Tagliari Ana Paula, Steckert Gabriela Vieira, da Silveira Lucas Molinari Veloso, Kochi Adriano Nunes, Wender Orlando Carlos Belmonte
Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Cardiovascular Surgery Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
J Card Surg. 2020 Aug;35(8):1905-1911. doi: 10.1111/jocs.14787. Epub 2020 Jun 29.
Infective endocarditis (IE) remains an expressive health problem with high morbimortality rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries.
This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors.
An observational, retrospective study of 167 patients, who fulfilled modified Duke's criteria during a six-year enrollment period, from January 2010 to December 2015. The primary outcome was defined as in-hospital mortality analyzed according to treatment received (clinical vs surgical). Multivariate analysis identified mortality predictors.
The median age was 60 years (Q -Q 50-71), and 66% were male. Echocardiogram demonstrated vegetations in 90.4%. An infective agent was identified in 76.6%, being Staphylococcus aureus (19%), Enterococcus (12%), coagulase-negative staphylococci (10%), and Streptococcus viridans (9.6%) the most prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4% to 34.1%, in clinical and surgical patients, respectively (P = .047). On multivariate analysis, diabetes mellitus (odds ratio [OR], 2.5), previous structural heart disease (OR, 3.1), and mitral valve infection (OR, 2.1) were all-cause death predictors. Surgical treatment was the only variable related to a better outcomes (OR, 0.45; 95% Confidence Interval, 0.2-0.9).
This study presents IE profile and all-cause mortality in a large patient's cohort, comprising a 6-years' time window, a rare initiative in developing countries. Elderly and male patients predominated, while S. aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.
感染性心内膜炎（IE）仍然是一个具有高发病率和死亡率的重大健康问题。尽管其重要性，但流行病学和微生物学数据仍然匮乏，尤其是在发展中国家。
本研究旨在描述南美洲一所三级大学中心的IE流行病学、临床和微生物学特征，并确定院内死亡率及预测因素。
对2010年1月至2015年12月六年入组期间符合改良杜克标准的167例患者进行观察性回顾性研究。主要结局定义为根据接受的治疗（临床治疗与手术治疗）分析的院内死亡率。多变量分析确定死亡率预测因素。
中位年龄为60岁（四分位间距50 - 71岁），66%为男性。超声心动图显示90.4%有赘生物。76.6%鉴定出感染病原体，其中金黄色葡萄球菌（19%）、肠球菌（12%）、凝固酶阴性葡萄球菌（10%）和草绿色链球菌（9.6%）最为常见。总体院内死亡率为41.9%，临床治疗患者和手术治疗患者的死亡率分别为49.4%和34.1%（P = 0.047）。多变量分析显示，糖尿病（比值比[OR]，2.5）、既往结构性心脏病（OR，3.1）和二尖瓣感染（OR，2.1）是全因死亡的预测因素。手术治疗是唯一与较好结局相关的变量（OR，0.45；95%置信区间，0.2 - 0.9）。
本研究呈现了一个大型患者队列的IE特征和全因死亡率，涵盖6年时间窗口，这在发展中国家是一项罕见的举措。老年和男性患者居多，而金黄色葡萄球菌是主要的微生物病原体。保守治疗的患者死亡率高于手术治疗的患者。发展中国家的流行病学研究对于增进对IE的了解至关重要。
