Profile of infective endocarditis at a tertiary-care hospital in Japan over a 14-year period: characteristics, outcome and predictors for in-hospital mortality

Highlights

• IE remains a highly lethal disease in the elderly population in Japan.

• MRSA, vascular phenomena, health care-associated IE and heart failure were independent predictors of in-hospital mortality.

• The very high mean age, low rate of culture-negative IE, high rate of definite IE without detected vegetation, and the predominance of S. aureus were unique characteristics in our cohort.

Summary

Objectives

The aims of this study were to describe the epidemiological features and clinical characteristics of infective endocarditis (IE) at a tertiary-care hospital in Japan and to identify the factors associated with in-hospital mortality.

Methods

A retrospective observational study was conducted at a 925-bed tertiary-care teaching hospital in Japan. All adult patients diagnosed with definite IE between August 2000 and July 2014 according to the modified Duke criteria were included.

Results

A total of 180 patients (60.6% men; mean age, 69.1 years) with definite IE were included. The most common pathogen was Staphylococcus aureus (27.2%). Nine patients (5.0%) had culture-negative IE. Transthoracic and transoesophageal echocardiography were performed in 180 (100%) and 132 patients (73.3%), respectively, and vegetations were detected in 128 patients (71.1%). Surgical therapy was performed in 31 patients (17.2%). Overall, the in-hospital mortality rate was 26.1%. The independent predictors of in-hospital mortality were methicillin-resistant S. aureus (MRSA), vascular phenomena, health care-associated IE and heart failure.

Conclusions

MRSA, vascular phenomena, health care-associated IE and heart failure were independent predictors of in-hospital mortality. The unique characteristics in our cohort were the very high mean age, low rate of culture-negative IE, high rate of definite IE without detected vegetations and predominance of S. aureus.