined the risk of bacteremia and endocarditis within the first 6 months and compared with the following 6-12 months after TUR-P. Microbiology findings were based on complete data on blood culture results. Incidences of bacteremia and endocarditis were calculated, and groups were compared with cumulative incidences. To account for predisposing endocarditis risk factors, multivariable time-dependent Cox regression analyses were performed on the associated risk of bacteremia and endocarditis. Results In total, 25.781 patients underwent TUR-P. Median age was 70.7 years (IQR: 64.9-76.3). Incidence of bacteremia was higher in the TUR-P group than the control group (727.47 [681.49-776.56] per 10,000 person years vs 84.75 [95% CI: 70.19-102.35)] per 10,000 person years). Incidence of endocarditis was also higher in the TUR-P group than the control group (34.64 [95% CI: 25.78-46.55] per 10,000 person years vs 3.14 [95% CI: 1.18-8.35] per 10,000 person years). In 72.7% of endocarditis-cases, Enterococcus Faecalis was the disease-causing pathogen in the TUR-P group. As compared with an age-matched control group, we found an increased associated risk of bacteremia in patients undergoing TUR-P within the first 6 months from the procedure (adj. HR: 7.72 [95% CI: 6.25-9.53]) and the increased risk persisted within the following 6-12 months (adj. HR 2.31 [95% CI: 1.83-2.91]). TUR-P was also associated with endocarditis within 6 months from the procedure (8.16 [95% CI 3.06-21.79]), but not significantly the following 6-12 months after (2.15 [95% CI: 0.91-5.07]) as compared with the age-matched control group. Conclusion Transurethral resection of the prostate (TUR-P) is associated with an almost 8 times increased risk of bacteremia and an 8 times increased risk of infective endocarditis. Our findings emphasize the necessity for development of better preventive strategies against infective endocarditis after TUR-P.Risk of endocarditis post-TUR-P

Infective endocarditis - characteristics and long-term outcomes in patients with congenital heart disease are distinct from those without congenital heart disease

Abstract Background Patients with congenital heart disease (CHD) form a high-risk niche among patients considered at high-risk of infective endocarditis (IE). Their life-long exposure to the risk of IE, starting from birth, necessitates a nuanced approach to both prevention and treatment strategies. However, comprehensive data from an unselected nationwide cohort, including children, are lacking. Purpose This study sets out to compare characteristics and associated outcomes among patients with IE with and without CHD. Methods Using nationwide registries, all Danish patients diagnosed with IE from 1977-2021 were identified and stratified on whether they had a diagnosis of CHD, regardless of its complexity. Characteristics prior to and during admission as well as associated outcomes (i.e., in-hospital mortality, 1-year mortality, and 10-year mortality, and IE recurrence) were compared between groups. Results In total, 14,040 patients were diagnosed with IE from 1977-2021 including 895 (6.4%) with a diagnosis of CHD. Patients with versus without CHD were significantly younger at time of IE diagnosis (median age 38.8 years [IQR 21.2-56.4 years] versus 70.7 years [IQR 58.8-78.9 years], Figure 1) and less comorbid. Patients with versus without CHD were hospitalized due to IE for a similar period of time but more often underwent cardiac surgery during admission (44.9% versus 21.3%). The IE-related bacteremia was significantly different between groups: the most common bacteriemia in relation to IE was Streptococci (29.9%) in patients with CHD and Staphylococcus Aureus (29.9%) in patients without CHD. Patients with CHD were associated with a significantly lower risk of in-hospital mortality (6.4% versus 19.8%), 1-year mortality (10.5% versus 32.4%) and 10-year mortality (21.3% versus 58.7%) compared with those without CHD. The 10-year incidence of IE recurrence was similar among groups (p-value 0.5). Conclusions Patients with CHD who develop IE are distinctive from patients with IE without CHD in terms of characteristics as well as long-term outcomes. Notably, our findings stress a key point: the majority of children and adolescents with IE have a CHD. These unselected findings should help guide future preventive strategies, diagnosis, and management.

Infective endocarditis: Awareness, knowledge gaps and behaviours amongst adults with congenital heart disease

BackgroundAdults with congenital heart disease (ACHD) have an increased risk of infective endocarditis (IE), associated with significant morbidity and mortality. This risk is compounded by patient-related factors, including lack of awareness of IE and the presence of a learning disability (LD). Our study sought to evaluate patients' understanding of the risks and symptoms of IE and to identify patients who could benefit from targeted education. MethodsPatients attending the outpatient department of a tertiary ACHD referral centre completed a questionnaire that assessed their knowledge, attitudes and behaviours towards IE. Baseline demographics and clinical data were collected from electronic patient records. ResultsA total of 132 ACHD patients completed the questionnaires (age 41.7 ± 16.4 years, 50 % male, 11 % with an LD). Only 37.1 % of patients accurately defined IE, none of whom had an LD. Most patients chose pyrexia (47 %) and tiredness (39.4 %) as potential symptoms of IE, however, none correctly identified all symptoms. Only 19.7 % were aware of the requirement for prolonged antibiotic treatment for IE. A third of all patients reported that they would have made lifestyle changes had they been aware of the complications of IE. There was a statistically significant association between learning disability and poor level of awareness in the questionnaire. ConclusionsOur study demonstrates awareness issues regarding IE among ACHD patients, highlighting the need to invest further on patient education. This should start at the time of transition from paediatric to adult services and continue lifelong, with emphasis on patients with a learning disability.

Comparison of Postoperative Outcomes between Leadless and Conventional Transvenous Pacemakers Implantation: An Up-to-Date Meta-analysis.

Leadless cardiac pacemakers (LCPs) are emerging as viable alternatives to conventional transvenous pacemakers (TVPs). This study aimed to systematically compare the postoperative outcomes of LCPs and TVPs based on available published studies. We conducted a systematic review and meta-analysis of literature comparing outcomes from LCP and TVP implantations. Data analysis was performed using Stata/MP 17.0. The evaluated endpoints included pericardial effusion or perforation, puncture site events, infective endocarditis, lead or device dislodgement, pocket-related complications, tricuspid regurgitation or dysfunction, any infection, increased right ventricle (RV) pacing threshold, embolism, and thrombosis. Aggregated odds ratios (OR) and 95% confidence intervals (CI) were determined. Sensitivity analyses were conducted for heterogeneity if I2 was >50% or p < 0.01, otherwise, the random-effects model was chosen. Publication bias was analyzed if the number studies exceeded ten. The meta-analysis included 24 observational studies with 78,938 patients, comprising 24,191 with LCP implantation and 54,747 with TVP implantation. The results indicated a significantly lower incidence of lead or device dislodgment (OR = 3.32, 95% CI: 1.91-5.77, p < 0.01), infective endocarditis (OR = 3.62, 95% CI: 3.10-4.24, p < 0.01), and infection (OR = 3.93, 95% CI: 1.67-9.24, p < 0.01) in the LCP group compared to the TVP group. In contrast, incidences of puncture site complications (OR = 0.24, 95% CI: 0.19-0.32, p < 0.01) and pericardial effusion or perforation (OR = 0.33, 95% CI: 0.28-0.39, p < 0.01) were significantly higher in the LCP group. Compared with TVP, LCP implantation is associated with a lower risk of infective endocarditis, lead or device dislodgment, infections, and pocket-related complications. However, LCP implantation carries a higher risk of puncture site complications and pericardial effusion or perforation. These findings underscore the need for careful consideration of patient-specific factors when choosing between LCP and TVP implantation. https://www.crd.york.ac.uk/prospero/ (CRD42023453145).

Effect of physical activity on risk reduction of infective endocarditis among patients with diabetes: a nationwide cohort study.

Patients with diabetes mellitus (DM) are at a higher risk of infectious diseases, and exercise is an important treatment modality for DM. Despite their susceptibility to infection in diabetic patients, the association between the amount of physical activity and the incidence of infective endocarditis (IE) is unclear. We attempted to demonstrate risk reduction by physical activity in diabetic patients with IE. From the National Health Insurance database, patients with DM were verified, and the incidence of IE was investigated. The level of physical activity was categorized into < 500, 500-999, 1,000-1,499, and ≥ 1,500 metabolic equivalent task (METs) minutes/week. Cox proportional hazard models were used to analyze the relationship between incident IE and physical activity. A total of 2,603,012 patients were included in this study. The incidence rate of IE was 10.06, 9.45, 7.78, and 8.84 in < 500, 500-999, 1,000-1,499, and ≥ 1,500 METs-minutes/week groups, respectively (100,000 person/year). A significant risk reduction of incident IE was observed in the 1,000-1499 and ≥ 1,500 METs-min/week groups compared to the < 500 METs-min/week group (Hazard ratio = 0.82, 95% confidence interval [0.690-0.976], HR = 0.831, 95% CI [0.704-0.981]). An analysis of a large national cohort database demonstrated that physical exercise reduced the risk of IE in patients with DM.

54759 Atopic Dermatitis increases risk of infective endocarditis in prosthetic heart valve patients - A retrospective study

54759 Atopic Dermatitis increases risk of infective endocarditis in prosthetic heart valve patients - A retrospective study

Infective Endocarditis in Patients with End-Stage Renal Disease on Dialysis: Epidemiology, Risk Factors, Diagnostic Challenges, and Management Approaches.

Infective endocarditis (IE) poses a significant clinical challenge, especially among patients with end-stage renal disease (ESRD) undergoing dialysis, and is associated with high morbidity and mortality rates. This review provides a contemporary discussion of the epidemiology, risk factors, diagnostic challenges, and management strategies for IE among ESRD patients, including a literature review of recent studies focused on this vulnerable population. The review highlights the multifactorial nature of IE risk in ESRD patients, emphasizing the roles of vascular access type, dialysis modality, and comorbid conditions. It also explores the diagnostic utility of different imaging modalities and the importance of a multidisciplinary approach in managing IE, including both medical and surgical interventions. The insights from this review aim to contribute to the improvement of patient outcomes through early recognition, appropriate antimicrobial therapy, and timely surgical intervention when necessary.

Infective Endocarditis in Patients With Bicuspid Aortic Valves: Unique Clinical and Microbiologic Features

Patients with bicuspid aortic valves (BAV) are at increased risk of infective endocarditis (IE). Information of the clinical presentation and the microbiology of BAV-associated IE, however, is limited. Therefore, our study aimed to characterise the clinical features native valve endocarditis (NVE) in the setting of BAV and compared them to patients with prosthetic valve endocarditis (PVE) following BAV replacement. Adult patients with BAV or history of BAV with aortic valve replacement (AVR) and a definite or possible IE diagnosis within the Mayo Clinic Enterprise (USA) from January 2008 to December 2021, were included. BAV was confirmed by trans-oesophageal echocardiography. IE was defined according to the modified Duke criteria and only an initial episode was included. Statistical analyses were performed to compare clinical characteristics, microbiology, and IE complications. Overall, 161 patients with BAV and IE (NVE [n=60], 37.3%) and PVE [n=101, 62.7%) were included. Mean age±SD was 56.5±16.1 years, and 139 (86.3%) patients were males. PVE patients were older (p<0.01) and had a higher rate of hypertension (p<0.01), chronic heart failure (p<0.01), chronic kidney disease (p<0.01), and perivalvular abscess (p<0.01). BAV patients with NVE had a higher prevalence of isolated mitral valve IE (p<0.01), moderate to severe aortic valve regurgitation (p<0.01) and combined aortic with mitral valve IE (p<0.01). Streptococcus mitis was the most common pathogen in NVE (30.0%) while Staphylococcus aureus was the most common in PVE (15.8%). Patients with BAV are at risk of both NVE and PVE. Each syndrome has unique clinical features, including microbiologic findings, that should be appreciated in IE diagnosis and management.

Evaluation of Oral Health Status and Treatment Needs of Children with Congenital and Acquired Heart Disease.

Objective: To evaluate the oral health status and treatment needs of children with congenital and acquired heart disease. Methods: This descriptive study included 301 children aged 5-14 from June 2022 to June 2023. Heart conditions were classified by congenital/acquired status and severity. The children's sociodemographic characteristics, medical and dental history, tooth brushing habits, and non-nutritional habits (bruxism, nail-biting, thumb-sucking, etc.) were evaluated. Oral health assessments including caries, oral hygiene, enamel defects, and dental treatment needs-related indices were recorded. Results: The mean age was 8.95 ± 2.91 years, and 271 (90%) of the children had congenital heart disease. The children with moderate and severe heart disease had significantly higher decayed/missing/filled surfaces (dmfs) (p = 0.038) and pulp exposure (p = 0.015) compared to the children with mild heart disease. According to the International Caries Detection and Assessment System II (ICDAS II) index, which included initial caries lesions, there were no caries-free children and 75.7% had extensive caries. The mean plaque index and gingival index were found to be 1.18 ± 0.38 and 0.69 ± 0.53, respectively. Enamel defects were observed in 15.9%. The Treatment Needs Index (TNI) was 85.8% for the primary teeth and 88.9% for the permanent teeth. The Care Index (CI) was 12.4% for the primary teeth and 10.8% for the permanent teeth. Conclusions: Children with congenital and acquired heart disease exhibit a high prevalence of untreated dental caries, gingivitis, and plaque accumulation, with a high need for dental treatments. Dentists should prioritize addressing these issues to prevent the risk of infective endocarditis (IE) and improve oral health outcomes in this population.

The role of time to positive blood cultures in enhancing the predictive capability of DENOVA score for diagnosing infective endocarditis in patients with Enterococcus faecalis bacteremia.

DENOVA-score is useful to stratify the risk of infective endocarditis (IE) in Enterococcus faecalis bacteremia. Recently, time to positive (TTP) of blood cultures has also been related with a higher risk of IE. The objective was to evaluate DENOVA- score with TTP to improve its specificity. We performed a retrospective, case-control study in adult patients with E. faecalis bacteremia. Thirty-nine patients with definite E. faecalis IE and 82 with E. faecalis bacteremia were included. The addition of a TTP ≤ 8 h to DENOVA-score did not improve the diagnostic accuracy of this score.

Impact of psoriasis on the risk of device-related infective endocarditis in patients with permanent pacemakers: a propensity-matched analysis.

Device-related infective endocarditis (IE) is associated with high mortality, resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis is increasingly being recognized as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemakers (PPM). Our study aimed to assess whether psoriasis is associated with an increased risk of developing IE in patients with PPM. The National Inpatient Sample database was utilized to extract patients with PPM. The presence of psoriasis stratified patients. Demographic and comorbidity data were collected. 1:10,000 propensity matching for IE risk factors was performed to examine independent associations between psoriasis and IE. Of 437,793 patients, 45 had psoriasis. Psoriasis patients had higher IE rates (4.4% vs. 0.6%; P < 0.01). On multivariate analysis, psoriasis was associated with a 7.2-fold high IE risk (OR: 7.2 [1.7-30.2]; P < 0.01). Post-match analysis showed an 8.3-fold IE risk in psoriasis patients (OR: 8.3 [2.0-34.4]; P < 0.001). Psoriasis was independently associated with elevated IE risk in patients with PPM. Further studies are required to corroborate these findings, which will have implications for IE prophylaxis.

Incidence and predictive factors of mortality of infective endocarditis in adults with congenital heart disease: A systematic review and meta-analysis

IntroductionCongenital heart diseases (CHD) with abnormal turbulent blood flow are associated with the highest risk of infective endocarditis (IE). Despite advancement in diagnostics and treatment, the mortality rate of IE remains high due the life-threatening complications. Our study aims to assess the incidence and mortality rates of IE and predictive factors for mortality among adults CHD (ACHD). MethodsA systematic literature search was conducted on PubMed, SCOPUS, and Ovid SP to retrieve relevant studies. The pooled estimates and predictors of mortality were calculated using the random-effects generic inverse variance method using R programming. Results12 studies involving 3738 ACHD patients were included in this meta-analysis. The overall incidence of IE in ACHD was 1.26 per 1000 patient-years (95% CI 0.55–1.96). 60% (95% CI 46–72%) of patients had surgical management for IE. The mortality rate of IE was 9% (95% CI 7–12%). The predictors of mortality were conservative management (OR: 5.07, 95% CI: 4.63–5.57), renal dysfunction (OR: 4.15, 95% CI: 2.92–5.88), cerebral complications (OR: 3.59, 95% CI: 1.78–7.23), abscesses/valve complications (OR: 2.67, 95% CI: 1.71–4.16), Staphylococcus aureus infection (OR: 2.32, 95% CI: 1.33–4.06), emboli (OR: 2.03, 95% CI: 1.47–2.79), body mass index (OR: 1.10, 95% CI: 1.01–1.21), age (OR: 1.02, 95% CI: 1.00–1.04), and previous IE (OR: 1.02, 95% CI: 1.00–1.04). ConclusionThe mortality rate of IE in ACHD is low. However, conservative management is associated with the highest risk of mortality.

Automated titanium fastener for surgical aortic valve replacement-preventive role for infective endocarditis?

Evidence on long-term clinical outcomes considering suture-securing techniques used for surgical aortic valve replacement is still uncertain. A total of 1405 patients who underwent surgical aortic valve replacement between January 2016 and December 2022 were included and grouped according to the suture-securing technique used (automated titanium fastener versus hand-tied knots). The occurrence of infective endocarditis during follow-up was set as the primary study end-point. As secondary study end-points, stroke, all-cause mortality, and a composite outcome of either infective endocarditis, stroke, or all-cause mortality were assessed. The automated titanium fastener was used in 829 (59%) patients, whereas the hand-knot tying technique was used in 576 (41%) patients. The multivariable proportional competing risk regression analysis showed a significantly lower risk of infective endocarditis during follow-up in the automated titanium fastener group (adjusted sub-hazard ratio 0.44, 95% confidence interval 0.20-0.94, p = 0.035). The automated titanium fastener group was not associated with an increased risk of mortality or attaining the composite outcome, respectively (adjusted hazard ratio 0.81, 95% confidence interval 0.60-1.09, p = 0.169), (adjusted hazard ratio 0.82, 95% confidence interval 0.63-1.07, p = 0.152). This group was not associated with an increased risk of stroke (adjusted sub-hazard ratio 0.82, 95% confidence interval 0.47-1.45, p = 0.504). Also, a significantly lower rate of early-onset infective endocarditis was observed in the automated titanium fastener group, (0.4% vs 1.4%, p = 0.032). Suture-securing with an automated titanium fastener device appears to be superior compared to the hand-knot tying technique in terms of lower risk of infective endocarditis.

Comparison of infective endocarditis in patients with and without malignancy: A propensity score matched analysis.

e24030 Background: Cancer patients are at a higher risk of infective endocarditis (IE) due to immunosuppressed state, indwelling catheters and recurrent infections. Due to the clinical scenario being relatively uncommon, there is lack of real-world data on prevalence, trends and outcomes of IE in cancer patients. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of IE with and without a cancer diagnosis using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 70,225 admissions for IE were identified between 2016-2020, of which 2,294 (3.27%) had a history or active cancer. The annual number of admissions for IE did not show a significant change (p trend = 0.56); however, the proportion of IE patients with cancer doubled from 2.33% to 4.61% (p trend &lt; 0.01) over the study period. After propensity score matching, there was no significant difference in in-hospital mortality (odds ratio [OR] 1.30, 95% CI 0.79-2.16, p = 0.31) between IE patients with and without cancer. Cohort with cancer had lower odds of experiencing respiratory failure (OR 0.52, 95% CI 0.33-0.83, p &lt; 0.01) and stroke (OR 0.35, 95% CI 0.25-0.49, p &lt; 0.01), although venous thromboembolism was more common in cohort with cancer (OR 3.03, 95% CI 1.76-5.21, p &lt; 0.01). There was no difference in acute kidney injury or shock between the two groups. Cohort with cancer was less likely to undergo valve replacement surgery (OR 0.42, 95% CI 0.31-1.24, p &lt; 0.01). The median length of stay (11 days vs 14 days, p &lt; 0.01) and hospital charges ($70,698 vs $86,763, p &lt; 0.01) were higher in the cohort without cancer. Conclusions: Underlying cancer was seen in growing proportion of admissions for IE over the study period. The pattern of complications was different between patients with and without cancer, which underscores the importance of cancer history in management of IE. Although there was no difference in mortality between patients with and without cancer, patients with cancer were less likely to undergo valve replacement surgery during the admission. Further research is needed to explore the specific factors influencing treatment decisions and long-term outcomes in cancer patients with IE.