Introduction Infective endocarditis (IE) is associated with a protracted inpatient stay, prolonged intravenous antimicrobial therapy and significant morbidity and mortality.
Methods All patients with a diagnosis of IE at the Sussex Cardiac Centre (SCC) between 2016 and 2020 were included. Demographics, clinical characteristics, management, complications and outcomes were analysed. Logistic EuroSCORE, EuroSCORE II and Risk-E Scores were calculated for patients undergoing operative management.
Results In the 5-year period 202 patients had 209 diagnoses of IE. Seven patients had recurrent IE; 3 with the same organism but with persistent risk factors after initial treatment (Intravenous drug users [IVDUs] n = 2 and colonic polyps n=1). IE cases increased yearly by approximately 4 cases per year (p<0.01). The increase was predominantly driven by cases from referring centres, with 41% transferred from other hospitals (n=85). Oral streptococci (n= 50), coagulase-positive staphylococci (n=43), non-oral streptococci (n=29) and enterococci (n=28) were the commonest organisms identified (figure 1). Only oral streptococci demonstrated a significant increase over time (p<0.05, figure 1). Men made up 78% (n=163) of cases, with a male predominance observed in all organism groupings. Surgical management occurred in 46% of cases (n=96). Transferred patients were more likely to undergo operative management (OR 3.3 , 95% CI: 1.8, 5.8). Although men were more likely to undergo surgical management than women (OR 2.0, 95% CI: 1.1, 4.2), this is explained by women being six times more likely to be IVDUs (OR 6.1 CI: 2.3, 16.3) and have right-sided IE (OR 6.2 CI: 2.2, 17.4). When including only left-sided IE, the rate of surgery was not different between males and females (p=0.1). There was no difference in in-hospital or 12-month mortality in patients admitted directly to SCC and those referred (p=0.56) and there was no mortality difference between the sexes (p=0.20). In-hospital mortality of surgically managed patients was predicted by the Risk-E Score and EuroSCORE II as 18 and 12 cases respectively. We observed 11 in-hospital deaths. This difference was not significant (p=0.22). Transferred patients had a higher mean Risk-E Score (p<0.05) and a higher score was associated with a shorter time between diagnosis and surgery (p<0.05, figure 2).
Conclusions There has been an increase in IE cases managed at the SCC over the last 5 years, with more transfers from other hospitals. This could be due to an increase in absolute IE numbers as well as better awareness of the need for early surgery and the involvement of an IE MDT. We report a previously unidentified male predominance in IE across all major organisms and a significant increase in oral streptococci infection; both require further exploration. In this population the Risk-E Score tended to overestimate in-hospital mortality. Larger multi-centre studies are required to explore these trends in sub-grouped populations.
Conflict of Interest None
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