Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis
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Cited by 3 publications
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Study of the Main Causes of Early Postoperative Mortality after Surgical Interventions on the Mitral Valve on the Background of Infective Endocarditis
The aim. To study the structural and functional changes of the mitral valve (MV) in patients with infective endocarditis, taking into account demographic differences that may affect early postoperative mortality. Materials and methods. The study included patients (n = 107) with a history of infective endocarditis with the MV damage. All the patients underwent surgical treatment taking into account the functional lesions of the MV. The material for the analysis was the data from medical records, findings of physical, clinical and instrumental examination, and the operation report. The patients were divided into two study groups: experimental group (n = 67) with the subjects who underwent MV repair, and control group (n = 40) with those who underwent MV replacement. Results. Analysis of gender-specific length of hospital stay showed that deceased male patients were treated for significantly less time compared to those who survived: 3.5 vs. 13.4 bed days (p = 0.02, χ2= 5.12). Assessment of length of stay in the intensive care unit (ICU) showed that deceased patients of experimental group stayed in the ICU significantly longer than those who survived: 14.2 vs. 4.2 bed days (p = 0.02, χ2= 4.85). It was established that there was a significant difference in gender-specific length of stay in the ICU: in male patients of experimental group (p = 0.03, χ2= 4.55) and in women of experimental group (p = 0.02, χ2= 5.24). It was found that deceased patients from the experimental group stayed in the ICU significantly longer compared to similar patients from the control group: 14.2 vs. 4.0 bed days (p = 0.02, χ2= 5.12). Among patients who died, the frequency of urgent operations was significantly higher than in those who survived: 28.6% vs. 12.0% (p = 0.006, χ2= 7.52). The frequency of scheduled operations in control group was significantly higher than that of urgent operations: 92.5% vs. 7.5% (p = 0.04, χ2= 3.98). The incidence of severe MV insufficiency was significantly higher in female patients of the experimental group who were discharged for rehabilitation compared to those in the control group: 100.0% vs. 62.5% (p = 0.02, χ2= 5.47). Conclusions. When analyzing the structural and functional changes in the mitral valve that could cause early post-operative mortality, it was found that severe mitral insufficiency was the most common (93.5%). It was established that mitral valve damage by massive vegetations with the threat of detachment was 57.0%. It was found that mitral valve abscesses were absent in 77.6% of patients, and among deceased patients they were not detected at all. Reliable features of providing qualified care to patients with MV lesions against the background of infective endocarditis are established; these are related to the duration of inpatient treatment, stay in the ICU, and urgency of surgical interventions.
Study of the Main Causes of Early Postoperative Mortality after Surgical Interventions on the Mitral Valve on the Background of Infective Endocarditis
The aim. To study the structural and functional changes of the mitral valve (MV) in patients with infective endocarditis, taking into account demographic differences that may affect early postoperative mortality. Materials and methods. The study included patients (n = 107) with a history of infective endocarditis with the MV damage. All the patients underwent surgical treatment taking into account the functional lesions of the MV. The material for the analysis was the data from medical records, findings of physical, clinical and instrumental examination, and the operation report. The patients were divided into two study groups: experimental group (n = 67) with the subjects who underwent MV repair, and control group (n = 40) with those who underwent MV replacement. Results. Analysis of gender-specific length of hospital stay showed that deceased male patients were treated for significantly less time compared to those who survived: 3.5 vs. 13.4 bed days (p = 0.02, χ2= 5.12). Assessment of length of stay in the intensive care unit (ICU) showed that deceased patients of experimental group stayed in the ICU significantly longer than those who survived: 14.2 vs. 4.2 bed days (p = 0.02, χ2= 4.85). It was established that there was a significant difference in gender-specific length of stay in the ICU: in male patients of experimental group (p = 0.03, χ2= 4.55) and in women of experimental group (p = 0.02, χ2= 5.24). It was found that deceased patients from the experimental group stayed in the ICU significantly longer compared to similar patients from the control group: 14.2 vs. 4.0 bed days (p = 0.02, χ2= 5.12). Among patients who died, the frequency of urgent operations was significantly higher than in those who survived: 28.6% vs. 12.0% (p = 0.006, χ2= 7.52). The frequency of scheduled operations in control group was significantly higher than that of urgent operations: 92.5% vs. 7.5% (p = 0.04, χ2= 3.98). The incidence of severe MV insufficiency was significantly higher in female patients of the experimental group who were discharged for rehabilitation compared to those in the control group: 100.0% vs. 62.5% (p = 0.02, χ2= 5.47). Conclusions. When analyzing the structural and functional changes in the mitral valve that could cause early post-operative mortality, it was found that severe mitral insufficiency was the most common (93.5%). It was established that mitral valve damage by massive vegetations with the threat of detachment was 57.0%. It was found that mitral valve abscesses were absent in 77.6% of patients, and among deceased patients they were not detected at all. Reliable features of providing qualified care to patients with MV lesions against the background of infective endocarditis are established; these are related to the duration of inpatient treatment, stay in the ICU, and urgency of surgical interventions.
Unexpected Infective Endocarditis: Towards a New Alert for Clinicians
Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.
Litigation in Cardiovascular Surgery: Risk Management Considerations in the Italian Context
Background/Objectives: Malpractice in cardiovascular surgery was addressed from the forensic pathology perspective, offering reflections on risk prevention in the Italian context. Litigation and risk management in healthcare, following the Italian law on safety of care, clinical risk management and professional liability, should be viewed in an integrated manner. Methods: We conducted a narrative review on litigation data and the principal areas of complaint in Italy regarding the cardiovascular field. The aim is to discuss human, communicative, organisational, technological and regulatory factors that may play a role in this phenomenon. Results: We discuss the importance of information and consent and the management and monitoring of competences, particularly in specialised activities, given the current human capital deficit. Furthermore, we focus on the centrality of the surgical indication focusing on benefit-risk balance in light of clinical guidelines and team-based evaluation, such as by an emergency heart team, to better tailor care to patients. At the facility level, the minimum volume of activity and the requirements for human resources, specialisations, technologies and organisation standards needed for health activity authorisation are highlighted as foundational to risk prevention. Furthermore, we discussed the availability of the minimum diagnostic and care tools in compliance with guidelines and the role of company clinical and organisational protocols. Conclusions: In the surgical, time-sensitive, highly specialised and technologically advanced sector, the importance of enterprise risk prevention and broad, value-based governance to ensure healthcare quality and safety is emphasised
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