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The hidden side of infective endocarditis: Diagnostic and management of 500 consecutive cases in noncardiac surgery centers (2009–2018)

2023; Elsevier BV; Volume: 174; Issue: 3 Linguagem: Inglês

10.1016/j.surg.2023.04.061

1532-7361

Sònia Calzado, Marta Hernández‐Meneses, Jaume Llopis, Lucía Boix-Palop, Beatriz Dietl, Esther Calbo, Marta Andrés, Xelo García, C Régulo Agusti, Esther Dorca, José Miguel Lera Tricas, Javier Díez de los Ríos, Jordi Cuquet, Antonio Cárdenas, Juan Manuel Roca, María José Ortiz, A.P. Caresia-Aróztegui, Laura Navarro Guillamón, Eduard Quintana, Juan Ambrosioni, Oriol Gasch, José M. Miró, José M. Miró, Juan Ambrosioni, Marta Hernández‐Meneses, Adrián Téllez, Juan M. Pericàs, Anders Dahl, Asunción Moreno, S Luis Aguilar, Alba Rueda López, Cristina García de la Mària, María Alejandra Cañas-Pacheco, Javier García‐González, Manel Almela, Yuliya Zboromyrska, Climent Casals‐Pascual, F Morales, Jordi Bosch, Francesc Marco, Jordi Vilà, Eduard Quintana, Elena Sandoval, J.C. Paré, Carlos Falces, Daniel Pereda, Ramón Cartañá, Salvador Pié i Ninot, Manel Azqueta, Marta Sitges, Bàrbara Vidal, José Luís Pomar, Manuel Castellá, José Marı́a Tolosana, Anders Regueiro, José Ortíz, Guillermina Fita, Irene Rovira, Andrés Perissinotti, David Fuster, José Ramírez, Merçè Brunet, Dolors Soy, Pedro Castro, David Nicolás, Jaume Llopis, Sònia Calzado, Oriol Gasch, Aina Gomila-Grange, Marc Pedrosa, Marina Alguacil, Isabel Sanfeliú, Eva Guillaumet, Laura Navarro Guillamón, A.P. Caresia-Aróztegui, Emilio Sánchez de Rojas Díaz, Lucía Boix-Palop, Beatriz Dietl, Laura Gisbert, Esther Calbo, Mariona Xercavins, Sónia Ibars, Josep Trenado, Javier Díez de los Ríos, Esteban Reynaga, María Navarro, Sílvia Montserrat, Rocío Robles, Jordi Cuquet, Itziar Arrieta, Núria Costa, Carmina Martí, Ángeles Pulido, Montserrat Ayats, Pau Garro, Xavier Esquirol, Marco A. Bustamante, Montserrat Sanmartí, Antonio Cárdenas, Gloria García, Marta Andrés, María Consuelo García, Carme Agustí Hanacsek, Esther Dorca, María Ortiz, Juan Manuel Roca, Fundació Sanitària Mollet, José Maria Tricas, Elisabet Maur, Isabel Romeo, Rosa Vidal-Galve,

Antimicrobial Resistance in Staphylococcus

Abstract Background We aimed to describe infective endocarditis cases from noncardiac surgery centers, as current knowledge on infective endocarditis is derived mostly from cardiac surgery hospitals. Methods An observational retrospective study (2009–2018) was conducted in 9 noncardiac surgery hospitals in Central Catalonia. All adult patients diagnosed with definitive infective endocarditis were included. Transferred and nontransferred cohorts were compared, and a logistic regression model was used to ascertain the prognostic factors. Results Overall, 502 infective endocarditis episodes were included: 183 (36.5%) were transferred to the cardiac surgery center, whereas 319 were not, with (18.7%) and without (45%) surgical indications. Cardiac surgery was performed in 83% of transferred patients. In-hospital (14% vs 23%) and 1-year (20% vs 35%) mortality rates were significantly lower in transferred patients ( P < .001). Among the patients not undergoing cardiac surgery despite an indication, 55 (54%) died within 1 year. The multivariate analysis identified the following independent predictive factors for in-hospital mortality: Staphylococcus aureus infective endocarditis (odds ratio: 1.93 [1.08, 3.47]), heart failure (odds ratio: 3.87 [2.28, 6.57]), central nervous system embolism (odds ratio: 2.95 [1.41, 5.14]), and Charlson score (odds ratio: 1.19 [1.09, 1.30]), whereas community acquisition (odds ratio: 0.52 [0.29, 0.93]), cardiac surgery (odds ratio: 0.42 [0.20, 0.87]), but not transfer (odds ratio: 1.23 [0.84, 3.95]) were identified as protective factors. One-year mortality was associated with S. aureus infective endocarditis (odds ratio: 1.82 [1.04, 3.18]), heart failure (odds ratio: 3.74 [2.27, 6.16]), and Charlson score (odds ratio: 1.23 [1.13, 1.33]), whereas cardiac surgery (odds ratio: 0.41 [0.21, 0.79]) was identified as a protective factor. Conclusion Patients not transferred to a referral cardiac surgery center have a worse prognosis compared to those ultimately transferred, as cardiac surgery is associated with lower mortality rates.