SPC365

The Burden of Infective Endocarditis in a Center Without Cardiac Surgery: A Retrospective Analysis

Session: SESSÃO DE POSTERS 15 - ENDOCARDITE INFECIOSA 2
Speaker: Sofia Andraz

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.4 Infective Endocarditis – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Sofia Andraz; Joana Massa Pereira; Lucas Hamann; Miguel Espírito Santo; Joana Guerreiro Pereira; Eunice Soromenho Silva; Dina Bento; Hugo Costa; Pedro Azevedo; Jorge Mimoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt">Introduction</span></strong><span style="font-size:10.0pt">: Infective endocarditis (IE) is a global public health challenge. While cardiac surgery is recommended to improve outcomes, many patients are treated conservatively with antibiotic therapy alone. Data on IE treatment and outcomes in centers without on-site cardiac surgery remain scarce.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt">Objective</span></strong><span style="font-size:10.0pt">: To assess treatment strategies and prognosis in patients with IE from a single cardiology center without onsite cardiac surgery.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt">Methods</span></strong><span style="font-size:10.0pt">: Retrospective analysis including consecutive IE patients admitted between January 2020 and December 2023 (mean follow-up&nbsp;19.8 &plusmn; 16.8 months). Data on demographics, microorganisms, infection sites, complications, surgical interventions, and clinical outcomes (IE recurrence, re-hospitalization and mortality) were compared between those undergoing surgery and those treated conservatively with antibiotics. Cox regression was performed to assess the impact of cardiac surgery after adjusting for relevant confounders.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt">Results</span></strong><span style="font-size:10.0pt">: 53 patients (70% male, mean age 62 years) were included. Comorbidities included hypertension (53%), diabetes mellitus (36%), dyslipidemia (43.1%), and atrial fibrillation/flutter (23%). Prosthetic material was present in 26%, most commonly biological (13%) or mechanical (6%) valves or pacemaker leads (6%). The aortic (45%) and mitral (36%) valves were the most frequently affected sites, with vegetations larger than 10 mm observed in 38% of cases. Positive blood cultures were found in 94%, with <em>S. aureus</em> (34%) as the predominant pathogen.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt">51% received conservative treatment, while 49% underwent surgery. No differences observed between groups&nbsp;in sex, age, comorbidities, pathogen or IE type, except for higher HIV prevalence (33% vs. 0%, p=0.02) and tricuspid valve involvement in the conservative group (19% vs. 0%, p=0.02). IE-related complications, including severe valve dysfunction (57%), heart failure (32 %), local fistula/abcess (8%) and embolic events (36%), were frequent and similarly distributed between groups. Overall mortality was 51%, with 30% in-hospital mortality and 38% within the first year. Re-hospitalization (35% vs. 7%, p=0.015), overall mortality (77% vs. 26%, p&lt;0.001) and first-year mortality (58% vs. 21%, p=0.030) rates were significantly higher in the conservative group. IE recurrence and in-hospital mortality were not significantly different between groups. Multivariate analysis identified conservative antibiotic treatment as the only variable independently associated with higher mortality (HR 5.8, </span><span style="font-size:10.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif">??</span></span><span style="font-size:10.0pt">=0.015).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt">Conclusions</span></strong><span style="font-size:10.0pt">: These results highlight the complexity and&nbsp;high mortality of IE. The underperformed surgical treatment significantly impacted prognosis, as those treated conservatively had about 6 times the mortality risk compared to those who underwent surgery. Optimizing referral pathways is of paramount importance in centers without onsite cardiac surgery.</span></span></span></p>