1
|
El-Dalati S, Paras ML, Strnad L, Harris AW, Gurley JC, Sekela M, Nauriyal V, Januzzi JL, DeFaria Yeh D, Yucel E. In Plain Sight: The Need for a Dedicated Cardiovascular Infectious Disease Subspecialty. JACC. ADVANCES 2024; 3:100748. [PMID: 38939821 PMCID: PMC11198213 DOI: 10.1016/j.jacadv.2023.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Sami El-Dalati
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Molly L. Paras
- Division of Infectious Diseases, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Strnad
- Division of Infectious Diseases, Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Andrew W. Harris
- Division of Cardiology, Department of Internal Medicine, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - John C. Gurley
- Division of Cardiology, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michael Sekela
- Department of Cardiac Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Varidhi Nauriyal
- Division of Infectious Diseases, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James L. Januzzi
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evin Yucel
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Chobufo MD, Atti V, Vasudevan A, Bhandari R, Badhwar V, Baddour LM, Balla S. Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm. J Am Heart Assoc 2023; 12:e031589. [PMID: 38088249 PMCID: PMC10863783 DOI: 10.1161/jaha.123.031589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Data on national trends in mortality due to infective endocarditis (IE) in the United States are limited. METHODS AND RESULTS Utilizing the multiple causes of death data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2020, IE and substance use were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Between 1999 and 2020, the IE-related age-adjusted mortality rates declined. IE-related crude mortality accelerated significantly in the age groups 25-34 years (average annual percentage change, 5.4 [95% CI, 3.1-7.7]; P<0.001) and 35-44 years (average annual percentage change, 2.3 [95% CI, 1.3-3.3]; P<0.001), but remained stagnant in those aged 45-54 years (average annual percentage change, 0.5 [95% CI, -1.9 to 3]; P=0.684), and showed a significant decline in those aged ≥55 years. A concomitant substance use disorder as multiple causes of death in those with IE increased drastically in the 25-44 years age group (P<0.001). The states of Kentucky, Tennessee, and West Virginia showed an acceleration in age-adjusted mortality rates in contrast to other states, where there was predominantly a decline or static trend for IE. CONCLUSIONS Age-adjusted mortality rates due to IE in the overall population have declined. The marked acceleration in mortality in the 25- to 44-year age group is a cause for alarm. Regional differences with acceleration in IE mortality rates were noted in Kentucky, Tennessee, and West Virginia. We speculate that this acceleration was likely due mainly to the opioid crisis that has engulfed several states and involved principally younger adults.
Collapse
Affiliation(s)
- Muchi Ditah Chobufo
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | - Varunsiri Atti
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | | | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public HealthWest Virginia UniversityMorgantownWVUSA
| | - Vinay Badhwar
- Department of Cardiothoracic SurgeryWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | - Larry M. Baddour
- Division of Infectious Diseases, Department of Internal Medicine, Mayo ClinicRochesterMNUSA
| | - Sudarshan Balla
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| |
Collapse
|
3
|
Novelli A, Ingason AB, Jirka C, Callas P, Hirashima F, Lovoulos C, Dauerman HL, Polomsky M. Impact of the COVID-19 Pandemic on Infective Endocarditis Management and Outcomes: Analysis of a National Clinical Database. Am J Cardiol 2023; 209:224-231. [PMID: 37922610 DOI: 10.1016/j.amjcard.2023.08.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 11/07/2023]
Abstract
COVID-19 has widely affected health care delivery, but its impact on the management of infective endocarditis (IE), including valve surgery, is uncertain. We compared the national trends in admissions, demographics, and outcomes of IE before and after COVID-19 onset, using a national sample of IE admissions between 2016 and 2022 from the Vizient Clinical Database. The pre-COVID-19 and post-COVID-19 time periods were separated by the start of the second quarter of 2020, the time during which the COVID-19 pandemic was declared. For all admissions and for admissions involving valve surgery, pre-COVID-19 versus post-COVID-19 baseline characteristics and outcomes were compared using 2-sample t tests or chi-square tests. Propensity score-matched cohorts were similarly compared. Before COVID-19, there were 82,867 overall and 11,337 valve-related surgical admissions, and after COVID-19, there were 45,672 overall and 6,322 valve-related surgical admissions. In the matched analysis for all admissions, the in-hospital mortality increased from 11.4% to 12.4% after COVID-19 onset (p <0.001); in-hospital stroke (4.9% vs 6.0%, p <0.001), myocardial infarction (1.3% vs 1.4%, p = 0.03), and aspiration pneumonia (1.8% vs 2.4%, p <0.001) also increased, whereas other complications remained stable. In the matched analysis of surgical admissions, there was decreased in-hospital mortality (7.7% vs 6.7%, p = 0.03) and intensive care unit stay (8.5 ± 12.5 vs 8.0 ± 12.6 days, p = 0.04); other outcomes remained stable. In conclusion, patients admitted with IE after COVID-19 were more medically complex with worsened outcomes and mortality, whereas patients who underwent valve surgery had stable outcomes and improved mortality despite the pandemic.
Collapse
Affiliation(s)
- Alexandra Novelli
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Arnar B Ingason
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Caroline Jirka
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Peter Callas
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Fuyuki Hirashima
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Constantinos Lovoulos
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Marek Polomsky
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
| |
Collapse
|
4
|
Agrawal P, Khan MZ, Mann C, Munir MB, Syed M, Raina S, Balla S, Patel B. Comparison of trends and outcomes of infective endocarditis in patients with versus without leukemia, 2002 to 2017, from a nationwide inpatient sample. Proc AMIA Symp 2023; 36:308-313. [PMID: 37091749 PMCID: PMC10120530 DOI: 10.1080/08998280.2023.2187209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Patients with leukemia are at an increased risk for infective endocarditis secondary to their immunocompromised state, chemotherapy, and specific risk factors such as the presence of indwelling central venous catheters. There is a paucity of data regarding temporal trends and clinical outcomes of infective endocarditis in leukemia patients. Previous studies have shown a high rate of complications related to surgical valve procedures for treatment of infective endocarditis in patients with hematological malignancies. In this study, we aimed to analyze the contemporary trends and clinical outcomes of treatment in infective endocarditis patients with and without leukemia based on data available from the Nationwide Inpatient Sample, which is a publicly accessible, large sample-sized national dataset of hospitalized patients across the US. We present key findings on baseline characteristics, microbiological profile, outcomes, rates of valve surgical procedures, and mortality in infective endocarditis patients with and without leukemia between 2002 and 2017 in the US.
Collapse
Affiliation(s)
- Pratik Agrawal
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Muhammad Zia Khan
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Chitsimran Mann
- Internal Medicine Residency, St. Elizabeth’s Youngstown Hospital, Youngstown, Ohio
| | | | - Moinuddin Syed
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Sameer Raina
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Sudarshan Balla
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Brijesh Patel
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
- Corresponding author: Brijesh Patel, DO, West Virginia University Heart & Vascular Institute, 1 Medicine Center Drive, Box 8003, Morgantown, WV26506 (e-mail: )
| |
Collapse
|
5
|
Johnstone R, Khalil N, Shojaei E, Puka K, Bondy L, Koivu S, Silverman M. Different drugs, different sides: injection use of opioids alone, and not stimulants alone, predisposes to right-sided endocarditis. Open Heart 2022; 9:openhrt-2021-001930. [PMID: 35878959 PMCID: PMC9328093 DOI: 10.1136/openhrt-2021-001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Many studies suggest that infective endocarditis (IE) in people who inject drugs is predominantly right sided, while other studies suggest left sided disease; few have differentiated by class of drug used. We hypothesised that based on differing physiological mechanisms, opioids but not stimulants would be associated with right sided IE. Methods A retrospective case series of 290 adult (age ≥18) patients with self-reported recent injection drug use, admitted for a first episode of IE to one of three hospitals in London Ontario between April 2007 and March 2018, stratified patients by drug class used (opioid, stimulant or both), and by site of endocarditis. Other outcomes captured included demographics, causative organisms, cardiac and non-cardiac complications, referral to addiction services, medical versus surgical management, and survival. Results Of those who injected only opioids, 47/71 (69%) developed right-sided IE, 17/71 (25%) developed left-sided IE and 4/71 (6%) had bilateral IE. Of those who injected only stimulants, 11/24 (46%) developed right-sided IE, 11/24 (46%) developed left-sided IE and 2/24 (8%) had bilateral IE. Relative to opioid-only users, stimulant-only users were 1.75 (95% CI 1.05 to 2.93; p=0.031) times more likely to have a left or bilateral IE versus right IE. Conclusions While injection use of opioids is associated with a strong predisposition to right-sided IE, stimulants differ in producing a balanced ratio of right and left-sided disease. As the epidemic of crystal methamphetamine injection continues unabated, the rate of left-sided disease, with its attendant higher morbidity and mortality, may also grow.
Collapse
Affiliation(s)
- Rochelle Johnstone
- Infectious Diseases, London Health Sciences Centre, London, Ontario, Canada.,Medicine, Western University, London, Ontario, Canada
| | - Nadine Khalil
- Infectious Diseases, London Health Sciences Centre, London, Ontario, Canada.,Medicine, Western University, London, Ontario, Canada
| | - Esfandiar Shojaei
- Infectious Diseases, London Health Sciences Centre, London, Ontario, Canada
| | - Klajdi Puka
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lise Bondy
- Infectious Diseases, London Health Sciences Centre, London, Ontario, Canada.,Medicine, Western University, London, Ontario, Canada
| | - Sharon Koivu
- Family Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Silverman
- Infectious Diseases, London Health Sciences Centre, London, Ontario, Canada .,Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
6
|
Sousa C, Pinto FJ. Endocardite Infecciosa: Ainda mais Desafios que Certezas. Arq Bras Cardiol 2022; 118:976-988. [PMID: 35613200 PMCID: PMC9368884 DOI: 10.36660/abc.20200798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.
Collapse
|
7
|
Caceres Polo M, Thibault D, Jawitz OK, Zwischenberger BA, O'Brien SM, Thourani VH, Jacobs JP, Hooker RL. AORTIC PROSTHETIC VALVE ENDOCARDITIS: ANALYSIS OF THE SOCIETY OF THORACIC SURGEONS DATABASE. Ann Thorac Surg 2021; 114:2140-2147. [PMID: 34875263 DOI: 10.1016/j.athoracsur.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/06/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to characterize the current U.S. experience of aortic prosthetic valve endocarditis (PVE) compared to native valve endocarditis (NVE). METHODS The Society of Thoracic Surgeons Database was queried for entries of active aortic infective endocarditis (IE). Two analyses were performed: 1) Trends of surgical volume and operative mortality (2011 to 2019) and 2) Descriptive and risk-adjusted comparisons between PVE and NVE (2014 to 2019), using multivariable logistic regression. RESULTS From 2011 to 2019, there was a yearly increase in the proportion of PVE (20.9% to 25.9%; p<0.001) with a concurrent decrease in operative mortality (PVE=22.5% to 10.4%; p<0.001; NVE=10.9% to 8.5%; p<0.001). From 2014 to 2019, active aortic IE was identified in 9,768 patients (NVE=6,842; PVE=2,926). Aortic root abscess (50.1% versus 25.2%; p<0.001), aortic root replacement (50.1% versus 12.8%; p<0.001), homograft implantation (27.2% versus 4.1%; p<0.001), and operative mortality (12.2% versus 6.4%; p<0.001) were higher in PVE. Following risk-adjustment, PVE (odds ratio [OR]=1.5; 95% confidence interval (CI):1.16-1.94; p<0.01), aortic root replacement (OR=1.49; 95% CI:1.15-1.92; p<0.001), staphylococcus aureus (OR=1.5; 95% CI:1.23-1.82; p<0.001), and unplanned revascularization (OR=5.83; 95% CI:4.12-8.23; p<0.001) or mitral valve surgery (OR=2.29; 95% CI:1.5-3.51; p<0.001) correlated with a higher operative mortality, while prosthesis type (p=0.68) was not an independent predictor. CONCLUSIONS IE in the U.S. has risen over the past decade. However, operative mortality has decreased for both PVE and NVE. PVE, extension of IE requiring aortic root replacement, and additional unplanned surgical interventions carry an elevated mortality risk. Prosthesis selection did not impact operative mortality.
Collapse
Affiliation(s)
- Manuel Caceres Polo
- Department of Cardiac Surgery, Christus Spohn Hospital, Corpus Christi, Texas.
| | - Dylan Thibault
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Oliver K Jawitz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Robert L Hooker
- Department of Surgery, University of Arizona, Tucson, Arizona
| |
Collapse
|
8
|
Ceftolozane/tazobactam for refractory P. aeruginosa endocarditis: A case report and pharmacokinetic analysis. J Infect Chemother 2021; 28:87-90. [PMID: 34535403 DOI: 10.1016/j.jiac.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
We describe a case of a 48 years old male with left sided endocarditis and septic emboli secondary to a Pseudomonas aeruginosa strain that developed resistance to other β-lactam antibiotics during therapy resulting in prolonged bacteremia. Blood cultures sterilized within 1 day of initiating ceftolozane/tazobactam 3 g every 8 hours in combination with ciprofloxacin. Steady state free ceftolozane plasma Cmax and Cmin concentrations were calculated to be 122.2μg/mL and 24.3μg/mL, respectively. The multidrug-resistant strain harbored chromosomal β-lactamases OXA-486 and PDC-3, mutations in ampD and dacB predicted to lead to ampC over-expression, and mutations in OprD predicted to decrease outer membrane permeability. Following completion of a 42 day course and aortic valve replacement, the patient was deemed clinically cured without recurrence of infection at follow up 2 years later. To our knowledge, this is the first reported case to measure ceftolozane concentrations during the treatment of endocarditis which supports dose optimization approaches of severe endovascular disease due to multidrug resistant pathogens.
Collapse
|
9
|
Trends in Infective Endocarditis in End-stage Renal Disease Patients (From National Inpatient Sample [2006-2017]). Am J Cardiol 2021; 147:149-150. [PMID: 33667449 DOI: 10.1016/j.amjcard.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
|
10
|
Khan MZ, Munir MB, Khan MU, Kuprica T, Balla S. Burden of Infective Endocarditis in Homeless Patients in the United States: A National Perspective. Am J Med Sci 2021; 362:39-47. [PMID: 33798460 DOI: 10.1016/j.amjms.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/06/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Earlier studies have shown disparate cardiovascular care in homeless patients. Limited data exist on burden of infective endocarditis (IE) in homeless patients and in this study, we aimed to analyze it using a nationally representative United States population sample. METHODS Data were extracted from National Inpatient Sample database from January 2000 to December 2017. Patients with endocarditis were sampled using International Classification of Diseases, 9th Revision, Clinical Modification codes of 421.0, 421.1 or 421.9 and International Classification of Diseases, 10th Revision, Clinical Modification codes of I33.0 or I33.9. Homeless patients were identified using codes of V60 and Z59. Linear regression was used for trend analysis and logistic regression was utilized to identify predictors of mortality. 1:1 propensity score (PS) matching was also done to balance confounders and outcomes were assessed in both unmatched and matched cohorts. RESULTS We found an increase in proportion of homeless patients admitted with endocarditis from 0.2% in year 2000 to 2.4% in year 2017. Mortality was not statistically significant in PS matched homeless and non-homeless cohorts (4.7% vs 6.6%, p = 0.072). There was a trend towards increased mortality in homeless endocarditis patients over our study years with lower utilization of valvular surgeries. Advanced age, alcohol abuse and admission to large hospitals were independently associated with mortality in homeless endocarditis patients. CONCLUSION Homeless patients have rising trend of IE and IE related mortality and also found to have low utilization of life saving valvular surgeries when compared to general population.
Collapse
Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Troy Kuprica
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| |
Collapse
|
11
|
Sousa C, Nogueira P, Pinto FJ. Insight into the epidemiology of infective endocarditis in Portugal: a contemporary nationwide study from 2010 to 2018. BMC Cardiovasc Disord 2021; 21:138. [PMID: 33726669 PMCID: PMC7962378 DOI: 10.1186/s12872-021-01937-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal. METHODS A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018. RESULTS 7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p < 0.001) and increased with age, peaking at patients 80 years old or older (40.62 per 100,000). In-hospital mortality rate significantly increased during the analyzed period, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, and acute renal failure. Younger age and cardiac surgery had a protective effect towards a fatal outcome. CONCLUSIONS In Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. Also, a significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.
Collapse
Affiliation(s)
- Catarina Sousa
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal. .,Serviço de Cardiologia, Centro Hospitalar Barreiro Montijo (CHBM), EPE, Barreiro, Portugal.
| | - Paulo Nogueira
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Instituto Medicina Preventiva E Saúde Publica, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon, 1649-028, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal.,Departamento Do Coração E Vasos, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
| |
Collapse
|
12
|
Abe T, Eyituoyo HO, De Allie G, Olanipekun T, Effoe VS, Olaosebikan K, Mather P. Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus. World J Cardiol 2021; 13:11-20. [PMID: 33552399 PMCID: PMC7821010 DOI: 10.4330/wjc.v13.i1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM).
AIM To investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes.
METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with vs without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block.
RESULTS Crude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% vs 35.6%; P < 0.0001). After propensity matching, in-hospital mortality (11.1% vs 11.9%; P < 0.0001), stroke (2.3% vs 3.0%; P < 0.0001), acute heart failure (4.6% vs 6.5%; P = 0.001), cardiogenic shock (1.5% vs 1.9%; P < 0.0001), septic shock (7.2% vs 9.6%; P < 0.0001), and atrioventricular block (1.5% vs 2.4%; P < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.
CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.
Collapse
Affiliation(s)
- Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Harry Onoriode Eyituoyo
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, United States
| | - Gabrielle De Allie
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Titilope Olanipekun
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Valery Sammah Effoe
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Kikelomo Olaosebikan
- Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen 4032, Hungary
| | - Paul Mather
- Department of Cardiovascular Disease, University of Pennsylvania, Pennsylvania, PA 19104, United States
| |
Collapse
|
13
|
Ma L, Ge Y, Ma H, Zhu B, Miao Q. Infective endocarditis at a tertiary-care hospital in China. J Cardiothorac Surg 2020; 15:135. [PMID: 32522279 PMCID: PMC7285574 DOI: 10.1186/s13019-020-01183-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with in-hospital mortality. Methods A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included. Results A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy. Conclusions Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.
Collapse
Affiliation(s)
- Lulu Ma
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ying Ge
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Isreal Deaconess Medical Center, Boston, MA, 02215, USA
| | - Bo Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|