SPC365

Comprehensive management of Infective Endocarditis: clinical findings and surgical outcomes

Session: SESSÃO DE POSTERS 15 - ENDOCARDITE INFECIOSA 2
Speaker: Joao Santos Fonseca

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: Joao Santos Fonseca; Ana Abrantes; Miguel Azaredo Raposo; Catarina Gregório; Marta Vilela; Daniel Cazeiro; Pedro Alves da Silva; Joana Rigueira; Rui Plácido; Daniel Caldeira; Fausto J. Pinto; Catarina Sousa

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Infective endocarditis (IE) is a life-threatening condition characterized by high mortality rates and the potential for severe complications. Effective management requires meticulous and prompt life-saving strategies, often involving surgical intervention. </span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To analyze the current management of IE in a tertiary hospital. </span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This study included 82 patients with a definite diagnosis of IE based on transesophageal echocardiography (TOE) findings, from January 2023 to October 2024. </span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Most patients were male (55; 67.1%) and the overall average age was 67.0 [25 &ndash; 89] years old.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The main findings in TOE included vegetations (62; 75.6% - average size: 12.6mm) and abscesses (5; 6.1%). Most involved structures were: mitral valve (37; 45.1%), aortic valve (33; 40.2%), electronic device lead (14; 17.1%) and central venous catheter (6; 7.3%). In the studied population, regarding the valves involved: native (45; 54.9%) and prosthetic (23; 28.0%). IE led to moderate-severe valve regurgitation in 29 (35.4%) of cases. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The primary isolated bacteria were <em>Staphylococcus aureus</em> (22; 26.8%) and <em>Enterococcus faecalis</em> (10; 12.2%). First-line antibiotics included Flucloxacillin (53 patients; 64.6%), Vancomycin (27 patients; 32.9%) and Piperacillin-tazobactam (11 patients; 13.4%). The average antibiotic treatment duration was 29.5 [2 &ndash; 331] days.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Overall, 29 (35.4%) patients met the criteria to IE complications requiring surgery and 15 (18.3% of the global population and 51.7% of those eligible for surgery) patients ultimately underwent surgical intervention.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Indications for surgery included heart failure (9; 31.0%), uncontrolled infection (17; 58.6%) and high risk of embolism or established embolism (3; 10.3%).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The average time from IE diagnosis to surgery was 32 days.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Surgical procedures involved valve replacement (12; 80%) or repair (3; 20%) of the aortic (7; 46.7%), mitral (5; 33.3%), aortic and mitral (2; 13.3%); or aortic and tricuspid (1; 6.7%) valves.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Among those patients eligible for surgery, there were differences between those that underwent surgery and those that didn&rsquo;t, respectively: male gender (8/11), age (62.6/76.9 years), vegetations size (11.5/22.5 mm), embolization (5/9), ischemic stroke (2/6), deaths (6/11).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In patients with cardiovascular implantable electronic devices, extraction was performed in 8 (53.3%) cases.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During the analyzed period, in the overall population there were 22 (26.8%) in-hospital deaths; specifically, in those that underwent surgery, 6 (40%) ultimately died.</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> This study highlights the significant clinical burden of IE. The importance of early diagnosis and prompt treatment, including targeted antibiotics and timely surgery, is underscored. Despite these efforts, the mortality rate remains a concern, emphasizing the need for continued research and improved management to enhance patient outcomes.</span></span></p>