Clinical manifestations of infective endocarditis in relation to infectious agents: An 8-year retrospective study.

AIM To compare clinical complications and outcomes of infective endocarditis (IE) episodes caused by Staphylococcus aureus (S. aureus) and other most frequent aetiological agents (streptococci, enterococci, coagulase-negative staphylococci, and culture-negative IE). METHODS A total of 117 IE episodes assessed by all internal medicine services of a major teaching institution in the Czech Republic over an eight-year period were identified. RESULTS We found that S. aureus IE episodes (n = 36) were significantly more associated with systemic embolism (41.7% vs 18.5%, P = 0.01), severe sepsis/septic shock (33.3% vs 3.7%, P < 0.0001), and in-hospital mortality (33% vs 12.3%, P = 0.01). No differences in local, structural, and/or functional complications (cardiac abscess formation, impaired integrity of the valvular apparatus, conduction disturbances, or incidence of heart failure) were observed between studied groups. Long-term survival estimates were significantly improved in patients with IE caused by agents other than S. aureus (13.78 median years vs 5.48 median years, P=0.03). CONCLUSIONS IE episodes caused by S. aureus are associated with both increased short-term and long-term mortality. Of all the studied parameters, only systemic embolism and severe sepsis/septic shock predicted in-hospital mortality.

[1]  J. Zamorano,et al.  [2015 ESC Guidelines for the management of infective endocarditis]. , 2015, Kardiologia polska.

[2]  V. Fowler,et al.  Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study. , 2015, Circulation. Cardiovascular imaging.

[3]  J. Mehta,et al.  Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. , 2015, Journal of the American College of Cardiology.

[4]  P. Grossi,et al.  Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI) , 2014, BMC Infectious Diseases.

[5]  D. Raoult,et al.  Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort. , 2013, Journal of the American College of Cardiology.

[6]  Jacobo A Silva,et al.  Contemporary epidemiology and prognosis of septic shock in infective endocarditis. , 2013, European heart journal.

[7]  F. Alla,et al.  Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  V. Fowler,et al.  Increasing US rates of endocarditis with Staphylococcus aureus: 1999-2008. , 2012, Archives of internal medicine.

[9]  U. Fedeli,et al.  Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system , 2011, BMC infectious diseases.

[10]  L. Kritharides,et al.  Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. , 2010, European heart journal.

[11]  L. Baddour,et al.  Epidemiological trends of infective endocarditis: a population-based study in Olmsted County, Minnesota. , 2010, Mayo Clinic proceedings.

[12]  V. Fowler,et al.  Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis: Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment-Selection Bias , 2010, Circulation.

[13]  L. Baddour,et al.  Infective endocarditis in the Czech Republic: eight years of experience at one of the country's largest medical centers. , 2009, The Journal of heart valve disease.

[14]  Andrew Wang,et al.  Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. , 2009, Archives of internal medicine.

[15]  M. Herregods,et al.  Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. , 2007, Mayo Clinic proceedings.

[16]  Gilbert Habib,et al.  Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography: A Prospective Multicenter Study , 2005, Circulation.

[17]  K. Anstrom,et al.  Staphylococcus aureus endocarditis: a consequence of medical progress. , 2005, JAMA.

[18]  J. Timsit,et al.  Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients , 2004, Intensive Care Medicine.

[19]  Vance G. Fowler,et al.  Early Predictors of In-Hospital Death in Infective Endocarditis , 2004, Circulation.

[20]  F. Alla,et al.  Changing profile of infective endocarditis: results of a 1-year survey in France. , 2002, JAMA.

[21]  Vance G Fowler,et al.  Changing patient characteristics and the effect on mortality in endocarditis. , 2002, Archives of internal medicine.

[22]  D Raoult,et al.  Echocardiography predicts embolic events in infective endocarditis. , 2001, Journal of the American College of Cardiology.

[23]  V. Fowler,et al.  Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  R Erbel,et al.  The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events. , 1999, Journal of the American College of Cardiology.

[25]  F Fedele,et al.  Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. , 1997, The American journal of cardiology.

[26]  L. Olaison,et al.  Epidemiologic Aspects of Infective Endocarditis in an Urban Population: A 5‐Year Prospective Study , 1995, Medicine.

[27]  C. Chastang,et al.  Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision. , 1995, Chest.

[28]  J D Thomas,et al.  Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. , 1991, Journal of the American College of Cardiology.

[29]  K. Bailey,et al.  Emboli in infective endocarditis: the prognostic value of echocardiography. , 1991, Annals of internal medicine.

[30]  J. Alpert,et al.  Increasing frequency of staphylococcal infective endocarditis. Experience at a university hospital, 1981 through 1988. , 1990, Archives of internal medicine.

[31]  C. Otto,et al.  Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. , 1990, Journal of the American College of Cardiology.

[32]  A Mügge,et al.  Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. , 1989, Journal of the American College of Cardiology.