Patients with Infective Endocarditis: Experience of a Single-Center and Tertiary Referral Hospital for Five-Years

Abstract

Objective: Infective endocarditis (IE) is a systemic infection which results from the inner surface of the heart. Due to rarity of disease and absence of data from large randomized clinical trials, recommendations for prevention, diagnosis and treatment of IE are still derived from expert opinion and observational cohort studies. In this study to we aimed to describe the epidemiological and clinical features of IE in a single tertiary-care hospital in Turkey.

Materials and Methods: The records of 61 patients aged ≥18 who were admitted to our cardiology clinic due to IE were investigated retrospectively. Clinical and demographic characteristics of patients, labratory values, microbiological findings, treatment modalities, records of transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE) examinations and hospitalization outcomes were evaluated.

Results: According to our data, serum white blood cell (WBC), sedimantation (ESR), C reactive protein (CRP) and procalcitonin levels were significantly higher in patients who died from IE compared to those who survived (p<0.05). In addition, there was a statistically significant association between in hospital mortality and presence of chronic renal failure and pericardial effussion (p<0.05). Furthermore, presence of valvular regurgitation and large vegetations were more prevalent in patients who died from IE compared to those who survived (p<0.05).

Conclusion: Our data showed that IE has a diverse etiology, various clinical manifestations and often requires different therapeutic approaches. In order to prevent complications, careful assessment and optimal timing of surgery is mandatory.

Keywords

• infective endocarditis
• heart failure
• valvular regurgitation

Enfektif Endokarditli Hastalar: Üçüncü Basamak Tek Merkez Sevk Hastanesinin Beş Yıllık Deneyimi

Öz

Amaç: Enfektif endokardit (EE), kalbin iç yüzeyinden kaynaklanan sistemik bir enfeksiyondur. Hastalığın nadir olması ve büyük randomize klinik çalışmalardan veri bulunmaması nedeniyle, EE'nin önlenmesi, teşhisi ve tedavisi için öneriler hala uzman görüşlerinden ve gözlemsel kohort çalışmalarından elde edilmektedir. Bu çalışmada Türkiye'deki tek bir üçüncü basamak hastanesinde EE'nin epidemiyolojik ve klinik özelliklerini tanımlamayı amaçladık.

Materyal ve Metot: Kardiyoloji kliniğimize EE nedeniyle başvuran 61 (≥18 yaş) hastanın kayıtları geriye dönük olarak incelendi. Hastaların klinik ve demografik özellikleri, laboratuvar değerleri, mikrobiyolojik bulgular, tedavi yöntemleri, transtorasik ekokardiyografi (TTE) kayıtları ve transözofageal ekokardiyografi (TÖE) tetkikleri ve hastanede yatış sonuçları değerlendirildi.

Bulgular: Verilerimize göre EE'den ölen hastalarda, hayatta kalanlara göre serum beyaz kan hücresi (WBC), sedimantasyon (ESR), C reaktif protein (CRP) ve prokalsitonin düzeyleri anlamlı olarak yüksekti (p<0,05). Ek olarak hastane içi mortalite ile kronik böbrek yetmezliği ve perikardiyal efüzyon varlığı arasında istatistiksel olarak anlamlı bir ilişki vardı (p<0,05). Ayrıca, EE'den ölen hastalarda, hayatta kalanlara göre kapak yetersizliği ve büyük vejetasyon varlığı daha yaygındı (p<0,05).

Sonuç: Verilerimiz, EE'nin farklı bir etiyolojiye, çeşitli klinik belirtilere sahip olduğunu ve sıklıkla farklı terapötik yaklaşımlar gerektirdiğini gösterdi. Komplikasyonları önlemek için dikkatli değerlendirme ve en uygun ameliyat zamanlaması çok önemlidir. 

Anahtar Kelimeler

• enfektif endokardit
• kalp kapak yetmezliği
• kalp yetmezliği

Kaynakça

1. 1. Kucukates E, Gultekin N, Bagdatli Y. Cases of active infective endocarditis in a university hospital during a 10-year period. J Pak Med Assoc 2013;63:1163–1167.
2. 2. Khan NU, Farman MT, Sial JA, Achakzai AS, Saghir T, Ishaq M. Changing trends of infective endocarditis. J Pak Med Assoc 2010;60:24–27
3. 3. Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ 2006; 333:334–339. doi: 10.1136/bmj.333.7563.334.
4. 4. Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med. 2002;162:90–4. doi: 10.1001/archinte.162.1.90.
5. 5. Nunes MC, Gelape CL, Ferrari TC. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome. Int J Infect Dis 2010;14:e394–398. doi: 10.1016/j.ijid.2009.06.024.
6. 6. Elbey MA, Akdağ S, Kalkan ME, Kaya MG, Sayın MR, Karapınar H, et al. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg 2013;13:523-7. doi: 10.5152/akd.2013.172.
7. 7. Crawford MH, Durack DT. Clinical presentation of infective endocarditis. Cardiol Clin 2003;21:159-66. doi: 10.1016/s0733-8651(03)00023-7.
8. 8. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–3128. doi:10.1093/eurheartj/ehv319.

9. 9. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200-9. doi: 10.1016/0002-9343(94)90143-0.
10. 10. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15:167–184. doi: 10.1067/mje.2002.120202.
11. 11. Dąbek J, Majewski M, Michalak-Kolarz M, Gąsior Z. Patients with infective endocarditis: Five-year observation from a single reference center. Adv Clin Exp Med. 2017;26:1197–1205. doi: 10.17219/acem/64874.
12. 12. Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363:139–149. doi: 10.1016/S0140-6736(03)15266-X.
13. 13. Cabell CH, Heidenreich PA, Chu VH, Moore CM, Stryjewski ME, Corey GR, et al. Jr. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. Am Heart J. 2004;147:582–586. doi: 10.1016/j.ahj.2003.06.005.
14. 14. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429. doi: 10.1056/NEJMra035415.
15. 15. McCarthy JT, Steckelberg JM. Infective endocarditis in patients receiving long-term hemodialysis. Mayo Clin Proc. 2000;75:1008–1014. doi: 10.4065/75.10.1008.
16. 16. Hogevik H, Olaison L, Andersson R, Lindberg J, Alestig K. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore). 1995;74:324–339. doi: 10.1097/00005792-199511000-00003.
17. 17. Slipczuk L, Codolosa JN, Davila CD, Corral AR, Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: A systematic review. PLoS One. 2013;9;8:e82665. doi: 10.1371/journal.pone. 0082665.
18. 18. Munita JM, Arias CA, Murray BE. Enterococcal endocarditis: Can we win the war? Curr Infect Dis Rep. 2012;14:339–349. doi:10.1007/s11908-012-0270-8.
19. 19. Damasco PV, Correal JCD, Cruz-Campos AC, Wajsbrot BR, Cunha RG, Fonseca AG, et al. Epidemiological and clinical profile of infective endocarditis at a Brazilian tertiary care center: an eight-year prospective study. J Braz Soc Trop Med. 2019;52:e2018375. doi:10.1590/0037-8682-0375-2018.
20. 20. Delahaye F, Alla F, Beguinot I, Bruneval P, Lecompte TD, Lacassin F, Stuy CS, et al. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scand J Infect Dis. 2007;39:849–857. doi: 10.1080/00365540701393088.
21. 21. Olmos C, Vilacosta I, Fernandez C, López, J, Sarriá, C, Ferrera C, et al. Contemporary epidemiology and prognosis of septic shock in infective endocarditis. Eur Heart J. 2013;34:1999–2006. doi: 10.1093/eurheartj/ehs336.
22. 22. Hase R, Otsuka Y, Yoshida K, Hosokawa N. Profile of infective endocarditis at a tertiary –care hospital in Japan over a 14- year period: characteristics, outcome and predictors for in-hospital mortality. Int J Infect Dis. 2015;33:62–6. doi: 10.1016/j.ijid.2015.01.003.
23. 23. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, et al. International collaboration on endocarditis-prospective cohort study (ICE PCS) investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169(5):463–73. doi: 10.1001/archinternmed.2008.603.