Contemporary epidemiology and outcomes in recurrent infective endocarditis. Issue 8 (3rd October 2019)

• Record Type: Journal Article
• Authors: Freitas-Ferraz, Afonso B; Tirado-Conte, Gabriela; Vilacosta, Isidre; Olmos, Carmen; Sáez, Carmen; López, Javier; Sarriá, Cristina; Pérez-García, Carlos Nicolás; García-Arribas, Daniel; Ciudad, Marianela; García-Granja, Pablo Elpidio; Ladrón, Raquel; Ferrera, Carlos; Di Stefano, Salvatore; Maroto, Luis; Carnero, Manuel; San Román, J Alberto
• Is Part Of: Heart. Volume 106:Issue 8(2020)
• Page Start: 596
• Page End: 602
• Publication Date: 2019-10-03
• Subjects: endocarditis -- valvular heart disease; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2019-315433
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Recurrent infective endocarditis (IE) is a major complication of patients surviving a first episode of IE. This study sought to analyse the current state of recurrent IE in a large contemporary cohort. Methods: 1335 consecutive episodes of IE were recruited prospectively in three tertiary care centres in Spain between 1996 and 2015. Episodes were categorised into group I (n=1227), first-IE episode and group II (n=108), recurrent IE (8.1%). After excluding six patients, due to lack of relevant data, group II was subdivided into IIa (n=87), reinfection (different microorganism), and IIb (n=15), relapse (same microorganism within 6 months of the initial episode). Results: The cumulative burden and incidence of recurrence was slightly lower in the second decade of the study (2006–2015) (7.17 vs 4.10 events/100 survivors and 7.51% vs 3.82, respectively). Patients with reinfections, compared with group I, were significantly younger, had a higher frequency of HIV infection, were more commonly intravenous drug users (IVDU) and prosthetic valve carriers, had less embolic complications and cardiac surgery, with similar in-hospital mortality. IVDU was found to be an independent predictor of reinfection (HR 3.92, 95% CI 1.86 to 8.28). In the relapse IE group, prosthetic valve endocarditis (PVE) and periannular complications were more common. Among patients treated medically, those with PVE had a higher relapse incidence (4.82% vs 0.43% in native valve IE, p=0.018). Staphylococcus aureus and PVE were independent predictors of relapse (HR 3.14, 95% CI 1.11 to 8.86 and 3.19, 95% CI 1.13 to 9.00, respectively) and in-hospital-mortality was similar to group I. Three-year all-cause mortality was similar in recurrent episodes compared with single episodes. Conclusion: Recurrent IE remains a frequent late complication. IVDU was associated with a fourfold increase in the risk of reinfection. PVE treated medically and infections caused by S. aureus increased the risk of relapse. In-hospital and long-term mortality was comparable among groups.