Skip to main content

Advertisement

SpringerLink
Log in

Infective endocarditis in Rio de Janeiro, Brazil: a 5-year experience at two teaching hospitals

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Introduction

Despite the recent advances in diagnosis and treatment, mortality rates due to infective endocarditis (IE) remain high if not aggressively treated with antibiotics, whether or not associated with surgery. Data on the prevalence, epidemiology and etiology of IE from developing countries remain scarce. The aim of this observational, prospective cohort study was to report a 5-year experience of IE at two teaching hospitals in Rio de Janeiro, Brazil.

Material and methods

Demographical, anamnestic and microbiological characteristics of 71 IE patients were evaluated during the period of January 2009 to March 2013.

Results

The mean age of the IE patients was 49.8 ± 2.4 years, of which 41 (57.7 %) were males. The median time between the onset of symptoms and diagnosis of IE was 35.8 ± 4.8 days. A total of 31 (43.6 %) cases of community-acquired infective endocarditis (CAIE) and 40 (56.3 %) cases of healthcare-acquired infective endocarditis (HAIE) were observed. Staphylococcus aureus (30 %) was the predominant cause of IE. Streptococcus spp. (45.1 %) was the predominant cause of the CAIE while S. aureus (32.5 %) and Enterococcus spp. (27.2 %) were the main etiological agents of HAIE. For 64 (90.1 %) patients with native valve endocarditis, the mitral valve was the most commonly affected (48.3 %). The main source of IE in this cohort was intravascular catheter. The tricuspid valve and renal chronic insufficiency were more frequent in patients with HAIE than CAIE (p = 0.001). The risk factors associated with in-hospital mortality rate (46.4 %) in IE patients were: age over 45 (OR 3.4; 95 % CI 1.03–11.24; p = 0.04) and chronic renal insufficiency (OR 38.3; 95 % CI 3.2–449.4; p = 0.004).

Conclusions

At two main teaching hospitals in Brazil, Streptococcus spp. was the principal pathogen of CAIE while S. aureus and Enterococcus spp. were the most frequent causes of HAIE. IE remains a serious disease associated with high in-hospital mortality rate (46.6 %); especially, in individuals over 45 years of age and with renal failure. Data suggest that early surgery may improve the outcome of IE patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sandre RM, Shafran SD. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis. 1996;22:276–86.

    Article  PubMed  CAS  Google Scholar 

  2. Trabelsi I, Rekik S, Znazen A, Maaloul I, Abid D, Maalej A, Kharrat I, Jemaa MB, Hammemi A, Kammoun S. Native valve infective endocarditis in a tertiary care center in a developing country (Tunisia). Am J Cardiol. 2008;102:1247–51.

    Article  PubMed  Google Scholar 

  3. Nunes MC, Gelape CL, Ferrari TC. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors an in-hospital outcome. Int J Infect Dis. 2010;14:e394–8.

    Article  PubMed  Google Scholar 

  4. Wu K, Lee SSJ, Tsai HC, Wann SR, Chen JK, Sy CL, Wang YH, Tseng YT, Chen YS. Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an under recognized disease with poor outcome. BMC Infections. 2011;11:211–21.

    Google Scholar 

  5. Hirata R Jr, Pereira GA, Filardy AA, Gomes DL, Damasco PV, Rosa AC, Nagao PE, Pimenta FP, Mattos-Guaraldi AL. Potential pathogenic role of aggregative-adhering Corynebacterium diphtheriae of different clonal groups in endocarditis. Braz JMed Biol Res. 2008;41:986–91.

    Article  CAS  Google Scholar 

  6. Begezsan II, Dorobat CM. Diagnostic approaches in infective endocarditis. Rev Med Chir Soc Med Nat Iasi. 2012;116:108–13.

    PubMed  Google Scholar 

  7. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:965–75.

    Article  PubMed  Google Scholar 

  8. Nkomo VT. Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa. Heart. 2007;93:1510–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sousa C, Botelho C, Rodrigues D, Azeredo J, Oliveira R. Infective endocarditis in intravenous drug abusers: an update. Eur J ClinMicrobiol Infect Dis. 2012;31:2905–10.

    Article  CAS  Google Scholar 

  10. Damasco PV, Cavalcante FS, Chamon RC, Ferreira DC, Rioja SS, Potsch MV, Pastura MP, Marques VD, Castier MB, Marques EA, Santos KR. The first case report of non-nosocomial healthcare-associated infective endocarditis due to methicillin- resistant Staphylococcus aureus USA400 in Rio de Janeiro Brazil. Infection. 2013;41:851–4.

    Article  PubMed  CAS  Google Scholar 

  11. Tariq M, Alam M, Munir G, Khan MA, Smego RA Jr. Infective endocarditis: a five experience at tertiary care hospital in Pakistan. Int J Infect Dis. 2004;8:163–70.

    Article  PubMed  Google Scholar 

  12. Ruiz BM. Castillo Rivera AM, Navarro RC. Infectious endocarditis in intensive care medicine. Med Intensiva. 2012;36:457–9.

    Article  Google Scholar 

  13. Lomas JM, Martinez-Marcos FJ, Placa A, Ivanova R, Gálvez J, Ruiz J, Reguera JM, Noureddine M, de la Torre J, de Alcarcón A. Healthcare-associated infective endocarditis: an undesirable effect of healthcare universalization. Clin Microbiol Infect. 2010;16:1683–90.

    Article  PubMed  CAS  Google Scholar 

  14. Carroll KC, Weinstein MP. Manual and automated systems for detection and identification of microorganisms. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, editors. Manual of clinical microbiology. 9th ed. Washington, DC: ASM Press; 2007. p. 192–217.

    Google Scholar 

  15. Mory F, Alauzet C, Matuszeswski C, Riegel P, Lozniewski A. Evaluation of the new vitek 2 anc card for identification of medically relevant anaerobic bacteria. J Clin Microbiol. 2009;47:1923–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Clinical and laboratory standards institute. performance for standards for antimicrobial susceptibility testing; twenty-third informational supplement. CLSI document M100-S-23. 2013.

  17. Fernández-Hidalgo N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, Pahissa A. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis. 2008;47:1287–97.

    Article  PubMed  Google Scholar 

  18. Sucutu M, Davutoglu V, Ozer O, Aksoy M. Epidemiological, clinical and microbiological profile of infective endocarditis in a tertiary hospital in the South-East Anatolia region. Arch Turk Soc Cardiol. 2010;38:107–11.

    Google Scholar 

  19. Ferreiros E, Nacinovich F, Casabé JH, Modenesi JC, Swieszkowski S, Corte C, Hernan CA, Kazelian L, Varini S. Epidemiologic, clinical and microbiologic profile of infective endocarditis in Argentina: a national survey. Am Heart J. 2006;151:545–52.

    Article  PubMed  Google Scholar 

  20. Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS, ICE Investigators. Staphylococcus aureus endocarditis a consequence of medical progress. JAMA. 2005;293:3022–61.

    Article  Google Scholar 

  21. Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, Sinha N. Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992–2001. Int J Cardiol. 2005;98:253–60.

    Article  PubMed  Google Scholar 

  22. Yen HS, Murdoch DR. Global trends in infective endocarditis epidemiology. Curr Infect Dis Rep. 2012;14:367–72.

    Article  Google Scholar 

  23. Hoen B, Duval X. Infective endocarditis. N Eng J Med. 2013;368:1425–33.

    Article  CAS  Google Scholar 

  24. Sy RW, kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population based profile of 1536 patients in Australia. Eur Heart J. 2010;31:1890–7.

    Article  PubMed  Google Scholar 

  25. Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte, Chirouze C, Lung B, Strady C, Revest M, Vandenesch F, Bouvet A, Delahaye F, Alfa F, Duval X, Hoen. Preeminence of Staphylococcus aureus in infective endocarditis: a 1 year population based survey. Clin Infect Dis. 2012;54:1230–9.

    Article  PubMed  Google Scholar 

  26. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis prospective cohort study. Arch Intern Med. 2009;169:463–73.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Geiβdörfer W, Moos V, Moter A, Loddenkemper C, Jansen A, Tandler R, Morguet AJ, Fenollar F, Raoult D, Bogdan C, Schneider T. High frequency of Tropheryma whipplei in culture negative endocarditis. J Clin Microbiol. 2012;50:216–22.

    Article  Google Scholar 

  28. Yiu KH, Siu CW, Lee KL, Fong YT, Chan HW, Lee SW, Lau CP, Tse HF. Emerging trends of community acquired infective endocarditis. Int J Cardiol. 2007;121:119–22.

    Article  PubMed  Google Scholar 

  29. Ramos JN, Santos LS, Vidal LMR, Pereira PMA, Salgado AA, Fortes CQ, Vieira VV, Mattos-Guaraldi AL, Hirata Jr R, Damasco PV. A case report and literature overview: Abiotrophia defectiva aortic valve endocarditis in developing countries. Infection 2014; [Epub ahead of print].

Download references

Acknowledgments

This work was supported by CAPES, FAPERJ, CNPq and SR-2/UERJ.

Conflict of interest

The authors have no disclosures or conflicts of interest to report.

Author information

Authors and Affiliations

  1. Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil

    P. V. Damasco, J. N. Ramos, T. C. F. Camello, V. D. Marques, E. A. Marques, R. Hirata Jr. & A. L. Mattos-Guaraldi

  2. Hospital Universitário Pedro Ernesto-HUPE, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil

    P. V. Damasco, J. C. D. Correal, T. C. F. Camello, V. D. Marques, E. A. Marques & M. B. Castier

  3. Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Rio de Janeiro, RJ, Brazil

    P. V. Damasco, M. V. Potsch & M. P. Pereira

  4. Instituto Nacional de Controle de Qualidade em Saúde, INCQS, Instituto Oswaldo Cruz, IOC, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil

    J. N. Ramos & V. V. Vieira

  5. Instituto de Microbiologia Paulo de Góes, Laboratório de Infecção Hospitalar, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil

    K. R. N. Santos

  6. Departamento de Medicina Preventiva, Faculdade de Medicina, Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil

    C. Q. Fortes

  7. Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil, 4.365, Pavilhão Leônidas Deanne, 6 andar, sala 607, Manguinhos, Rio de Janeiro, RJ, CEP: 21040-360, Brazil

    J. N. Ramos

Authors
  1. P. V. Damasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. N. Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. C. D. Correal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. V. Potsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. V. Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. C. F. Camello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. P. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. V. D. Marques
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K. R. N. Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. A. Marques
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. B. Castier
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. R. Hirata Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. A. L. Mattos-Guaraldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. Q. Fortes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. N. Ramos.

Additional information

P. V. Damasco and J. N. Ramos contributed equally for the first authorship in this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Damasco, P.V., Ramos, J.N., Correal, J.C.D. et al. Infective endocarditis in Rio de Janeiro, Brazil: a 5-year experience at two teaching hospitals. Infection 42, 835–842 (2014). https://doi.org/10.1007/s15010-014-0640-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-014-0640-2

Keywords

Search

Navigation