Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Acta Cardiol. 2021 Oct;76(8):838-841. doi: 10.1080/00015385.2020.1781423. Epub 2020 Jun 26.
The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside.
In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this.
Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics ( = 0.04) and higher rate of positive blood culture ( 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT ( 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT ( < 0.001) and consequently in-hospital mortality reduced significantly ( 0.05).
Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.
过去 30 年来，人们对感染性心内膜炎（IE）各个方面的认识有了重大进展。伊朗感染性心内膜炎注册研究（IRIE）成立了 12 年，旨在针对主要病原体和潜在心脏病，了解 IE 的流行病学方面。事实上，同时也成立了一个感染性心内膜炎多学科团队（MDT）。
在一项纵向观察性研究中，我们从 2007 年至 2016 年在伊朗的一家三级中心收集了符合改良 Duke 标准的成人明确或可能 IE 患者的数据。从 2016 年到 2019 年，我们使用 IE-MDT 的组建进行了一项前瞻性观察性研究，以提供更好的患者管理，并比较了在此之前和之后的数据。
共纳入 645 名平均年龄为 48±17 岁的患者。分别比较了 IRIE 和 MDT 成立前后的 445 名和 200 名患者的数据。我们发现抗生素的种类和数量明显减少（ 0.04），阳性血培养率更高（ 0.001）。IRIE 和 IE-MDT 成立后，住院时间明显延长（ 0.02）。心力衰竭、新脓肿形成和脑栓塞的发生率在 IRIE 和 IE-MDT 后显著降低（ 0.001），因此院内死亡率显著降低（ 0.05）。
建立国家注册中心和 MDT 有潜力改善患者管理，降低 IE 负担。我们的结果表明，伊朗 IRIE 和 IE-MDT 的建立提供了更好的诊断、标准化治疗，并显著降低了心脏和心脏外发病率。
