Retrospective Analysis of Infective Endocarditis at an Urban Hospital
Infective endocarditis (IE) is a disease that causes significant morbidity and mortality. A multinational study of the presentation, etiology, and outcome of patients infected with endocarditis has been described, but it is unknown whether these parameters are similar in an urban, socioeconomically disadvantaged patient population.
We conducted a retrospective analysis of patients of at least 18 years of age admitted to an urban, academic hospital with a diagnosis of endocarditis. Echocardiograms performed between September 2006 and September 2011 for the indication of endocarditis were evaluated for the presence of vegetations on one or more valves or intracardiac devices. Patient-specific risk factors (intravenous drug use, dialysis catheters, pacemakers), co-morbidities (diabetes), and sequelae (mortality, septic emboli, etc) were compared to a multinational cohort of patients diagnosed with endocarditis using chi-squared analysis.
The results from more than 1880 echocardiograms were reviewed, revealing 180 cases of IE (165 cases were native valve IE and 15 were prosthetic valve IE). Men slightly outnumbered women (109 to 71). Fifty-five patients had implantable devices or catheters; 12 had an AV graft or fistula, 27 had permacaths, and 16 had pacers or AICDs (10 of which were infected). The organisms isolated were as follows: 104 S. aureus(65 MRSA), 16 viridans Streptococci, 14 beta-hemolytic Streptococci, 11 Enterococcus spp., 10 coagulase-negative Staphylococci, 2 HACEK organisms, and 5 Fungi. The mitral valve was most commonly involved (65 cases), followed by aortic (62), tricuspid (60), and pulmonic (4).
Our urban cohort had significantly higher percentages of patients with diabetes and intravenous drug use, more tricuspid valve disease, more frequent septic embolization, and fewer heart failure symptoms. Valvular surgery was less frequently performed, and there was a trend toward higher overall mortality (23% vs. 18%; p = 0.08).
Patients in our cohort had more co-morbidities, were less likely to undergo valve replacement surgery, and had higher mortality than the multinational cohort. Further investigation is needed to in order to understand the difference in valve-replacement frequency between the two groups and whether this has any impact on mortality.
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