The Changing ‘Face’ of Endocarditis in Kentucky: An Increase in Tricuspid Cases

Abstract

Background Advancements in medical technology and increased life expectancy have been described as contributing to the evolution of endocarditis. We sought to determine whether there has been a change in the incidence, demographics, microbiology, complications, and outcomes of infective endocarditis over a ten-year time span. Methods We screened 28,420 transthoracic and transesophageal echocardiogram reports performed at our center for the following indications: fever, masses, emboli (including stroke), sepsis, bacteremia, and endocarditis in two time periods: 1999 through 2000 and 2009 through 2010. Data were collected from diagnosed endocarditis cases. Results Overall, 143 cases of infective endocarditis were analyzed (48 in 1999-2000 and 95 in 2009-2010). The endocarditis incidence per number of admissions remained nearly constant at 0.113% for 1999-2000 and 0.148% for 2009-2010 (p = 0.153). However, tricuspid valve involvement increased markedly from 6% to 36% (p < 0.001). Also, reported history of intravenous drug use increased from 15% to 40% (p = 0.002). Valvular complications doubled from 17% to 35% (p = 0.031). Septic pulmonary emboli increased from 10% to 25% (p = 0.047). Despite these noted differences, inpatient mortality remained unchanged at 25% and 28% (p = 0.696) for the two time periods, respectively. Conclusions The incidence of endocarditis at our center has not changed and mortality remains high, but the “face of endocarditis” in Kentucky has evolved with an increased incidence of tricuspid valve involvement, valvular complications, and embolic events.

Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis

“…D espite improvements in its diagnosis and management, infective endocarditis (IE) remains a high-risk condition [1]. The incidence of tricuspid valve IE has been steadily increasing over the last 2 decades [2,3]. The primary causes are intravenous drug use, rightsided cardiac device implantation, central venous catheterization, and repaired congenital defects, all of which are increasing in prevalence [2].…”

“…The incidence of tricuspid valve IE has been steadily increasing over the last 2 decades [2,3]. The primary causes are intravenous drug use, rightsided cardiac device implantation, central venous catheterization, and repaired congenital defects, all of which are increasing in prevalence [2]. Most patients with tricuspid valve IE can be treated successfully with antibiotic therapy but in approximately 20% of cases, persistent infection, symptomatic valvular regurgitation, concomitant left-sided infection, or recurrent septic pulmonary embolic complications necessitate surgical intervention [4].…”

Surgical Treatment for Tricuspid Valve Infective Endocarditis

“…The 2015 European Society of Cardiology guidelines for the management of infective endocarditis stated that surgery should be considered in the following situations with class IIa recommendations: [1] right heart failure secondary to severe tricuspid regurgitation with poor response to diuretic therapy, [2] infective endocarditis caused by organisms that are difficult to eradicate (e.g. persistent fungi) or bacteremia for at least 7 days despite adequate antimicrobial therapy, and [3] tricuspid valve vegetations >20 mm that persist after recurrent pulmonary emboli with or without concomitant right heart failure [8].…”

“…urgent in pacemaker and prosthetic infective endocarditis), [2] causative infective factors (e.g. fungal and Staphylococcus aureus), [3] coexistent left-sided infection, [4] response to antibiotic therapy, [5] toxicity of medical treatment, and [6] complications of disease (e.g. abscess and increased vegetation size) [13].…”

“…However, the frequency of tricuspid valve infective endocarditis is rapidly increasing along with the epidemic of intravenous drug use. Seratnahaei et al reported that the incidence of tricuspid valve infective endocarditis was 6% between 1999 and 2000, and it markedly increased to 36% between 2009 and 2010 [3]. Also reported history of intravenous drug use increased from 15 to 40%.…”