We aimed to identify factors associated with unfavorable outcome in patients treated for infective endocarditis (IE), with a focus on departure from European guidelines. We conducted a retrospective audit of all adult patients treated for endocarditis during a 1-year period across a regional network of nine care centers in the south-east of France. Medical records were reviewed regarding patient and infection characteristics, antibiotic therapy, outcome, and compliance to the European Society of Cardiology guidelines. Antibiotic treatment appropriateness was evaluated regarding molecule, dosage, and duration, according to guidelines. Primary endpoint was the assessment of factors associated with unfavorable outcome, defined as in-hospital mortality or IE relapse at 1-year follow-up. Secondary endpoints were intensive care admission, iatrogenic events, and nosocomial infections that occurred during hospital stay. One hundred patients were included. Median age was 71 years old. Twenty-two patients died and IE relapse occurred in two patients, representing 24 patients with unfavorable outcome. Overall, antibiotic treatment was deemed appropriate in 28 cases. Thirty-three patients required intensive care, 34 iatrogenic events were found, including 19 acute kidney injuries, and 13 nosocomial infections occurred during care. Using a logistic regression, factors associated with unfavorable outcome were admission in the intensive care unit (adjusted odd ratio 7.26 [1.8–29.28]; p = 0.005), new-onset nosocomial infection (adjusted odd ratio 8.83 [1.42–54.6]; p = 0.019), and age > 71 years old (adjusted odd ratio 11.2 [2.76–46.17]; p < 0.001). Departure from guidelines was frequent but not related to unfavorable outcome in our study. Only intensive care, age, and nosocomial infections were associated with mortality and relapse. Iatrogenic events were numerous, with no impact on outcome.
This is a preview of subscription content, log in to check access.
The authors would like to thank S. Chadapaud, M. Della Guardia, E. Denis, E. Leroux, N. Martis, V. Mondain, P. Pietri, F. Tiger, and M. Vassalo for their participation in this audit.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
As this was a retrospective study with no immediate impact on patient care, we did not seek the approval of an ethics committee.
During their hospital stay, all patients signed a chart regarding the anonymous use of their medical information.
Abdulhak AAB, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA et al (2014) Global and regional burden of infective endocarditis, 1990–2010: a systematic review of the literature. Glob Heart 9:131–143CrossRefGoogle Scholar
Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana J et al (2017) The changing epidemiology of infective endocarditis in the twenty-first century. Curr Infect Dis Rep 19:1–10CrossRefGoogle Scholar
Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F et al (2017) Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther 7:27–35CrossRefGoogle Scholar
Chirillo F, Scotton P, Rocco F, Rigoli R, Borsatto F, Pedrocco A et al (2013) Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis. Am J Cardiol 112:1171–1176CrossRefGoogle Scholar
Lagier J-C, Aubry C, Delord M, Michelet P, Tissot-Dupont H, Million M et al (2017) From expert protocols to standardized management of infectious diseases. Clin Infect Dis 65:S12–S19CrossRefGoogle Scholar
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I et al (2009) Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 30:2369–2413CrossRefGoogle Scholar
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F et al (2015) 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 36:3075–3128CrossRefGoogle Scholar
Tissot-Dupont H, Casalta JP, Gouriet F, Hubert S, Salaun E, Habib G et al (2017) International experts’ practice in the antibiotic therapy of infective endocarditis is not following the guidelines. Clin Microbiol Infect 23:736–739CrossRefGoogle Scholar
Béraud G, Pulcini C, Paño-Pardo JR, Hoen B, Beovic B, Nathwani D (2016) How do physicians cope with controversial topics in existing guidelines for the management of infective endocarditis? Results of an international survey. Clin Microbiol Infect 22:163–170CrossRefGoogle Scholar
Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A et al (2015) Trends in infective endocarditis: incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 65:2070–2076CrossRefGoogle Scholar
Gonzalez de Molina M, Fernández-Guerrero JC, Azpitarte J (2002) Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice. Rev Esp Cardiol 55:793–800CrossRefGoogle Scholar
Demonchy E, Dellamonica P, Roger PM, Bernard E, Cua E, Pulcini C (2011) Audit of antibiotic therapy used in 66 cases of endocarditis. Méd Mal Infect 41:602–607CrossRefGoogle Scholar
Di Mauro M, Dato GMA, Barili F, Gelsomino S, Santè P, Corte AD et al (2017) A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis: the EndoSCORE. Int J Cardiol 241:97–102CrossRefGoogle Scholar
Subbaraju P, Rai S, Morakhia J, Midha G, Kamath A, Saravu K (2018) Clinical – microbiological characterization and risk factors of mortality in infective endocarditis from a tertiary care academic hospital in Southern India. Indian Heart J 70:259–265CrossRefGoogle Scholar
Iung B, Doco-Lecompte T, Chocron S, Strady C, Delahaye F, Le Moing V et al (2016) Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J 37:840–848CrossRefGoogle Scholar
Ibrahim SL, Zhang L, Brady TM, Hsu AJ, Cosgrove SE, Tamma PD (2015) Low-dose gentamicin for uncomplicated Enterococcus faecalis bacteremia may be nephrotoxic in children. Clin Infect Dis 61:1119–1124CrossRefGoogle Scholar
Ritchie BM, Hirning BA, Stevens CA, Cohen SA, DeGrado JR (2017) Risk factors for acute kidney injury associated with the treatment of bacterial endocarditis at a tertiary academic medical center. J Chemother 29:292–298CrossRefGoogle Scholar