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

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-12-26 DOI:10.59958/hsf.6717
John Duggan, Alex Peters, Sarah Halbert, Jared Antevil, Gregory D Trachiotis
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Abstract

Background: Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020.

Methods: We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests.

Results: Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043).

Conclusions: In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.

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美国退伍军人感染性心内膜炎的微生物学研究--致病菌与短期和长期结果之间的关联》(Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short and Long Term Outcomes)。
背景:以往的研究已经阐明了致病菌与感染性心内膜炎预后之间的关系,但这种关系尚未在美国退伍军人中得到研究。本稿件旨在评估 2010-2020 年间美国退伍军人感染性心内膜炎(IE)患者的致病菌与短期和长期预后之间的关系:我们分析了退伍军人事务局(VA)外科质量改进计划和退伍军人事务局信息学与计算基础设施数据库中489名接受过手术治疗的IE患者。根据从血液或术中培养物中确定的致病菌将患者分为几组--葡萄球菌、链球菌、革兰氏阴性杆菌、肠球菌、多微生物和未知/培养阴性菌。分析中不包括其他已确定的微生物。采用 Cox 比例危险模型计算中风/短暂性脑缺血发作 (TIA)、心肌梗死 (MI) 和死亡的组别风险。模型采用反向消除法对协变量进行了调整。连续变量的比较采用方差分析或 Kruskal-Wallis H 检验,分类变量的比较采用卡方检验:平均随访时间为 4.0 ± 6.3 年。革兰氏阴性杆菌(GNRs)与更高的长期死亡风险相关(调整后危险比(aHR)2.15,95% CI:1.20-3.86,p = 0.01)。肠球菌与心肌梗死的长期风险有关(aHR 2.05,95% CI:1.07-3.94,p = 0.03)。耐甲氧西林金黄色葡萄球菌等耐药菌与心肌梗死的长期风险有关(aHR 2.51,95% CI:1.14-5.45,p = 0.02)。多菌感染与围手术期并发症风险增加有关,包括机械通气时间延长(48 小时)(aHR 1.76,95% CI:1.05-2.97,p = 0.034)、气管切开术(aHR 5.64,95% CI:2.35-13.55,p <0.001)和重症监护病房住院时间延长(5 天)(aHR 1.39,95% CI:1.01-1.91,p = 0.043):结论:在美国退伍军人中,与单微生物感染相比,多微生物感染的围手术期预后明显较差,但长期预后相似。GNR感染与长期死亡率增加有关。肠球菌和耐药菌与心肌梗死的长期风险增加有关。多微生物感染与围手术期并发症风险增加有关,包括机械通气时间延长、气管切开术和重症监护室住院时间延长。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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