Long-term follow-up of infective endocarditis: Rates of reinfection, mortality, and predictors of outcome

Year 2024, Volume: 37 Issue: 3, 366 - 372, 30.10.2024

Mehmet Altunova , Recep Gülmez Hicaz Zincirkiran Ağuş Tugba Aktemur , Serpil Öztürk , Ali Evsen , Yusuf Demir Uğur Köktürk , Mehmet Köseoğlu , Gamze Babur Güler

https://doi.org/10.5472/marumj.1573453

Abstract

Objective: Infective endocarditis (IE) is a severe condition characterized by high mortality rates. We aimed to assess reinfection and
mortality rates in IE patients at a tertiary referral center during long-term follow-up.
Patients and Methods: We retrospectively analyzed 204 patients meeting modified Duke criteria for definite IE between 2009 and 2019.
Early reinfection was defined as occurrence within 6 months, and late reinfection was defined as occurrence 6 months after the initial
diagnosis.
Results: Mean follow-up duration was 40.3 ± 26.4 months. Valve surgery was performed in 125 patients (69.8%), while 54 (30.2%)
received medical therapy alone. Early reinfection was
seen in 9 patients (5.1%), and late reinfection in 12 patients (6.7%). Staphylococci (41.9%), Streptococci (26.3%), and Enterococci
(15.6%) were common pathogens. Peripheral limb emboli predicted reinfection (HR 4.118, 95% CI 1.471-11.528, p=0.007). Survival
rates at 1, 2, and 5 years were 70.2%, 65.7%, and 57.3%, respectively. Age (HR 1.030, 95% CI 1.011 – 1.049, p=0.002), peripheral limb
emboli (HR 2.994, 95% CI 1.509-5.940, p=0.002), and septic shock (HR 2.357, 95% CI 1.097-5.065, p=0.028) predicted mortality.
Conclusion: Infective endocarditis mortality rates remain high regardless of reinfection. Peripheral limb emboli independently
determine reinfection and mortality. Careful management of this group may reduce morbidity and mortality.

Keywords

Infective endocarditis, Reinfection, Long-term mortality

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