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Evolution of epidemiological characteristics of infective endocarditis in Greece. Int J Infect Dis 2021; 106:213-220. [PMID: 33711517 DOI: 10.1016/j.ijid.2021.03.009] [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: 12/06/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. METHODS A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. RESULTS Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. CONCLUSIONS A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.
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Cecchi E, Ciccone G, Chirillo F, Imazio M, Cecconi M, Del Ponte S, Moreo A, Faggiano P, Cialfi A, Squeri A, Enia F, Forno D, De Rosa FG, Rinaldi M, Castiglione A. Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study. Interact Cardiovasc Thorac Surg 2019; 26:602-609. [PMID: 29272391 DOI: 10.1093/icvts/ivx394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda, Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | | | - Angelo Squeri
- Dipartimento Cardio, Nefro-Polmonare, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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