[Epidemiology and temporal trends of infective endocarditis between 2006 and 2018 at a tertiary referral center].

Abstract

Introduction: Despite modern diagnostics, targeted antibiotic therapy and surgical treatment, the mortality rate of infective endocarditis remains high. In developed countries, both the risk factors and pathogens have changed. Objective and method: In our retrospective single-center study, we analyzed the clinical and microbiological characteristics, short- and long-term all-cause mortality, and temporal trends of patients admitted with infective endocarditis before COVID–19 pandemic, between 2006 and 2018. Results: We included 537 consecutive cases in our study, the mean age was 56 years (73% male). 339 (63%) cases were native valve infective endocarditis, 130 (24%) cases were prosthetic valve infective endocarditis, 62 (12%) cases were intracardiac device-related infective endocarditis and 6 (1%) other cases. The most common microorganisms were Staphylococci (n = 175; 33%), including 104 cases of methicillin-sensitive Staphylococcus aureus, 27 cases of methicillin-resistant Staphylococcus aureus and 44 cases of coagulase-negative Staphylococci. Streptococcus species were identified in 141 cases (26%), Enterococcus species in 88 cases (17%) and 72 cases (13%) were classified as blood culture-negative infective endocarditis. In-hospital all-cause mortality was 14%, mortality at 6 months was 27%, at 1 year was 31%, and at 5 year was 44%. The incidence of methicillin-sensitive S. aureus infections increased over time (p<0.05), while coagulase-negative Staphylococci (p<0.001), and Streptococci (p<0.05) infections decreased. None of the observed mortality rates showed significant change over the study period. Predictors of mortality were advanced age (HR: 1.37 [1.23–1.51]; p<0.001), impaired renal function (HR: 1.03 [1.01–1.04]; p<0.001), reduced ejection fraction at admission (HR: 1.38 [1.25–1.52]; p<0.001), cerebral embolism (HR: 1.74 [1.25–2.42]; p = 0.001), and methicillin-resistant S. aureus infection compared to Streptococcal infection (HR: 2.56 [1.39–4.7]; p = 0.002) based on multivariate Cox-regression. Conclusion: During the observed 13 years, Staphylococci were the most common pathogens with an increasing incidence of methicillin-sensitive S. aureus infection in our tertiary center. The mortality rate of infective endocarditis remained high and showed no improvement over time. Orv Hetil. 2024; 165(38): 1500–1508.