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

Yıl 2024, Cilt: 37 Sayı: 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

Öz

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.

Anahtar Kelimeler

Infective endocarditis, Reinfection, Long-term mortality

Kaynakça

• Galar A, Weil AA, Dudzinski DM, Muñoz P, Siedner MJ. Methicillin- Resistant Staphylococcus aureus Prosthetic Valve Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev. 2019 Mar 20;32(2). doi: 10.1128/CMR.00041- 18.
• Abdulhak AAB, Baddour LM, Erwin PJ, et al. Global and regional burden of infective endocarditis, 1990–2010: a systematic review of the literature. Glob Heart. 2014;9(1):131– 43. doi: 10.1016/j.gheart.2014.01.002
• Correa de Sa DD, Tleyjeh IM, Anavekar NS, et al. Epidemiological trends of infective endocarditis: a populationbased study in Olmsted County, Minnesota. Mayo Clin Proc. 2010 May;85(5):422-6. doi: 10.4065/mcp.2009.0585.
• Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57–185. doi: 10.1016/j.jacc.2014.02.536.
• Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016 Feb 27;387(10021):882-93. doi: 10.1016/S0140- 6736(15)00067-7.
• Sunder S, Grammatico-Guillon L, Baron S, et al. Clinical and economic outcomes of infective endocarditis. Infect Dis (Lond). 2015 Feb;47(2):80-7. doi: 10.3109/00365.548.2014.968608.
• Alagna L, Park LP, Nicholson BP, et al. Repeat endocarditis: analysis of risk factors based on the International Collaboration on Endocarditis – Prospective Cohort Study. Clin Microbiol Infect. 2014 Jun;20(6):566-75. doi: 10.1111/1469-0691.12395.
• Alkhouli M, Alqahtani F, Alhajji M, Berzingi CO, Sohail MR. Clinical and Economic Burden of Hospitalizations for Infective Endocarditis in the United States. Mayo Clin Proc. 2020 May;95(5):858-866. doi: 10.1016/j.mayocp.2019.08.023.
• Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000 Apr;30(4):633-8. doi: 10.1086/313753.
• Habib G, Lancellotti P, Antunes MJ, et al.; 2015 ESC Guidelines for the management of infective endocarditis: Eur Heart J. 2015 Nov 21;36(44):3075-3128. doi: 10.1093/eurheartj/ehv319.
• Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132(15):1435e86. doi; 10.1161/ CIR.000.000.0000000296.
• Henriquez E, Fatima N, Sayabugari R, et al. Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin- Resistant Staphylococcus aureus Endocarditis. Cureus. 2023 Jun 5;15(6):e39996. doi: 10.7759/cureus.39996.
• Tahon J, Geselle PJ, Vandenberk B, et al. Long-term follow-up of patients with infective endocarditis in a tertiary referral center. Int J Cardiol. 2021 May 15;331:176-182. doi: 10.1016/j. ijcard.2021.01.048.
• Silaschi M, Nicou N, Deshpande R, et al. Complicated infective aortic endocarditis: comparison of different surgical strategies. Interact Cardiovasc Thorac Surg. 2017 Sep 1;25(3):343-349. doi: 10.1093/icvts/ivx109.
• Heiro M, Helenius H, Hurme S, et al. Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years. BMC Infect Dis. 2008 Apr 17;8:49. doi: 10.1186/1471-2334-8-49.
• Freitas-Ferraz AB, Tirado-Conte G, Vilacosta I, et al. Contemporary epidemiology and outcomes in recurrent infective endocarditis. Heart. 2020 Apr;106(8):596-602. doi: 10.1136/heartjnl-2019-315433.
• Thornhill MH, Jones S, Prendergast B, et al. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J. 2018 Feb 14;39(7):586- 595. doi: 10.1093/eurheartj/ehx655.
• Fernández-Hidalgo N, Almirante B, Tornos P, et al. Contemporary epidemiology and prognosis of health careassociated infective endocarditis. Clin Infect Dis. 2008 Nov 15;47(10):1287-97. doi: 10.1086/592576.
• Lawrence CHD, Cheaveau J, Kavourides M, Chadwick D, McCarron B. Endocarditis and the impact of intravenous drug use: a cohort study. Infect Dis (Lond). 2021 Oct;53(10):772- 778. doi: 10.1080/23744.235.2021.1928279
• Huuskonen A, Kesävuori R, Raivio P. Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers. Thorac Cardiovasc Surg. 2023 Jan;71(1):38-45. doi: 10.1055/s-0041.172.7231.
• Fabri J Jr, Issa VS, Pomerantzeff PM, Grinberg M, Barretto AC, Mansur AJ. Time- related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol. 2006 Jun 28;110(3):334-9. doi: 10.1016/j.ijcard.2005.07.016.
• Lovelock T, Zhu MZL, Saran A, Vasudevan T. Embolic phenomena to the limbs are an independent predictor of inhospital mortality from infective endocarditis. ANZ J Surg. 2022 Sep;92(9):2312-17. doi: 10.1111/ans.17907.
• Delahaye F, Alla F, Béguinot I, et al.; AEPEI Group. Inhospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scand J Infect Dis. 2007;39(10):849-57. doi: 10.1080/003.655.40701393088.
• Gelsomino S, Maessen JG, van der Veen F, et al. Emergency surgery for native mitral valve endocarditis: the impact of septic and cardiogenic shock. Ann Thorac Surg. 2012 May;93(5):1469-76. doi: 10.1016/j.athoracsur.2011.11.025.
• Shiue AB, Stancoven AB, Purcell JB, et al. Relation of level of B-type natriuretic peptide with outcomes in patients with infective endocarditis. Am J Cardiol. 2010 Oct 1;106(7):1011- 5. doi: 10.1016/j.amjcard.2010.05.034.
• Miro JM, Anguera I, Cabell CH, et al.; International Collaboration on Endocarditis Merged Database Study Group. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis. 2005 Aug 15;41(4):507-14. doi: 10.1086/431979.
• Ferrera C, Vilacosta I, Fernández C, et al. Reassessment of blood culture-negative endocarditis: its profile is similar to that of blood culture-positive endocarditis. Rev Esp Cardiol (Engl Ed). 2012 Oct;65(10):891-900. English, Spanish. doi: 10.1016/j.recesp.2012.04.004.
• Castillo JC, Anguita MP, Ramírez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study. Heart. 2000 May;83(5):525-30. doi: 10.1136/heart.83.5.525
• Cabell CH, Jollis JG, Peterson GE, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med. 2002 Jan 14;162(1):90-4. doi: 10.1001/ archinte.162.1.90.
• Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Intern Med. 2009 Jul 27;169(14):1290-8. doi: 10.1001/archinternmed.2009.192.
• Ting SW, Chen JJ, Lee TH, Kuo G. Surgical versusmedical treatment for infective endocarditis in patients on dialysis: a systematic review and meta-analysis. Ren Fail. 2022 Dec;44(1):706-713. doi: 10.1080/0886022X.2022.206.4756.