Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

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Objective: The mortality rate from Staphylococcus aureus endocarditis remains as high as 20-30% despite better medical and surgical treatment. This study evaluates the efficiency and tolerance of a combination of trimethoprim-sulfamethoxazole and clindamycin (T&C) +/rifampicin and gentamicin, with rapid switch to oral T&C. Methods: Before-after intervention study to compare the outcome of 170 control patients before the introduction of the T&C protocol (2001 to 2011) to 171 patients in the T&C group (2012 to 2016). All patients diagnosed as S. aureus-infective endocarditis, and referred to our center between 2001 and 2016 were included. Between 2001 and 2011, the patients were given a standardized antibiotic treatment: oxacillin or vancomycin, for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol includes high dose of T&C (intravenously, switched to oral at day 7). Rifampicin and gentamicin can be added (if blood culture positive after 48 hours or cardiac abscess). Results:The two groups were slightly different. In intention to treat, the global mortality rate was lower in the T&C group (19.3% vs 30% -p=0.024), as well as the in-hospital mortality (9.9% vs 18.2% -p=0.03), and the 30-days mortality (7.1% vs 14.2% -p=0.05). The mean duration of hospital stay alive was significantly shorter in the T&C group (30 vs 39 days -p=0.005) Conclusions:The management of S. aureus IE in our multidisciplinary team, using a rapid shift to oral antibiotic with T&C, shows promising results reducing length of hospital stay and the mortality rate.

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