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Graversen PL, Østergaard L, Smerup MH, Strange JE, Hadji-Turdeghal K, Voldstedlund M, Køber L, Fosbøl E. Surgery in patients with infective endocarditis and prognostic importance of patient frailty. Infection 2024:10.1007/s15010-024-02262-5. [PMID: 38676904 DOI: 10.1007/s15010-024-02262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Surgery is required in 20-50% of patients with infective endocarditis (IE). Frailty increases surgical risk; however, the prognostic implications of frailty in patients undergoing IE-related surgery remain poorly understood. We aimed to assess the association between frailty and all-cause mortality or rehospitalization after discharge (≥ 14 days). METHODS We identified all IE patients who underwent surgery during admission (2010-2020) in Denmark. The Hospital Frailty Risk Score was used to categorize patients into two frailty risk groups, patients with low frailty scores (< 5 points) and frail patients (≥ 5 points). We analyzed time hospitalized after discharge and all-cause mortality from the date of surgery with a one-year follow-up. Statistical analyses utilized the Kaplan-Meier estimator, Aalen-Johansen estimator, and the Cox regression model. RESULTS We identified 1282 patients who underwent surgery during admission, of whom 967 (75.4%) had low frailty scores, and 315 (24.6%) were frail. Frail patients were characterized by advanced age, a lower proportion of males, and a higher burden of comorbidities. Frail patients were more hospitalized (> 14 days) in the first post-discharge year (19.1% vs.12.3%) compared to patients with low frailty scores. Additionally, frail patients had higher rates of all-cause mortality including in-hospital deaths (27% vs. 15%) and rehospitalizations (43.5% vs 26.1%) compared to patients with low frailty scores. This was also evident in the adjusted analysis (hazard ratio 1.36 [CI 95% 1.09-1.71]). CONCLUSION Frailty was associated with an ≈40% increased rate of rehospitalization (≥ 14 days) or death. Further studies are needed to assess the effectiveness of surgery with a focus on frailty to improve prognostic outcomes in these patients.
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Affiliation(s)
- Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Morten Holdgaard Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Katra Hadji-Turdeghal
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Salsano A, Di Mauro M, Labate L, Della Corte A, Lo Presti F, De Bonis M, Trumello C, Rinaldi M, Cura Stura E, Actis Dato G, Punta G, Nicolini F, Carino D, De Vincentiis C, Garatti A, Cappabianca G, Musazzi A, Cugola D, Merlo M, Pacini D, Folesani G, Sponga S, Vendramin I, Pilozzi Casado A, Rosato F, Mikus E, Savini C, Onorati F, Luciani GB, Scrofani R, Epifani F, Musumeci F, Lio A, Colli A, Falcetta G, Nicolardi S, Zaccaria S, Vizzardi E, Pantaleo A, Minniti G, Villa E, Dalla Tomba M, Pollari F, Barili F, Parolari A, Lorusso R, Santini F. Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry. J Clin Med 2023; 13:153. [PMID: 38202159 PMCID: PMC10779833 DOI: 10.3390/jcm13010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. METHODS This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. RESULTS Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). CONCLUSIONS The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
| | - Michele Di Mauro
- CARIM Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Laura Labate
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy;
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, 16132 Genoa, Italy
| | - Alessandro Della Corte
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Federica Lo Presti
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Michele De Bonis
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Cinzia Trumello
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | - Erik Cura Stura
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | | | - Giuseppe Punta
- Cardiac Surgery, Mauriziano Hospital, 10128 Turin, Italy; (G.A.D.); (G.P.)
| | - Francesco Nicolini
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Davide Carino
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Carlo De Vincentiis
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | - Andrea Garatti
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | | | - Andrea Musazzi
- Cardiac Surgery, University Hospital, 21100 Varese, Italy; (G.C.); (A.M.)
| | - Diego Cugola
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Maurizio Merlo
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Davide Pacini
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Gianluca Folesani
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Sandro Sponga
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | - Igor Vendramin
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | | | - Francesco Rosato
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Elisa Mikus
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Carlo Savini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Francesco Onorati
- Cardiac Surgery, University Hospital, University of Verona, 37129 Verona, Italy; (F.O.); (G.B.L.)
| | | | - Roberto Scrofani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Epifani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Musumeci
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Antonio Lio
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Andrea Colli
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | - Giosuè Falcetta
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | | | - Salvatore Zaccaria
- Cardiac Surgery, Vito Fazzi Hospital, 73100 Lecce, Italy; (S.N.); (S.Z.)
| | | | - Antonio Pantaleo
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Giuseppe Minniti
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Margherita Dalla Tomba
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg–Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Fabio Barili
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Alessandro Parolari
- Department of Universitary Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, 20122 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
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3
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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4
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Bundgaard JS, Iversen K, Pries-Heje M, Ihlemann N, Gill SU, Madsen T, Elming H, Povlsen JA, Bruun NE, Høfsten DE, Fuursted K, Christensen JJ, Schultz M, Rosenvinge F, Helweg-Larsen J, Køber L, Torp-Pedersen C, Fosbøl EL, Tønder N, Moser C, Bundgaard H, Mogensen UM. Self-assessed health status and associated mortality in endocarditis: secondary findings from the POET trial. Qual Life Res 2022; 31:2655-2662. [PMID: 35349038 DOI: 10.1007/s11136-022-03126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Self-assessed poor health status is associated with increased risk of mortality in several cardiovascular conditions, but has not been investigated in patients with endocarditis. We examined health status and mortality in patients with endocarditis. METHODS This is a re-specified substudy of the randomized POET endocarditis trial, which included 400 patients. Patients completed the single-question self-assessed health status from the Short-Form 36 questionnaire at time of randomization and were categorized as having poor or non-poor (excellent/very good, good, or fair) health status. Self-assessed health status and all-cause mortality were examined by a Cox regression model. RESULTS Self-assessed health status was completed by 266 (67%) patients with a mean age of 68.0 years (± 11.8), 54 (20%) were females, and 86 (32%) had one or more major concurrent medical conditions besides endocarditis. The self-assessed health status distribution was poor (n = 21, 8%) and non-poor (n = 245, 92%). The median follow-up was 3.3 years and death occurred in 9 (43%) and 48 (20%) patients reporting poor and non-poor health status, respectively, and mortality rates [mortality/100 person-years, 95% confidence interval (CI)] were 18.1 (95% CI 9.4-34.8) and 5.4 (95% CI 4.1-7.2), i.e., the crude hazard ratio for death was 3.4 (95% CI: 1.7-7.0, p < 0.01). CONCLUSION Self-assessed poor health status compared with non-poor health status as assessed by a single question was associated with a threefold increased long-term mortality in patients with endocarditis. POET ClinicalTrials.gov number, NCT01375257. TRIAL REGISTRY POET ClinicalTrials.gov number, NCT01375257.
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Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia Pries-Heje
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sabine U Gill
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Trine Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Dan E Høfsten
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - Jens J Christensen
- The Regional Department of Clinical Microbiology, Region Zealand Slagelse Hospital, Region Zealand, Denmark
| | - Martin Schultz
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Flemming Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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5
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Kytö V, Gunn J. The difficult choice of prosthetic valve in infective endocarditis. Eur J Cardiothorac Surg 2021; 60:1395-1396. [PMID: 34282444 DOI: 10.1093/ejcts/ezab323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ville Kytö
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
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Rubino AS, Della Ratta EE, Galbiati D, Ashurov R, Galgano VL, Montella AP, De Feo M, Della Corte A. Can prosthesis type influence the recurrence of infective endocarditis after surgery for native valve endocarditis? A propensity weighted comparison. Eur J Cardiothorac Surg 2021; 60:1388-1394. [PMID: 34008022 DOI: 10.1093/ejcts/ezab238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/03/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Our goal was to investigate whether the incidence of valve-related adverse events might be different depending on the valve substitute after valve replacement for left-sided native valve endocarditis. METHODS We assessed the long-term freedom from recurrence, reoperation and survival of 395 patients who had valve replacements for native valve endocarditis (314 mechanical vs 81 biological). Age <18 years, reoperation, prosthetic endocarditis, right valve involvement, valve repair and homograft implants were the main exclusion criteria. The balance between the 2 groups was addressed by weighting the results on the inverse of the propensity score. RESULTS After inverse probability of treatment weighting (IPTW), freedom from recurrence of infective endocarditis was not significantly different (mechanical 84.1 ± 3.2% vs 50.6 ± 21.7%; P = 0.29) nor was freedom from reoperation different (mechanical 85.7 ± 3.1% vs biological 50.9 ± 21.9%; P = 0.29). Excluding competing deaths, patients receiving a bioprosthesis had a similar subdistribution hazard of the above end points compared to recipients of a mechanical valve [recurrence IPTW: hazard ratio (HR) 1.631, 95% confidence interval (CI) 0.756-3.516; P = 0.21; reoperation IPTW-HR 1.737, 95% CI 0.780-3.870; P = 0.18]. Mechanical valves were associated with improved long-term survival (34.9 ± 5.8% vs 10.5 ± 7.4% at 30 years; P = 0.0009; in particular: aortic valve subgroup 41.6 ± 9.3% vs 10.1 ± 8.2%; P < 0.0001), although the hazard of cardiovascular mortality did not favour either valve type (IPTW: HR 1.361, 95% CI 0.771-2.404; P = 0.29). CONCLUSIONS Our analysis showed a clinical trend in favour of mechanical valves as valve substitutes for native valve endocarditis, especially in the aortic position. In view of long-term freedom from adverse events, the choice of the valve type should be tailored according to patient characteristics and specific clinical conditions.
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Affiliation(s)
- Antonino S Rubino
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Papardo Hospital, Messina, Italy
| | - Ester E Della Ratta
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Denise Galbiati
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rasul Ashurov
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Viviana L Galgano
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio P Montella
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marisa De Feo
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Della Corte
- Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Havers-Borgersen E, Fosbøl EL, Butt JH, Petersen JK, Dalsgaard A, Kyhl F, Schou M, Phelps M, Kragholm K, Gislason GH, Torp-Pedersen C, Køber L, Østergaard L. Incidence of infective endocarditis during the coronavirus disease 2019 pandemic: A nationwide study. IJC HEART & VASCULATURE 2020; 31:100675. [PMID: 33235900 PMCID: PMC7670237 DOI: 10.1016/j.ijcha.2020.100675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022]
Abstract
The incidence of IE during lockdown was 11.1 IE cases per 100,000 PY. No reduction in the incidence of IE during the lockdown compared to preceding years. No difference in the incidence of IE pre- versus post-lockdown in 2020.
Background The incidence of infective endocarditis (IE) has increased in recent decades. Societal lockdown including reorganization of the healthcare system during the COVID-19 pandemic may influence the incidence of IE. This study sets out to investigate the incidence of IE during the Danish national lockdown. Methods In this nationwide cohort study, patients admitted with IE in either one of two periods A) A combined period of 1 January to 7 May for 2018 and 2019, or B) 1 January to 6 May 2020, were identified using Danish nationwide registries. Weekly incidence rates of IE admissions for the 2018/2019-period and 2020-period were computed and incidence rate ratios (IRR) for 2020-incidence vs 2018/2019-incidence were calculated using Poisson regression analysis. Results In total, 208 (67.3% men, median age 74.1 years) and 429 (64.1% men, median age 72.7 years) patients were admitted with IE in 2020 and 2018/2019, respectively. No significant difference in incidence rates were found comparing the 2020-period and 2018/2019-period (IRR: 0.96 (95% CI: 0.82–1.14). The overall incidence rate pre-lockdown (week 1–10: 1 January to 11 March 2020) was 14.2 IE cases per 100,000 person years (95% CI: 12.0–16.9) as compared with 11.4 IE cases per 100,000 person years (95% CI: 9.1–14.1) during lockdown (week 11–18: 12 March to 6 May 2020) corresponding to an IRR of 0.80 (95% CI: 0.60–1.06) and thus no significant difference pre- versus post-lockdown. Conclusion In this nationwide cohort study, no significant difference in the incidence of IE admissions during the national lockdown due to the COVID-19 pandemic was found.
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Affiliation(s)
- Eva Havers-Borgersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Corresponding author at: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark.
| | - Emil L. Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jawad H. Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe K. Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Dalsgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederik Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | | | - Kristian Kragholm
- Departments of Cardiology, North Denmark Regional Hospital and Aalborg University Hospital, Denmark
| | - Gunnar H. Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology. Clin Res Cardiol 2020; 110:332-342. [PMID: 32488586 PMCID: PMC7906935 DOI: 10.1007/s00392-020-01678-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
Aims Upon suspicion of infective endocarditis, the causative microorganism must be identified to optimize treatment. Blood cultures and culturing of removed valves are the mainstay of this diagnosis and should be complemented by growth-independent methods. We assessed the diagnostic benefit of examining removed endocarditis valves by broad-range bacterial PCR to detect causative bacteria in cases where culturing was not available, negative, or inconclusive because a skin commensal was detected, in patients from our clinical routine practice. Methods and results Patients from Heidelberg University Hospital with suspicion of endocarditis, followed by valve replacement and analysis by 16S rDNA PCR, between 2015 and 2018, were evaluated. 146 patients with definite infective endocarditis, confirmed by the valve macroscopics and/or histology, were included. Valve PCRs were compared to corresponding blood and valve culture results. Overall, valve PCR yielded an additional diagnostic benefit in 34 of 146 cases (23%) and was found to be more sensitive than valve culture. In 19 of 38 patients with both negative blood and valve cultures, valve PCR was the only method rendering a pathogen. In 23 patients with positive blood cultures detecting skin commensals, 4 patients showed discordant valve PCR results, detecting a more plausible pathogen, and in 11 of 23 cases, valve PCR confirmed commensals in blood culture as true pathogens. Only the remaining 8 patients had negative valve PCRs. Conclusion Valve PCR was found to be a valuable diagnostic tool in surgical endocarditis cases with negative blood cultures or positive blood cultures of unknown significance. Trial registration S-440/2017 on 28.08.2017 retrospectively registered. Graphic abstract Subdividing of all infective endocarditis patients in this study, showing that valve PCR yields valuable information for patients with skin commensals in blood cultures, which were either confirmed by the same detection in valve PCR or refuted by the detection of a different and typical pathogen in valve PCR. Additionally, benefit was determined in patients with negative or not available blood cultures and only positive detection in valve PCR. +: Positive; −: negative; n/a: not available results ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01678-x) contains supplementary material, which is available to authorized users.
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