Infective endocarditis: a Hunter New England perspective

Doig, Fiona; Loewenthal, Mark; Lai, Katy; Mejia, Ross; Iyengar, Ajay J.

doi:10.1111/imj.13797

Cited by 8 publications

(9 citation statements)

References 13 publications

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“…We found that patients with S. aureus bacteraemia tended to be younger, with a higher likelihood of intravenous drug use, compared to those with an E. faecalis bacteraemia, who were older and more likely to have a PPM in situ or prosthetic valve endocarditis. This is consistent with previous reports of a bimodal distribution in age of patients with infective endocarditis 12 . Only 15% of our patients were intravenous drug users, compared to a rate of 30% reported in an interstate cohort 15 .…”

Section: Discussionsupporting

confidence: 93%

“…We also found older age, ICU admission prior to or without subsequent cardiac surgery and severe LVEF impairment as other independent predictors of mortality. Increased age, LVEF impairment and inotrope requirement (a proxy for ICU admission) have similarly been reported in other cohorts as predictors of mortality 12,13 . Other studies have also found prosthetic valve endocarditis, S. aureus bacteraemia and increased vegetation size as predictors of mortality, which was not the case in our cohort 13,14 .…”

Section: Discussionsupporting

confidence: 76%

“…Increased age, LVEF impairment and inotrope requirement (a proxy for ICU admission) have similarly been reported in other cohorts as predictors of mortality. 12,13 Other studies have also found prosthetic valve endocarditis, S. aureus bacteraemia and increased vegetation size as predictors of mortality, which was not the case in our cohort. 13,14 Differences in the aetiology of infective endocarditis between this study and these other studies may explain this.…”

Section: Discussioncontrasting

confidence: 55%

“…This is consistent with previous reports of a bimodal distribution in age of patients with infective endocarditis. 12 Only 15% of our patients were intravenous drug users, compared to a rate of 30% reported in an interstate cohort. 15 The characteristics of intravenous drug users who present to our institution with infective endocarditis has been previously reported, 13 in particular the effects of concomitant psychiatric diagnoses and opiate replacement therapy on outcomes.…”

Section: Discussionmentioning

confidence: 60%

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Embolic phenomena to the limbs are an independent predictor of in‐hospital mortality from infective endocarditis

Lovelock

Zhu

Saran

et al. 2022

ANZ Journal of Surgery

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Background: Infective endocarditis (IE) is a morbid condition with high mortality. We investigated predictors of in-hospital mortality and embolic phenomena in a contemporary Australasian cohort. Methods: We identified all patients with IE admitted between January 2017 and 30th April 2020 (40 months). Patient characteristics, risk factors and clinical outcomes were retrospectively collected and analysed. Results: One hundred and seventy-two consecutive patients (mean age: 56.8 AE 17.9 years, male: 63%, 114/172) were included. Causative organisms were Staphylococcus aureus (44%, 75/172), Enterococcus faecalis (15%, 26/172), Streptococcus mitis (6%, 10/172) and Staphylococcus epidermidis (3%, 6/172). In-hospital mortality was 15% (25/172). Embolic complications were found among 57% (98/172) of patients, the most common being stroke (23%, 40/172), septic pulmonary emboli (17%, 29/172), splenic and/or renal emboli (17%, 26/172) and peripheral limb emboli (15%, 25/172). Sixty (35%, 60/172) patients underwent cardiac surgery. On multivariable analysis, independent predictors of in-hospital mortality were: increased age (odds ratio: 1.064, per year older, P = 0.001), ICU admission independent of cardiac surgery (OR 9.81, P < 0.001), moderate or severe LV impairment (OR 5.19, P = 0.012) and any sign of embolic phenomena to limbs (OR 5.02, P = 0.006). Multivariable predictors of embolic complications were S. aureus bacteraemia (OR 3.22, P = 0.001) and large vegetation >10 mm (OR 3.04, P = 0.002). Conclusion:We demonstrate predictors of in-hospital mortality and embolic phenomena in our cohort. Though age remains a consistent predictor of mortality, surprisingly, signs of embolic phenomena to the limbs was established as an independent predictor of mortality. The mechanism of this is unclear and warrants further evaluation. ‡ Multivariable model: Area under receiver-operating characteristic curve (AU-ROC) = 0.847 (95% CI 0.765-0.929), P < 0.001.Variables with p < 0.05 on multivariable analysis are presented in bold.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 60%

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Embolic phenomena to the limbs are an independent predictor of in‐hospital mortality from infective endocarditis

Lovelock

Zhu

Saran

et al. 2022

ANZ Journal of Surgery

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“…The last but not the least was the high rate of surgical treatment. Better prognosis had been reported in IE patients with a higher rate of valvular surgery [20,21].…”

Section: Discussionmentioning

confidence: 93%

Infective endocarditis at a tertiary-care hospital in China

et al. 2020

J Cardiothorac Surg

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Background: The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with in-hospital mortality. Methods: A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included. Results: A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy. Conclusions: Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.

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Infective Endocarditis: A Contemporary Study of Microbiology, Echocardiography and Associated Clinical Outcomes at a Major Tertiary Referral Centre

Holland

Simos

Yoon

et al. 2020

Heart, Lung and Circulation

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Infective endocarditis: a Hunter New England perspective

Abstract: IE in the HNELHD affects a relatively young cohort of patients and is associated with a high mortality. Outcomes could be improved by implementation of a multidisciplinary team approach and inpatient cardiac surgery.

Cited by 8 publications

References 13 publications

Embolic phenomena to the limbs are an independent predictor of in‐hospital mortality from infective endocarditis

Embolic phenomena to the limbs are an independent predictor of in‐hospital mortality from infective endocarditis

Infective endocarditis at a tertiary-care hospital in China

Infective Endocarditis: A Contemporary Study of Microbiology, Echocardiography and Associated Clinical Outcomes at a Major Tertiary Referral Centre

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