Infective endocarditis in the Netherlands: current epidemiological profile and mortality

Abstract

Introduction Infective endocarditis (IE) is associated with a high in-hospital and long term mortality. Although progress has been made in diagnostic approach and management of IE, morbidity and mortality of IE remain high. In the latest European guidelines, the importance of the multi-modality imaging in diagnosis and follow up of IE is emphasized. Aim The aim was to provide information regarding mortality and adverse events of IE, to determine IE characteristics and to assess current use of imaging in the diagnostic workup of IE. Methods This is a prospective observational cohort study. We used data from the EURO-ENDO registry. Seven hospitals in the Netherlands have participated and included patients with IE between April 2016 and April 2018. Results A total of 139 IE patients were included. Prosthetic valve endocarditis constituted 32.4% of the cases, cardiac device related IE 7.2% and aortic root prosthesis IE 3.6%. In-hospital mortality was 14.4% (20 patients) and one-year mortality was 21.6% (30 patients). The incidence of embolic events under treatment was 16.5%, while congestive heart failure or cardiogenic shock occurred in 15.1% of the patients. Transthoracic and transoesophageal echocardiography were performed most frequently (97.8%; 81.3%) and within 3 days after IE suspicion, followed by 18F‑fluorodeoxyglucose positron emission tomography/computed tomography (45.3%) within 6 days and multi-slice computed tomography (42.4%) within 7 days. Conclusion We observed a high percentage of prosthetic valve endocarditis, rapid and extensive use of imaging and a relatively low in-hospital and one-year mortality of IE in the Netherlands. Limitations include possible selection bias.

Infective endocarditis in developing countries: An update

“…Similarly, other studies by Njuguna et al ( 3 ) and Noubiap et al ( 12 ) have reported a relatively similar in-hospital mortality due to IE with an in-hospital mortality rate of 22.6% (11.2–31.2%). Surprisingly, the observed mortality is similar to the 20% that is reported in HIC ( 6 , 35 , 36 ). In HIC patients present early and get diagnosed early ( 6 , 36 ).…”

“…Our findings are similar to what has been reported in previous studies ( 3 , 43 ). On the contrary, Noubiap et al ( 12 ) has reported in their review that Staphylococcus is the leading cause of IE in Africa, same as it is in HIC ( 6 , 36 ). The difference observed between our review and that of Noubiap et al could be due to the difference in the studied populations, we recruited studies across many developing countries and mostly adults while they reviewed African studies with a large proportion of children.…”

“…These findings imply that IE in developing countries affects the young and this is probably due to the common predisposing conditions in these areas which are RHD and CHD. On the contrary, native valve IE in the HIC commonly affects the old population of which DVD is the major underlying cardiac disease ( 6 , 35 , 36 ). Our review showed a male predominance in all except one study.…”

Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

“…According to the Euro-Endo registry, TTE has been performed in 91% of cases, while TOE in 53% of native valves' IE [21]. However, some heterogeneity in the diagnostic workup has been reported, with some countries having a more extensive use of imaging, possibly associated with a relatively low mortality [22]. Globally, the data confirm the current role of TTE as a first-line test, while TOE is still limited to selected cases.…”

A Perforated Mitral Valve Aneurysm: A Rare but Serious Complication of Aortic Valve Endocarditis Resulting From a Regurgitant Jet Lesion

“…Presentation is diverse, varying from patients presenting with isolated fevers and decompensated heart failure to patients presenting with hemorrhagic or ischemic stroke resulting from either septic or thrombus embolization [ 5 ]. Because of its many complications, early diagnosis and treatment of IE are of utmost importance [ 6 ]. We describe a case where delayed recognition of IE resulted in a rare but severe complication culminating in the death of our patient.…”