1887
Volume 2020, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Infective endocarditis (IE) is a serious and potentially life-threatening disease. The epidemiology, treatment options, and outcomes have changed considerably over the last two decades. The aim of the study was to describe the epidemiology, clinical characteristics, and outcomes of patients with IE in Qatar.

Methods: Patients were identified from Hamad Medical Corporation hospitals’ electronic records, the national referral center for the State of Qatar. We included those aged ≥ 18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017. Demographic and clinical data were retrieved. Descriptive statistics were performed, and logistic regression analysis was used to describe the relationship between patient characteristics and all-cause in-hospital mortality. All potentially relevant variables were included in the univariate analysis, while those with  < 0.1 in the univariate logistic regression model were included in the multivariate analysis. For the final model, we calculated odds ratios (OR) adjusted for each of the variables included, along with their 95% confidence intervals (95% CI). Data were analyzed using STATA software version 15 (StataCorp, College Station, Texas, USA). The study was approved by the Institutional Research Board with a waiver for informed consent.

Results: Fifty-seven cases were included, of which 70% were males. The mean age was 51 years ( ± 16.8 years). Eleven (19%) were associated with prosthetic valves, and 6 (11%) with implantable cardiac devices. Fever (84%), dyspnea (46%), and heart failure (37%) were the most common presentations. Only 58% of patients had known preexisting valvular heart disease or an intracardiac device. Skin infections (10 patients, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery, and implantable cardiac devices. were implicated in 19 (34%) and in 9 (16%) patients, whereas 21 (37%) patients were culture negative. Left-side IE (49 patients, 86%) was predominant. Acute kidney injury (AKI) (17 patients, 30%) and heart failure (11 patients, 19%) were common complications. The majority of patients received targeted antimicrobial therapy with at least two active agents. Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock [OR 57.8, 95% CI 2.6–1360.2;  < 0.01] and AKI OR 33.9, 95% CI 2.9–398.1;  < 0.01) as the only risk factors independently associated with in-hospital mortality.

Conclusion: Staphylococci are the most common microbiological cause of IE in Qatar. Surgical intervention is uncommon, and mortality is relatively high. Our findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encouraging early microbiological investigations and improving medical and surgical management.

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2020-09-28
2024-03-28
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References

  1. Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther. 2017 Feb;7(1):27–35.
  2. Joffre J, Dumas G, Aegerter P, Dubée V, Bigé N, Preda G, et al. Epidemiology of infective endocarditis in French intensive care units over the 1997–2014 period-from CUB-Réa Network. Crit Care Lond Engl. 2019 Apr 25;23(1):143.
  3. Fefer P, Raveh D, Rudensky B, Schlesinger Y, Yinnon AM. Changing epidemiology of infective endocarditis: a retrospective survey of 108 cases, 1990–1999. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2002 Jun;21(6):432–7.
  4. Murdoch DR. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: The International Collaboration on Endocarditis–Prospective Cohort Study. Arch Intern Med. 2009 Mar 9;169(5):463.
  5. Zhu W, Zhang Q, Zhang J. The changing epidemiology and clinical features of infective endocarditis: A retrospective study of 196 episodes in a teaching hospital in China. BMC Cardiovasc Disord. 2017 May 8;17(1):113.
  6. Fernández-Hidalgo N, Tornos Mas P. Epidemiology of infective endocarditis in Spain in the last 20 years. Rev Esp Cardiol Engl Ed. 2013 Sep;66(9):728–33.
  7. Fernández-Hidalgo N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2008 Nov 15;47(10):1287–97.
  8. Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review. JAMA. 2018 Jul 3;320(1):72–83.
  9. Tariq M, Alam M, Munir G, Khan MA, Smego RA. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis. 2004 May;8(3):163–70.
  10. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. Circulation. 2015 Oct 13;132(15):1435–86.
  11. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015 May;65(19):2070–6.
  12. Vilacosta I, Olmos C, Agustín A de, López J, Islas F, Sarriá C, et al. The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert Rev Cardiovasc Ther. 2015 Nov 2;13(11):1225–36.
  13. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, 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 Nov 21;36(44):3075–128.
  14. Van Riet J, Hill EE, Gheysens O, Dymarkowski S, Herregods M-C, Herijgers P, et al. (18)F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging. 2010 Jun;37(6):1189–97.
  15. Fowler VG, Boucher HW, Corey GR, Abrutyn E, Karchmer AW, Rupp ME, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006 Aug 17;355(7):653–65.
  16. Fernández-Hidalgo N, Almirante B, Gavaldà J, Gurgui M, Peña C, de Alarcón A, et al. Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating Enterococcus faecalis infective endocarditis. Clin Infect Dis. 2013 May 1;56(9):1261–8.
  17. Tong SYC, Lye DC, Yahav D, Sud A, Robinson JO, Nelson J, et al. Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: a randomized clinical trial. JAMA. 2020 Feb 11;323(6):527–37.
  18. Davis JS, Sud A, O'Sullivan MVN, Robinson JO, Ferguson PE, Foo H, et al. Combination of Vancomycin and β-Lactam therapy for methicillin-resistant Staphylococcus aureus bacteremia: a pilot multicenter randomized controlled trial. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016 Jan 15;62(2):173–80.
  19. Ho TT, Cadena J, Childs LM, Gonzalez-Velez M, Lewis JS. Methicillin-resistant Staphylococcus aureus bacteremia and endocarditis treated with ceftaroline salvage therapy. J Antimicrob Chemother. 2012 May 1;67(5):1267–70.
  20. Alsoub H. Brucella infective endocarditis: a report of four successfully treated patients. Clin Microbiol Infect. 2001;7(7):382–5.
  21. Al Suob H, Saif AS. Infective endocarditis due to streptococcus pneumonia. Qatar Med J. 2003 Jun;2003(1):17.
  22. Salam AMF, Albinali H, Singh R, Al-Qahtani A, Al Suwaidi J. Incidence of infective endocarditis before and after the 2007 endocarditis prevention guidelines: a population-based study from Qatar (2002–2012). European Heart Journal. 2014;35:908.
  23. McKinsey DS, Ratts TE, Bisno AL. Underlying cardiac lesions in adults with infective endocarditis: the changing spectrum. Am J Med. 1987 Apr 1;82(4):681–8.
  24. Prasad Y, Bhalodkar NC. Aortic sclerosis—a marker of coronary atherosclerosis. Clin Cardiol. 2004 Dec;27(12):671–3.
  25. Al Abri SS, Zahedi FI, Kurup PJ, Al-Jardani AK, Beeching NJ. The epidemiology and outcomes of infective endocarditis in a tertiary care hospital in Oman. J Infect Public Health. 2014 Sep;7(5):400–6.
  26. Heiro M. Infective endocarditis in a Finnish teaching hospital: a study on 326 episodes treated during 1980–2004. Heart. 2006 May 15;92(10):1457–62.
  27. Loupa C, Mavroidi N, Boutsikakis I, Paniara O, Deligarou O, Manoli H, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect. 2004 Jun;10(6):556–61.
  28. Letaief A, Boughzala E, Kaabia N, Ernez S, Abid F, Chaabane TB, et al. Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study. Int J Infect Dis. 2007 Sep;11(5):430–3.
  29. 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 Jan 14;162(1):90–4.
  30. Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A, Briançon S, et al. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA. 2002 Jul 3;288(1):75–81.
  31. Toyoda N, Chikwe J, Itagaki S, Gelijns AC, Adams DH, Egorova NN. Trends in infective endocarditis in California and New York State, 1998–2013. JAMA. 2017 Apr 25;317(16):1652.
  32. Cetinkaya Y, Akova M, Akalin HE, Aşçioğlu S, Hayran M, Uzuns O, et al. A retrospective review of 228 episodes of infective endocarditis where rheumatic valvular disease is still common. Int J Antimicrob Agents. 2001 Jul;18(1):1–7.
  33. Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017 24;377(8):713–22.
  34. Correa de Sa DD, Tleyjeh IM, Anavekar NS, Schultz JC, Thomas JM, Lahr BD, et al. Epidemiological trends of infective endocarditis: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 2010 May;85(5):422–6.
  35. Castillo JC, Anguita MP, Ruiz M, Peña L, Santisteban M, Puentes M, et al. Changing epidemiology of native valve infective endocarditis. Rev Esp Cardiol Engl Ed. 2011 Jul;64(7):594–8.
  36. Juson ADS, Delgado J. The clinical profile of native-valve infective endocarditis in a tertiary hospital in the Philippines: a twelve-year retrospective study. Int J Infect Dis. 2019 Feb 1;79:47–8.
  37. Poesen K, Pottel H, Colaert J, Niel CDe. Epidemiology of infective endocarditis in a large Belgian non-referral hospital. Acta Clin Belg. 2014 Jun;69(3):183–90.
  38. Assiri AS. Clinical and microbiological profiles of infective endocarditis in a tertiary hospital in Aseer region, Saudi Arabia. J Saudi Heart Assoc. 2011 Oct;23(4):207–11.
  39. Rasmussen RV, Host U, Arpi M, Hassager C, Johansen HK, Korup E, et al. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteremia: the value of screening with echocardiography. Eur J Echocardiogr. 2011 Jun 1;12(6):414–20.
  40. Hoen B, Duval X. Infective endocarditis. N Engl J Med. 2013 Apr 11;368(15):1425–33.
  41. Ambroselli PN, Azar V, Fantoni NS, Michaan MG, Lozano JP, Scala SL, et al. Infective endocarditis: a clinical analysis of 68 cases at a referral hospital. Int J Infect Dis. 2018 Aug 1;73:146.
  42. Chahoud J, Sharif Yakan A, Saad H, Kanj SS. Right-Sided Infective Endocarditis and Pulmonary infiltrates: an update. Cardiol Rev. 2016 Oct;24(5):230–7.
  43. Mostaghim AS, Lo HYA, Khardori N. A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary-care teaching hospital. SAGE Open Med. 2017 Dec;5:205031211774177.
  44. Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana JM, et al. The changing epidemiology of infective endocarditis in the twenty-first century. Curr Infect Dis Rep. 2017 May;19(5):21.
  45. Ba DM, Mboup MC, Zeba N, Dia K, Fall AN, Fall F, et al. Infective endocarditis in Principal Hospital of Dakar: a retrospective study of 42 cases over 10 years. Pan Afr Med J. 2017;26.
  46. Vogkou CT, Vlachogiannis NI, Palaiodimos L, Kousoulis AA. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases. Eur J Clin Microbiol Infect Dis. 2016 Aug;35(8):1227–45.
  47. Xu H, Cai S, Dai H. Characteristics of infective endocarditis in a tertiary hospital in East China. Xu P, editor. PLOS ONE. 2016 Nov 18;11(11):e0166764.
  48. Al-Tawfiq JA, Sufi I. Infective endocarditis at a hospital in Saudi Arabia: epidemiology, bacterial pathogens and outcome. Ann Saudi Med. 2009;29(6):433–6.
  49. Nakatani S, Mitsutake K, Ohara T, Kokubo Y, Yamamoto H, Hanai S, et al. Recent picture of infective endocarditis in Japan. Circ J. 2013;77(6):1558–64.
  50. Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, et al. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral center. QJM Mon J Assoc Physicians. 2015 Mar;108(3):219–29.
  51. Fournier P-E, Gouriet F, Casalta J-P, Lepidi H, Chaudet H, Thuny F, et al. Blood culture-negative endocarditis. Medicine (Baltimore). 2017 Nov 27;96(47).
  52. Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore). 2005 May;84(3):162–73.
  53. Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev. 2001 Jan;14(1):177–207.
  54. Butt AA, Navasero CS, Thomas B, Marri SA, Katheeri HA, Thani AA, et al. Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2017 Feb;55:20–3.
  55. Ferreiros E, Nacinovich F, Casabé JH, Modenesi JC, Swieszkowski S, Cortes C, et al. Epidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: a national survey. The Endocarditis Infecciosa en la República Argentina–2 (EIRA-2) Study. Am Heart J. 2006 Feb;151(2):545–52.
  56. Leone S, Ravasio V, Durante-Mangoni E, Crapis M, Carosi G, Scotton PG, et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012 Oct;40(5):527–35.
  57. Ortiz-Soriano V, Donaldson K, Du G, Li Y, Lambert J, Rudy M, et al. Incidence and cost of acute kidney injury in hospitalized patients with infective endocarditis. J Clin Med. 2019 Jun 27;8(7).
  58. Fortrie G, de Geus HRH, Betjes MGH. The aftermath of acute kidney injury: a narrative review of long-term mortality and renal function. Crit Care. 2019 Jan 24;23(1):24.
  59. Boils CL, Nasr SH, Walker PD, Couser WG, Larsen CP. Update on endocarditis-associated glomerulonephritis. Kidney Int. 2015 Jun;87(6):1241–9.
  60. Durante-Mangoni E, Bradley S, Selton-Suty C, Tripodi M-F, Barsic B, Bouza E, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med. 2008 Oct 27;168(19):2095–103.
  61. Wang A, Athan E, Pappas PA, Fowler VG, Olaison L, Paré C, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA. 2007 Mar 28;297(12):1354–61.
  62. Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM. AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg. 2017;153(6):1241–1258.
  63. Hill EE, Vanderschueren S, Verhaegen J, Herijgers P, Claus P, Herregods M-C, et al. Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. Mayo Clin Proc. 2007 Oct;82(10):1165–9.
  64. Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med. 2019 Jan 31;380(5):415–24.
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  • Article Type: Research Article
Keyword(s): epidemiologyinfective endocarditismicrobiologymortalityoutcomes and Qatar
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