Infective endocarditis profile, prognostic factors and in-hospital
mortality: six-year trends from a tertiary university center in South
America
Abstract
Background: Infective endocarditis (IE) remains an expressive health
problem with high morbimortali-ty rates. Despite its importance,
epidemiological and microbiological data remain scarce, especially in
developing countries. Aim: This study aims to describe IE
epidemiological, clinical, and microbiological profile in a tertiary
university center in South America, and to identify in-hospital
mortality rate and predictors. Methods: Observational, retrospective
study of 167 patients, who fulfilled modified Duke’s criteria during a
six-year enrollment period, from January 2010 to December 2015. Primary
outcome was de-fined as in-hospital mortality analyzed according to
treatment received (clinical vs. surgical). Multivari-ate analysis
identified mortality predictors. Results: Median age was 60years (Q1-Q3
50-71), and 66% were male. Echocardiogram demonstrated vegetations in
90.4%. An infective agent was identified in 76.6%, being
Staphylococcus aureus (19%), Enterococcus (12%), Coagulase-negative
staphylococci (10%), and Streptococcus viridans (9.6%) the most
prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4%
to 34.1%, in clinical and surgical patients, respectively (p=0.047). On
multivariate analysis, diabetes mellitus (OR 2.5), previous structural
heart disease (OR 3.1), and mitral valve infection (OR 2.1) were
all-cause death predictors. Surgical treatment was the only variable
related to better outcome (OR 0.45; 95%IC 0.2-0.9). Conclusion: This
study presents IE profile and all-cause mortality in a large patient’s
cohort, compris-ing a 6-years’ time window, a rare initiative in
developing countries. Elderly and male patients predom-inated, while
Staphylococcus aureus was the main microbiological agent. Patients
conservatively treated presented higher mortality than surgically
managed ones. Epidemiological studies from developing countries are
essential to increase IE understanding.