Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Infection. 2024 Feb;52(1):117-128. doi: 10.1007/s15010-023-02066-z. Epub 2023 Jul 4.
Embolic events (EEs) are a common complication of left-side infective endocarditis (IE). The aim of the present study was to identify risk factors for the occurrence of EEs before or after antibiotic treatment instauration among patients with definite or possible IE.
This retro-prospective study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria.
A total of 441 left-side IE episodes were included (334: 76% were definite and 107; 24% possible IE). EE were diagnosed in 260 (59%) episodes; in 190 (43%) before antibiotic treatment initiation and 148 (34%) after. Central nervous system (184; 42%) was the most common site of EE. Multivariable analysis identified S. aureus (P 0.022), immunological phenomena (P < 0.001), sepsis (P 0.027), vegetation size ≥ 10 mm (P 0.003) and intracardiac abscess (P 0.022) as predictors of EEs before antibiotic treatment initiation. For EEs after antibiotic treatment initiation, multivariable analysis revealed vegetation size ≥ 10 mm (P < 0.001), intracardiac abscess (P 0.035) and prior EE (P 0.042), as independent predictors of EEs, while valve surgery (P < 0.001) was associated with lower risk for EEs.
We reported a high percentage of EEs among patients with left-side IE; vegetation size, intracardiac abscess, S. aureus and sepsis were independently associated with the occurrence of EEs. In addition to antibiotic treatment, early surgery led to further decrease in EEs incidence.
栓塞事件（EEs）是左侧感染性心内膜炎（IE）的常见并发症。本研究旨在确定明确或可能 IE 患者在开始抗生素治疗前后发生 EE 的危险因素。
这项回顾性前瞻性研究于 2014 年 1 月至 2022 年 6 月在瑞士洛桑大学医院进行。EEs 和 IE 根据改良的 Duke 标准定义。
共纳入 441 例左侧 IE 发作（334 例：76%为明确的，107 例：24%为可能的 IE）。260 例（59%）发作中诊断出 EE；190 例（43%）在开始抗生素治疗之前，148 例（34%）在之后。中枢神经系统（184 例：42%）是 EE 最常见的部位。多变量分析发现金黄色葡萄球菌（P 0.022）、免疫现象（P < 0.001）、败血症（P 0.027）、赘生物大小≥10 毫米（P 0.003）和心内脓肿（P 0.022）是抗生素治疗前发生 EE 的预测因素。对于抗生素治疗后发生的 EE，多变量分析显示赘生物大小≥10 毫米（P < 0.001）、心内脓肿（P 0.035）和先前的 EE（P 0.042）是 EE 的独立预测因素，而瓣膜手术（P < 0.001）与 EE 的风险降低相关。
我们报告了左侧 IE 患者中 EE 的高比例；赘生物大小、心内脓肿、金黄色葡萄球菌和败血症与 EE 的发生独立相关。除了抗生素治疗外，早期手术进一步降低了 EE 的发生率。
