Abstract
In-hospital and long-term mortality of infective endocarditis (IE) are well noted, but the studies for mid-term (90-day) mortality of IE is still limited. We determine the mid-term mortality rate of IE and its significant predictors. Seventy patients with IE were hospitalised at St. Luke’s International Hospital between January 1996 and March 2009, of whom 62 consecutive patients could be followed up for 90 days after diagnosis. We then calculated Kaplan–Meier (KM) estimates and performed time-to-event analysis. The mean (standard deviation, SD) age was 66.6 (15.3) years. Thirty-five patients (56%) were male. Blood cultures were positive in 87%. Causative microorganisms were: viridans group streptococci (23%), β-streptococci (16%), Staphylococcus aureus (15%), including methicillin-resistant S. aureus (MRSA) (5%). Thirty-three cases (53%) had at least one complication such as heart failure (34%), central nervous system (CNS) complication (29%) or emboli peripheral to CNS (6%). KM estimates (95% CI) of the 90-day mortality was 14.5% (7.8–25%). In multiple regression analysis using the Cox proportional hazards model, hazard ratios of at least one complication for the 90-day mortality was 8.2 (1.4–155). Mid-term mortality of IE continues to be high and the presence of at least one complication may be considered as an independent risk factor of mid-term mortality.
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Tuğcu A, Yildirimtürk O, Baytaroğlu C, Kurtoğlu H, Köse O, Sener M, Aytekin S (2009) Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey. Turk Kardiyol Dern Ars 37(1):9–18
Al-Tawfiq JA, Sufi I (2009) Infective endocarditis at a hospital in Saudi Arabia: epidemiology, bacterial pathogens and outcome. Ann Saudi Med 29(6):433–436
Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A, Briançon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F (2002) Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 288(1):75–81
López-Dupla M, Hernández S, Olona M, Mercé J, Lorenzo A, Tapiol J, Gómez F, Santamaría J, García R, Auguet T, Richart C, Castells E, Bardají A, Vidal F (2006) Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases. Rev Esp Cardiol 59(11):1131–1139
Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, Woods CW, Reller LB, Ryan T, Fowler VG Jr (2002) Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 162(1):90–94
Mouly S, Ruimy R, Launay O, Arnoult F, Brochet E, Trouillet JL, Leport C, Wolff M (2002) The changing clinical aspects of infective endocarditis: descriptive review of 90 episodes in a French teaching hospital and risk factors for death. J Infect 45(4):246–256
Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE (2007) Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J 28(2):196–203
Ruotsalainen E, Sammalkorpi K, Laine J, Huotari K, Sarna S, Valtonen V, Järvinen A (2006) Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients. BMC Infect Dis 6:137
Heiro M, Helenius H, Hurme S, Savunen T, Metsärinne K, Engblom E, Nikoskelainen J, Kotilainen P (2008) Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years. BMC Infect Dis 8:49
Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, Olaison L, Eykyn S, Hoen B, Abrutyn E, Raoult D, Bayer A, Fowler VG Jr (2005) Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis 41(4):507–514
Heiro M, Helenius H, Hurme S, Savunen T, Engblom E, Nikoskelainen J, Kotilainen P (2007) Short-term and one-year outcome of infective endocarditis in adult patients treated in a Finnish teaching hospital during 1980–2004. BMC Infect Dis 7:78
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638
Haddad SH, Arabi YM, Memish ZA, Al-Shimemeri AA (2004) Nosocomial infective endocarditis in critically ill patients: a report of three cases and review of the literature. Int J Infect Dis 8(4):210–216
Martínez-Sellés M, Muñoz P, Estevez A, del Castillo R, García-Fernández MA, Rodríguez-Créixems M, Moreno M, Bouza E (2008) Long-term outcome of infective endocarditis in non-intravenous drug users. Mayo Clin Proc 83(11):1213–1217
Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, Bisno AL, Ferrieri P, Shulman ST, Durack DT (1995) Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA 274(21):1706–1713
Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA (2005) Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 111(23):e394–e434
Jacob S, Tong AT (2002) Role of echocardiography in the diagnosis and management of infective endocarditis. Curr Opin Cardiol 17(5):478–485
Beynon RP, Bahl VK, Prendergast BD (2006) Infective endocarditis. BMJ 333(7563):334–339
Moreillon P, Que YA (2004) Infective endocarditis. Lancet 363(9403):139–149
Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, Levison ME, Korzeniowski OM, Kaye D (2000) Risk factors for infective endocarditis: oral hygiene and nondental exposures. Circulation 102(23):2842–2848
Mylonakis E, Calderwood SB (2001) Infective endocarditis in adults. N Engl J Med 345(18):1318–1330
Netzer RO, Altwegg SC, Zollinger E, Täuber M, Carrel T, Seiler C (2002) Infective endocarditis: determinants of long term outcome. Heart 88(1):61–66
Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, Sexton DJ, Corey GR, Wang A (2004) Early predictors of in-hospital death in infective endocarditis. Circulation 109(14):1745–1749
Acknowledgements
The authors would like to express their gratitude to Dr. Yuki Uehara for the design of study, and Dr. Hiromichi Tamaki and Dr. Gautam Deshpande for their comments on the manuscript.
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Nomura, A., Omata, F. & Furukawa, K. Risk factors of mid-term mortality of patients with infective endocarditis. Eur J Clin Microbiol Infect Dis 29, 1355–1360 (2010). https://doi.org/10.1007/s10096-010-1006-z
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DOI: https://doi.org/10.1007/s10096-010-1006-z