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Original research
Clinical profile and outcome of recurrent infective endocarditis
  1. Rodolfo Citro1,2,
  2. Kwan-Leung Chan3,
  3. Marcelo Haertel Miglioranza4,5,6,
  4. Cécile Laroche7,
  5. Rossella Maria Benvenga8,
  6. Shumaila Furnaz9,
  7. Julien Magne10,11,
  8. Carmen Olmos12,
  9. Bernard P. Paelinck13,
  10. Agnès Pasquet14,
  11. Cornelia Piper15,
  12. Antonio Salsano16,
  13. Arnaud Savouré17,
  14. Seung Woo Park18,
  15. Piotr Szymański19,
  16. Pierre Tattevin20,
  17. Nuria Vallejo Camazon21,
  18. Patrizio Lancellotti22,23,24,
  19. Gilbert Habib25
  20. EURO ENDO Investigators group
  1. 1Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Campania, Italy
  2. 2IRCCS Neurological Institute of Southern Italy Neuromed, Pozzilli, Molise, Italy
  3. 3Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  4. 4Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil
  5. 5Mae de Deus Hospital, Porto Alegre, Brazil
  6. 6Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
  7. 7EurObservational Research Progamme Department, European Society of Cardiology, Sophia Antipolis, France
  8. 8Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Campania, Italy
  9. 9Department of Research, National Institute of Cardiovascular Diseases, Karachi, Pakistan
  10. 10Department of Cardiology, University Hospital Centre of Limoges, Dupuytren Hospital, Limoges, France
  11. 11INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
  12. 12Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
  13. 13Cardiac Surgery Department, Antwerp University Hospital, Edegem, Belgium
  14. 14Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Brussels, Belgium
  15. 15Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
  16. 16Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, DISC Department, Genoa, Italy
  17. 17Cardiology Department, University Hospital of Rouen, Rouen, France
  18. 18Heart Stroke Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Gangnam-Gu, Seoul, The Republic of Korea
  19. 19Noninvasive Cardiovascular Diagnostic Department, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Poland and Center for Postgraduate Medical Education, Warsaw, Poland
  20. 20Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
  21. 21Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
  22. 22Department of Cardiology and Cardiovascular Surgery, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
  23. 23Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
  24. 24Anthea Hospital, Bari, Italy
  25. 25Service de Cardiologie, Insuffisance Cardiaque et Valvulopathie, Hôpital de la Timone, Marseille, France
  1. Correspondence to Dr Rodolfo Citro; rodolfocitro{at}


Aims Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE).

Methods Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode.

Results 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE.

Conclusions In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.

  • endocarditis
  • heart valve diseases
  • cardiac surgical procedures

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @marcelohaertel, @Gilbert HABIB

  • RC and K-LC contributed equally.

  • Contributors Coauthors involved in conduct, planning and reporting: RC, K-LC, MHM, CL, RMB, SF, JM, CO, BP, AP, CP, ASal, ASav, SWP, PS, PT, NV, PL. GH is the guarantor of the overall content.

  • Funding Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2018), Vifor (2019–2022).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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