Factors associated with unfavorable outcome in a multicenter audit of 100 infective endocarditis

  • David ChirioEmail author
  • Marion Le Marechal
  • Pamela Moceri
  • Arnaud de la Chapelle
  • Sylvie Chaillou-Optiz
  • Anaïs Mothes
  • Cédric Foucault
  • Laurence Maulin
  • Chirine Parsaï
  • Pierre-Marie Roger
  • Elisa Demonchy
Original Article


We aimed to identify factors associated with unfavorable outcome in patients treated for infective endocarditis (IE), with a focus on departure from European guidelines. We conducted a retrospective audit of all adult patients treated for endocarditis during a 1-year period across a regional network of nine care centers in the south-east of France. Medical records were reviewed regarding patient and infection characteristics, antibiotic therapy, outcome, and compliance to the European Society of Cardiology guidelines. Antibiotic treatment appropriateness was evaluated regarding molecule, dosage, and duration, according to guidelines. Primary endpoint was the assessment of factors associated with unfavorable outcome, defined as in-hospital mortality or IE relapse at 1-year follow-up. Secondary endpoints were intensive care admission, iatrogenic events, and nosocomial infections that occurred during hospital stay. One hundred patients were included. Median age was 71 years old. Twenty-two patients died and IE relapse occurred in two patients, representing 24 patients with unfavorable outcome. Overall, antibiotic treatment was deemed appropriate in 28 cases. Thirty-three patients required intensive care, 34 iatrogenic events were found, including 19 acute kidney injuries, and 13 nosocomial infections occurred during care. Using a logistic regression, factors associated with unfavorable outcome were admission in the intensive care unit (adjusted odd ratio 7.26 [1.8–29.28]; p = 0.005), new-onset nosocomial infection (adjusted odd ratio 8.83 [1.42–54.6]; p = 0.019), and age > 71 years old (adjusted odd ratio 11.2 [2.76–46.17]; p < 0.001). Departure from guidelines was frequent but not related to unfavorable outcome in our study. Only intensive care, age, and nosocomial infections were associated with mortality and relapse. Iatrogenic events were numerous, with no impact on outcome.


Infective endocarditis Iatrogenic event Audit Guidelines Antibiotic therapy 



The authors would like to thank S. Chadapaud, M. Della Guardia, E. Denis, E. Leroux, N. Martis, V. Mondain, P. Pietri, F. Tiger, and M. Vassalo for their participation in this audit.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

As this was a retrospective study with no immediate impact on patient care, we did not seek the approval of an ethics committee.

Informed consent

During their hospital stay, all patients signed a chart regarding the anonymous use of their medical information.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • David Chirio
    • 1
    Email author
  • Marion Le Marechal
    • 1
  • Pamela Moceri
    • 2
  • Arnaud de la Chapelle
    • 3
  • Sylvie Chaillou-Optiz
    • 4
  • Anaïs Mothes
    • 5
  • Cédric Foucault
    • 6
  • Laurence Maulin
    • 7
  • Chirine Parsaï
    • 8
  • Pierre-Marie Roger
    • 1
  • Elisa Demonchy
    • 1
  1. 1.Infectiologie, Hôpital l’Archet 1Centre Hospitalier Universitaire de NiceNiceFrance
  2. 2.Cardiologie, Hôpital PasteurCentre Hospitalier Universitaire de NiceNiceFrance
  3. 3.Réanimation cardio-thoraciqueInstitut Arnault TzanckSaint-Laurent-du-VarFrance
  4. 4.GériatrieCentre Hospitalier Princesse GrasseMonacoMonaco
  5. 5.Médecine Interne et PolyvalenteCentre Hospitalier de la DracénieDraguignanFrance
  6. 6.Médecine Polyvalente et InfectiologieCentre Hospitalier d’HyèresHyèresFrance
  7. 7.InfectiologieCentre Hospitalier du Pays d’AixAix-en-ProvenceFrance
  8. 8.CardiologiePolyclinique Les FleursOllioulesFrance

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