Abstract 10881: Clinical Presentation and Outcome of Infective Endocarditis in Italy: Results from the Italian Registry of Infective Endocarditis (RIEI)
The Italian Registry of Infective Endocarditis (RIEI) sought to provide a contemporary picture of the presentation and outcome of infective endocarditis (IE) in a large cohort from Italy. Data from 680 consecutive patients with definite IE who were admitted to 16 hospitals were prospectively collected from August 2006 through August 2010. The mean age of the cohort was 61 ± 16 years, male sex was prevalent (72.5%), 60% of patients had a predisposing cardiac condition, and 69% had native valve IE. Infection on prosthetic valve was found in 18% and on non-prosthetic cardiac devices in 11% of patients. Patients presented late in the diseases (mean interval from onset of symptoms to admission was 43.5 ± 49 days) with few of the classic clinical hallmarks of IE. Healthcare-related infection was identified in 23 % of cases (12% nosocomial, 11% nosohusial infection). Dental procedures in the 90 days preceding IE onset was identified only in 6% of patients. Staphylococcus aureus was the most common pathogen (19%), followed by oral Streptococci (11%), and Enterococcus spp (10%). The mitral (31%) and aortic (31%) valves were infected most commonly. The following complications were common: heart failure (35%), arterial embolization (14%) and persistent infection after 1 week of intravenous antibiotics (10%). Surgical therapy during the active phase of the disease was common (56%), and in-hospital mortality remained high (14%) with a similar mortality rate between patients treated medically (8%) and surgically (6%). Age > 65 years (odds ratio, 2.35; 95% confidence interval, 1.38- 4.02), chronic kidney disease (3.03; 1.64-5.58), heart failure (4.50; 1.74-11.63), paraprosthetic complications (3.31; 1.98- 5.52), persistent positive blood cultures (4.49; 1.01-19.8) and persistent fever (4.03; 1.865-8.69) after 1 week of adequate antibiotic therapy were associated with an increased risk of in-hospital death, whereas surgery during the index hospitalization (0.21; 0.10-0.43) was associated with a decreased risk. In conclusion notwithstanding advances in diagnosis and medical therapy and the increasing rate of surgery IE retains a persistently high morbidity and mortality rate.
- © 2012 by American Heart Association, Inc.