Risk of embolic events before and after antibiotic treatment initiation among patients with left-side infective endocarditis

Abstract

Purpose Embolic events (EEs) are a common complication of left-side infective endocarditis (IE). The aim of the present study was to identify risk factors for the occurrence of EEs before or after antibiotic treatment instauration among patients with definite or possible IE. Methods This retro-prospective study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. Results A total of 441 left-side IE episodes were included (334: 76% were definite and 107; 24% possible IE). EE were diagnosed in 260 (59%) episodes; in 190 (43%) before antibiotic treatment initiation and 148 (34%) after. Central nervous system (184; 42%) was the most common site of EE. Multivariable analysis identified S. aureus (P 0.022), immunological phenomena (P < 0.001), sepsis (P 0.027), vegetation size ≥ 10 mm (P 0.003) and intracardiac abscess (P 0.022) as predictors of EEs before antibiotic treatment initiation. For EEs after antibiotic treatment initiation, multivariable analysis revealed vegetation size ≥ 10 mm (P < 0.001), intracardiac abscess (P 0.035) and prior EE (P 0.042), as independent predictors of EEs, while valve surgery (P < 0.001) was associated with lower risk for EEs. Conclusions We reported a high percentage of EEs among patients with left-side IE; vegetation size, intracardiac abscess, S. aureus and sepsis were independently associated with the occurrence of EEs. In addition to antibiotic treatment, early surgery led to further decrease in EEs incidence.

Eyes Wide Shut: A Cohort Study Questioning the Role of Fundoscopy in Infective Endocarditis Diagnosis

“…In the present study among S. aureus bacteremia episodes, OEEs were found in 7%, consistent with previous findings (9%) [ 6 ]. As expected, OEEs were associated with embolic events outside the eye and factors generally linked to systemic embolization, such as large vegetations (≥10 mm), S. aureus , persistent bacteremia/candidemia, and intracardiac abscess [ 10 , 11 ].…”

Cryoglobulinemic vasculitis triggered by Staphylococcus aureus endocarditis with chronic hepatitis C virus co-infection: a case report and literature review

“…Epidemiologically, comparing cases from this review ( Supplementary Table 1 ) with data from the institutional IE cohort reveals a higher proportion of intracellular pathogens (40% versus 1–2% in the cohort) and a lower proportion of S. aureus (20% versus 39%) ( 31 ). IE caused by intracellular pathogens typically follows a subacute or chronic course, leading to diagnostic delays due to sterile blood cultures and nonspecific symptoms.…”

Exploring Unusual Cardiac Complications: Chorda Tendinea Rupture and Pulmonary Valve Vegetation in Infective Endocarditis—A Comprehensive Review

“…The risk of embolic events in IE is influenced by various factors, including the dimensions of vegetation on the heart valves, specific bacteria such as Staphylococcus aureus, and abscesses or other cardiac complications [ 17 - 19 ]. Notably, vegetation size emerges as a robust predictor of embolic events, with more extensive vegetation (>10 mm) associated with a heightened risk of embolization [ 18 , 19 ]. Early identification of these risk factors assumes paramount importance in the effective management of IE, as it enables clinicians to pinpoint patients who may derive benefit from early surgical intervention to avert further embolization.…”

“…Early identification of these risk factors assumes paramount importance in the effective management of IE, as it enables clinicians to pinpoint patients who may derive benefit from early surgical intervention to avert further embolization. Indeed, research indicates that prompt surgical intervention can significantly diminish the incidence of embolic events in IE patients [ 18 , 19 ]. Although the incidence of embolic events in IE exhibits variability across studies, it is generally reported to range between 20% and 40% of cases [ 20 ].…”