Clinical suspicion and empirical treatment of infective endocarditis on hospital admission - a population-based cohort study.

Abstract

Introduction: Infective endocarditis (IE) is a challenging diagnosis to suspect and to confirm. The purpose of this study was to clarify how often IE is suspected already on hospital admission, which clinical signs trigger the physicians' suspicions and to investigate if the empirical treatment is adequate.

Methods: A retrospective observational study of cases with definitive IE, during 2018-2019 in Skåne Region, Sweden was performed. Cases were identified by ICD-codes for IE and medical records were reviewed to reveal if IE was suspected at hospital admission and if empirical treatment was adequate.

Results: Of 156 episodes with definitive IE, suspicion of IE arose on admission in 36 (23%) of the cases. A longer symptom duration, heart murmurs, male sex, and lower age were significantly more common in the group where IE was suspected. In the 118 cases where empirical antibiotic treatment was initiated, 98 (83%) got an adequate empirical treatment while in 16 (14%) of the cases the organism identified was resistant. IE-directed treatment was achieved significantly earlier in the suspicion group, median of 1 day, compared to a median of 2 days (p < 0.0001) when endocarditis was not initially suspected.

Conclusion: IE is suspected already upon admission mainly in cases with a subacute presentation. Increased knowledge of IE with acute presentation could possibly result in earlier diagnosis and correct IE-directed treatment. The clinical impact of this is uncertain since most cases still were treated with adequate empirical antibiotics.