Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Abstract

Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

“…Echocardiography and cardiac CT/CTA are currently the first-line imaging studies for devicerelated and prosthetic valve endocarditis diagnosis, recommended in the 2014 guideline of the American Heart Association/American College of Cardiology (6) and the 2015 guideline of the European Society for Cardiology (7). Results of the recent European Infectious Endocarditis Registry showed that 99.8% of the patients received echocardiography, with TEE being more frequently used in prosthetic valve endocarditis patients (8). Abnormal findings on echocardiography as a major criterion were present in 89.1% of the patients (8).…”

“…Results of the recent European Infectious Endocarditis Registry showed that 99.8% of the patients received echocardiography, with TEE being more frequently used in prosthetic valve endocarditis patients (8). Abnormal findings on echocardiography as a major criterion were present in 89.1% of the patients (8). Echocardiography, particularly TEE, can detect valvular vegetation and can also assess perivalvular complications (perforation, pseudoaneurysm, fistulas, and valve dehiscence) with acceptable accuracy (9).…”

“…However, clinical use of 18 F-FDG PET/CT is low in the workup of cardiac device infection. For example, the European Infectious Endocarditis Registry data showed that 18 F-FDG PET/CT was performed on only 16.6% of patients, with a better sensitivity in prosthetic valve endocarditis (62.5%) than in native (28.0%) and device-related endocarditis (16.3%) (8). The use of 18 F-FDG PET/CT in the United States to image cardiac device infection is probably even lower, as such use has not been endorsed in the U.S. guidelines and is not currently reimbursed for infection or inflammation imaging.…”

Antibiotic Prophylaxis of Infective Endocarditis: From the History of the Concept to Modern Recommendations (Review)

“…Несмотря на значительные достижения в диагностике, антибактериальной терапии, кардиохирургическом лечении инфекционного эндокардита (ИЭ), принятие согласительных документов, определяющих оптимальные стратегии ведения пациентов, это заболевание и сегодня, в XXI веке, характеризуется тяжелыми осложнениями и неблагоприятным прогнозом [1][2][3][4][5][6]. Уровень внутрибольничной летальности при ИЭ достигает 20% [7][8][9], а годичной -40% [10][11][12][13], что превышает таковой при некоторых видах рака. В таких условиях профилактика ИЭ представляется одной из важнейших задач научной и практической медицины.…”

Nuklearmedizinische Bildgebung bei infektiöser Endokarditis und Device-Infektionen

“…S. epidermidis ist als Verursacher von polymerassoziierten Endokarditiden bedeutsam, da ein Teil dieser Erreger über die Fähigkeit verfügt, irreversibel an Polymeroberflächen zu haften und eine Matrix auszubilden [13]. In der EURO-ENDO-Kohorte (European Infective Endocarditis Registry) fanden sich als häufigste Erreger Staphylokokken (44,1 %), orale Streptokokken (12,4 %), Enterokokken (15,8 %) und Streptokokkus gallolyticus (6,6 %) [10]. Nachgewiesen werden die Erreger in Blutkulturen, allerdings gelingt bei 10 -30 % der Patienten auf diesem Weg kein Erregernachweis.…”