A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018

Abstract

BackgroundInfective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years.MethodsMedical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018.ResultsA Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality.ConclusionsOur study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.

Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study

“…In the present study, blood cultures were negative in 56.7% of cases, similar to the data in some Asiatic populations (30–61%) 32–34 but surpassing the number in other developed countries (7–20%). 33 , 35 , 36 The high prevalence of negative blood cultures was usually associated with the antibiotic treatment given before the blood culture, the insufficient number of blood cultures submitted, highly fastidious bacterial or nonbacterial infections, and inadequate microbiological techniques.…”

Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018

“…Our study also attempted to explore the effect of blood culture results on the accuracy of echocardiographic diagnosis of IE, but the results were not satisfactory. In our previous study [ 11 ], we mentioned that the blood culture positive rate of IE in our hospital was only 58.2% due to antibiotic abuse and other reasons, which was roughly consistent with the results of the present study. We speculated that this might affect the univariate analysis results.…”

“…Several previous studies pointed out that surgery was independently associated with a lower risk of in-hospital mortality [ 13 – 15 ]. We previously performed a multivariate analysis in 313 cases of IE (including prosthetic valve endocarditis) [ 11 ] and identified intravenous drug addiction, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, and early surgery as independent predictors of in-hospital mortality. According to this data, we concluded that the surgery and less frequent occurrence of hemorrhagic stroke were protective factors for good prognosis of IE in the surgery group.…”

“…We consecutively collected data from 313 consecutive IE cases through the electronic medical records system of Nanfang Hospital, a comprehensive teaching hospital, between June 2001 and June 2018. The partial results of this study were published in 2019 [ 11 ]. We excluded 11 cases of prosthetic valve IE and 2 cases with a history of pacemaker transplantation.…”

Prosthetic heart valves and the COVID‐19 pandemic era: What should we be concerned about?

“…In our study, four patients had a fever on admission, but none fulfilled the modified Duke criteria as a definite or suspected case for infectious endocarditis. 10,11 Only 2 of 10 patients had increased prosthetic mitral valve gradients without significant transvalvular or paravalvular leakage. The two patients also had no apparent vegetation in transthoracic echocardiography.…”