Endocarditis at a large community hospital with on-site cardiac surgery

Abstract

Objective Infective endocarditis (IE) is still a serious disease. The currently published EURO-ENDO registry showed a rate of surgery of 51.2% and a lower mortality in operated IE patients. We hypothesized differences between our data and the registry. Methods Retrospective single centre registry on the hospital course of patients with IE. Results In four years, 171 IE patients were treated at our hospital. Mean age of patients was 66.5 ± 13.8 years and 62.6% of patients were transferred from other hospitals. There were 85 (49.7%) patients with native valve IE (NVE), 53 (31%) with prosthetic valve IE (PVE) and 33 (19.3%) with either intra-cardiac device related IE (n = 29) or IE associated with central access lines (n = 4) (DRE). A total of 81.3% (n = 139) of patients were sent to cardiac surgery. Using a logistic regression model to analyse predictors of conservative instead of surgical therapy the only independent variables were: presence of large vegetation or abscesses (OR: 0.36, 95%CI 0.15–0.83; p = 0.016) and age (for each ten years) (OR: 1.61, 95%CI 1.11–2.32, p = 0.01). Hospital mortality was 21.6% (n = 37/171), with no difference (p = 0.97) between those who were operated (21.6%, n = 30/139) and those treated conservatively (21.9%, n = 7/32). Comparing those treated conservatively without an indication for surgery with those with an indication, mortality was 9.5% versus 45.5%, p = 0.02. Conclusions In this registry from a hospital with on-site cardiac surgery more than half of patients were referred. The rate of patients treated surgically was 81.3%. Hospital mortality was 21.6%, with no difference between operated and conservatively treated patients.

Infectious endocarditis without intracardiac devices or underlying structural heart disease

“…Over the past 5 years, a 45.5% increase vs the previous 5 years (2001-2005) was reported. This increase is consistent with the current trend observed in high-income countries, such as Germany, where Zahn et al 18 reported more cases and a high in-hospital mortality rate (21.96%), which does not seem to drop despite advances made in diagnostic and surgical treatment.…”

Endocarditis infecciosa sin dispositivos intracardiacos ni cardiopatía estructural subyacente

“…En los últimos 5 años se ha registrado un incremento de un 45.5% con respecto a los 5 años anteriores (2001)(2002)(2003)(2004)(2005). Este aumento es concordante con la tendencia actual observada en países de alto ingresos, como Alemania, donde Zahn et al 18 describen un incremento de casos y adicionalmente una…”