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Damasco PV, Solórzano VEF, Fortes NRQ, Setta DXDB, da Fonseca AG, Perez MCA, Jazbick JC, Gonçalves-Oliveira J, Horta MAP, de Lemos ERS, Fortes CQ. Trends of Infective Endocarditis at Two Teaching Hospitals: A 12-Year Retrospective Cohort Study in Rio de Janeiro, Brazil. Trop Med Infect Dis 2023; 8:516. [PMID: 38133448 PMCID: PMC10747105 DOI: 10.3390/tropicalmed8120516] [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: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. METHODS This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. FINDINGS The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). INTERPRETATION In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.
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Affiliation(s)
- Paulo Vieira Damasco
- Escola de Medicina e Cirurgia, Departamento de Doenças Infecciosas e Parasitárias, Universidade do Federal do Estado do Rio de Janeiro—UNIRIO, Rio de Janeiro 20271-062, Brazil
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | | | - Natália Rodrigues Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro—UFRJ, Rio de Janeiro 21941-617, Brazil; (N.R.Q.F.); (C.Q.F.)
| | - Daniel Xavier de Brito Setta
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Aloysio Guimaraes da Fonseca
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Mario Castro Alvarez Perez
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - João Carlos Jazbick
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Jonathan Gonçalves-Oliveira
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Marco Aurélio Pereira Horta
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Elba Regina Sampaio de Lemos
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Claudio Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro—UFRJ, Rio de Janeiro 21941-617, Brazil; (N.R.Q.F.); (C.Q.F.)
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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: 157] [Impact Index Per Article: 157.0] [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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Flores-Patiño JJ, Durán-Pacheco MJ, Cázares-Marroquín AM, Gastélum-Cano JM, Islas-Osuna MA, Arízaga-Berber JA. Endocarditis due to Candida albicans in an immunocompromised patient: A case report. Rev Iberoam Micol 2023; 40:31-34. [PMID: 37770333 DOI: 10.1016/j.riam.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%. CASE REPORT Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. CONCLUSIONS Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.
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Affiliation(s)
| | | | | | - José M Gastélum-Cano
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - María A Islas-Osuna
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - José A Arízaga-Berber
- Escuela de Medicina, Universidad de Celaya, Celaya, Guanajuato, Mexico; Hospital General Zona 4 del Instituto Mexicano del Seguro Social (IMSS), Celaya, Guanajuato, Mexico.
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Lefèvre B, Legoff A, Boutrou M, Goehringer F, Ngueyon-Sime W, Chirouze C, Revest M, Vernet Garnier V, Duval X, Delahaye F, Le Moing V, Selton-Suty C, Filippetti L, Hoen B, Agrinier N. Staphylococcus aureus endocarditis: Identifying prognostic factors using a method derived from morbidity and mortality conferences. Front Med (Lausanne) 2022; 9:1053278. [PMID: 36561723 PMCID: PMC9763316 DOI: 10.3389/fmed.2022.1053278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Lethality of Staphylococcus aureus (Sa) infective endocarditis (IE) is high and might be due to yet unidentified prognostic factors. The aim of this study was to search for new potential prognostic factors and assess their prognostic value in SaIE. Materials and methods We used a two-step exploratory approach. First, using a qualitative approach derived from mortality and morbidity conferences, we conducted a review of the medical records of 30 patients with SaIE (15 deceased and 15 survivors), randomly extracted from an IE cohort database (NCT03295045), to detect new factors of possible prognostic interest. Second, we collected quantitative data for these factors in the entire set of SaIE patients and used multivariate Cox models to estimate their prognostic value. Results A total of 134 patients with modified Duke definite SaIE were included, 64 of whom died during follow-up. Of the 56 candidate prognostic factors identified at the first step, 3 had a significant prognostic value in multivariate analysis: the prior use of non-steroidal anti-inflammatory drugs [aHR 3.60, 95% CI (1.59-8.15), p = 0.002]; the non-performance of valve surgery when indicated [aHR 1.85, 95% CI (1.01-3.39), p = 0.046]; and the decrease of vegetation size on antibiotic treatment [aHR 0.34, 95% CI (0.12-0.97), p = 0.044]. Conclusion We identified three potential SaIE prognostic factors. These results, if externally validated, might eventually help improve the management of patients with SaIE.
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Affiliation(s)
- Benjamin Lefèvre
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France,Université de Lorraine, APEMAC, Nancy, France,*Correspondence: Benjamin Lefèvre,
| | - Antoine Legoff
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France
| | - Mathilde Boutrou
- CH Andrée Rosemon, Unité de Maladies Infectieuses et Tropicales, Cayenne, France
| | | | - Willy Ngueyon-Sime
- CHRU-Nancy, Institut National de la Sante et de la Recherche Medicale (INSERM), Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Catherine Chirouze
- UMR 6249 CNRS-UFC Chrono-environnement, Service de Maladies Infectieuses, CHRU Besançon, Besançon, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France,CIC-Institut National de la Sante et de la Recherche Medicale (INSERM) 1414, Pontchaillou University Hospital, Rennes, France,University of Rennes, Institut National de la Sante et de la Recherche Medicale (INSERM), Bacterial Regulatory RNAs and Medicine, UMR 1230, Rennes, France
| | | | - Xavier Duval
- Institut National de la Sante et de la Recherche Medicale (INSERM) CIC 1425, Bichat–Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Institut National de la Sante et de la Recherche Medicale (INSERM), UMR-1137, IAME, Paris University, Paris, France,Université de Paris, IAME, Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France,Centre for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | | | - Vincent Le Moing
- Montpellier University Hospital, Department of Infectious and Tropical Diseases, Montpellier, France
| | | | | | - Bruno Hoen
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France,Université de Lorraine, APEMAC, Nancy, France
| | - Nelly Agrinier
- Université de Lorraine, APEMAC, Nancy, France,CHRU-Nancy, Institut National de la Sante et de la Recherche Medicale (INSERM), Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
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Tan R, Yu JQ, Wang J, Zheng RQ. Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature. World J Clin Cases 2022; 10:10670-10680. [PMID: 36312476 PMCID: PMC9602224 DOI: 10.12998/wjcc.v10.i29.10670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a rare disease with a high mortality rate. Leclercia adecarboxylata (L. adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae, and it can rarely be a pathogen which often affects immunodeficient patients. There are about three cases of immunocompetent patients with monomicrobial L. adecarboxylata infection. There are only three reported cases of IE caused by L. adecarboxylata in the world. The mitral valve is often affected in IE, and the prognosis for IE with mitral valve lesions is often poor.
CASE SUMMARY A 51-year-old man was found to have moderate to severe mitral stenosis on echocardiography. He came to our Cardiothoracic Surgery Department for surgical management. A diastolic murmur was heard on auscultation of the heart in the mitral region. On the second day of hospitalisation, he presented with slurred speech, reduced muscle strength in the left limb, and acute cerebral infarction on cranial computed tomography. Surgical treatment was decided to postpone. On the ninth day of admission, the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit, where echocardiogram revealed an anterior mitral valve leaflet vegetation. After empirical anti-infective treatment with vancomycin (1g q12h), an emergency valve replacement was performed. Bacterial culture identified L. adecarboxylata. Anti-infective treatment with piperacillin-tazobactam (4.5g q8h) was added for 4 wk. Follow-up echocardiography showed normal bioprosthetic valve function after mitral valve replacement.
CONCLUSION We report the first case of L. adecarboxylata IE in China, and clinicians should pay attention to this pathogen.
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Affiliation(s)
- Rui Tan
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Jiang-Quan Yu
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Jing Wang
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Rui-Qiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
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Zhang X, Jin F, Lu Y, Ni F, Xu Y, Xia W. Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study. Infect Drug Resist 2022; 15:3179-3189. [PMID: 35754785 PMCID: PMC9215907 DOI: 10.2147/idr.s362601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups. Methods A total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50–65 y, and > 65 y. Results The mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). Streptococcus was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection. Conclusion CHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. Streptococcus is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection showed poorer in-hospital outcomes.
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Affiliation(s)
- Xiaohui Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fei Jin
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yanfei Lu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fang Ni
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yuqiao Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Wenying Xia
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
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Urina-Jassir M, Jaimes-Reyes MA, Martinez-Vernaza S, Quiroga-Vergara C, Urina-Triana M. Clinical, Microbiological, and Imaging Characteristics of Infective Endocarditis in Latin America: A Systematic Review. Int J Infect Dis 2022; 117:312-321. [PMID: 35181535 DOI: 10.1016/j.ijid.2022.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We aimed to describe the clinical, microbiological, and imaging characteristics of patients with infective endocarditis (IE) in studies from Latin America (LATAM). METHODS A systematic search through PubMed, EMBASE, LILACS, and SciELO from inception until February 2021 was conducted. We included observational studies that assessed adults with IE from LATAM and reported data on clinical, microbiological, or imaging characteristics. Data were independently extracted by 2 authors and the risk of bias was evaluated by study design with its respective tool. Findings were summarized using descriptive statistics. RESULTS Forty-four studies were included. Most cases were male (68.5%), had a predisposing condition including valve disease (24.3%), or had a prosthetic valve (23.4%). Clinical manifestations included fever (83.9%), malaise (63.2%), or heart murmur (57.7%). A total of 36.4% and 27.1% developed heart failure or embolism, respectively. Blood cultures were negative in 23.9% and S. aureus (18.6%) and the viridans group streptococci (17.8%) were the most common isolates. Most cases were native valve IE (67.3%) affecting mainly left-sided valves. Echocardiographic findings included vegetations (84.3%) and regurgitation (75.9%). In-hospital mortality was 25.1%. CONCLUSIONS This is the first systematic review that evaluated the characteristics of IE in LATAM patients. A lack of multicenter studies reflects the need for these studies in LATAM.
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Affiliation(s)
- Manuel Urina-Jassir
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Maria Alejandra Jaimes-Reyes
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Samuel Martinez-Vernaza
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Camilo Quiroga-Vergara
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Miguel Urina-Triana
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia; Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 59 # 59 - 65, Barranquilla, Atlántico, Colombia.
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Williams ML, Doyle MP, McNamara N, Tardo D, Mathew M, Robinson B. Epidemiology of infective endocarditis before versus after change of international guidelines: a systematic review. Ther Adv Cardiovasc Dis 2021; 15:17539447211002687. [PMID: 33784909 PMCID: PMC8020745 DOI: 10.1177/17539447211002687] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: All major international guidelines for the management of infective endocarditis (IE) have undergone major revisions, recommending antibiotic prophylaxis (AP) restriction to high-risk patients or foregoing AP completely. We performed a systematic review to investigate the effect of these guideline changes on the global incidence of IE. Methods: Electronic database searches were performed using Ovid Medline, EMBASE and Web of Science. Studies were included if they compared the incidence of IE prior to and following any change in international guideline recommendations. Relevant studies fulfilling the predefined search criteria were categorized according to their inclusion of either adult or pediatric patients. Incidence of IE, causative microorganisms and AP prescription rates were compared following international guideline updates. Results: Sixteen studies were included, reporting over 1.3 million cases of IE. The crude incidence of IE following guideline updates has increased globally. Adjusted incidence increased in one study after European guideline updates, while North American rates did not increase. Cases of IE with a causative pathogen identified ranged from 62% to 91%. Rates of streptococcal IE varied across adult and pediatric populations, while the relative proportion of staphylococcal IE increased (range pre-guidelines 16–24.8%, range post-guidelines 26–43%). AP prescription trends were reduced in both moderate and high-risk patients following guideline updates. Discussion: The restriction of AP to only high-risk patients has not resulted in an increase in the incidence of streptococcal IE in North American populations. The evidence of the impact of AP restriction on IE incidence is still unclear for other populations. Future population-based studies with adjusted incidence of IE, AP prescription rates and accurate pathogen identification are required to delineate findings further in these other regions.
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Affiliation(s)
- Michael L Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Mathew P Doyle
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Keiraville, Australia
| | - Nicholas McNamara
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Daniel Tardo
- Department of Medicine, St Vincents Hospital, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Manish Mathew
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Robinson
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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