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Infective Endocarditis: experience of the last 20 years
Session:
Posters (Sessão 5 - Écran 8) - Doença Valvular 4 - Foco na Endocardite
Speaker:
Catarina Ribeiro Carvalho
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.6 Infective Endocarditis – Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Ribeiro Carvalho; José João Monteiro; Pedro Rocha Carvalho; Marta Bernardo; Ana Baptista; José Ilídio Moreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>infective endocarditis (IE) as an important rate of in-hospital complications and mortality. However, there is a paucity of randomized controlled trials to guide clinical practice. In that way, characterization of this population is relevant to improve our understanding and thus the management of IE. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> this was a retrospective study that included all patients hospitalized in a single centre with diagnosis of IE, between January 2000 and December 2020. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 161 patients were selected. Patients were predominantly males (65.8%), with a mean age of 66.4±16.4 years. Diagnosis was based mainly on the following Modified Duke Criteria: echocardiographic major criteria (91.7%), fever (82.1%) and blood cultures positive for IE (49.3%), allowing a definite diagnosis in 59.0% of the patients. Most patients had some predisposing factor for IE, predominantly valvular disease. Native valve IE was more frequent than prosthetic or device IE (67.8%, 16.1% and 16.1%, respectively), involving predominantly mitral and aortic valves (35.6% and 30.0%, respectively). The most commonly identified microorganisms were Staphylococcus (28.8%) and Streptococcus (28.5%). In 27.5% of the patients, blood cultures were sterile.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The most used antibiotics were vancomycin followed by beta-lactams and aminoglycosides, with a medium duration of therapy of 33.9±22.5 days. Embolic complications occurred in 31.3% of the patients, most frequently cerebral (16.4%) and splenic embolic events (10.3%). Furthermore, 43.4% of the patients developed acute renal failure, 33.3% acute heart failure and 13.8% septic shock. Echocardiography revealed perivalvular complications in 26.1% of the patients, namely fistulae in 18.5%, abscess in 13.2% and pseudoaneurysm in 11.3%.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Although 48.6% of the patients had indication for surgery, only 37.2% were submitted to this procedure during admission, after 22.0 (IQR 14.0-50.5) days of admission. The main reason for surgery was locally uncontrolled infection in 29.2%, followed by heart failure (20.0%) and prevention of embolic events (18.1%). Device extraction was performed in 70.4% of the 26 patients presenting with electrocatheter involvement. In-hospital mortality reached 16.8%, occurring on average 35.0±17.5 days after admission. The average length of stay was 44.5±22.8 days.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> this single centre study illustrates the burden of IE, with prolonged hospitalizations and high rates of complications and in-hospital mortality.</span></span></p>
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