Long-Term Therapeutic Results After Surgically Treated Infective Endocarditis - a Single Centre Experience

Molnar, Adrian; Kovács, Emese; Rancea, Raluca; Mateas, Flavius; Beyer, Ruxandra; Săcui, Diana; Trifan, Catalin; Turturica, Sergiu; Manea, Alexandru

doi:10.1080/24748706.2019.1589808

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“…This multicentric study managed to provide a comprehensive analysis of infective endocarditis cases from western Romania during a four-year period and described in detail the antibiotic and antifungal management of the affected patients, along with the treatment complications and risk factors for mortality. Set in the global context of infective endocarditis, the data from Romania are limited to clinical monocentric studies [ 32 , 33 ], while country-wide epidemiologic data and real-world statistics are scarcely reported or lacking. Therefore, a real estimate of the recent evolution of cases over time is a difficult estimate in the country.…”

Section: Discussionmentioning

confidence: 99%

“…However, during the four-year period of the data analysis, nearly two-thirds (62.6%) of the participants in our research were older than 65. In older patients, the incidence of endocarditis was described to be about nine times greater compared to that in younger patients, although the threshold for old age is a matter of constant change and debate [ 32 , 33 , 34 ]. The age distribution of endocarditis is also changing, as endocarditis mostly impacted young individuals with rheumatic valvular disease, but it now primarily affects elderly patients, as rheumatic heart disease is widely prevented through prophylaxis methods [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Antibacterial and Antifungal Management in Relation to the Clinical Characteristics of Elderly Patients with Infective Endocarditis: A Retrospective Analysis

et al. 2022

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Infective endocarditis (IE) is increasingly prevalent in the elderly, particularly due to the rising frequency of invasive procedures and intracardiac devices placed on these individuals. Several investigations have highlighted the unique clinical and echocardiographic characteristics, the microorganisms implicated, and the prognosis of IE in the elderly. In addition, the old population seems to be fairly diverse, ranging from healthy individuals with no medical history to patients with many ailments and those who are immobile. Furthermore, the therapy of IE in this group has not been well investigated, and worldwide recommendations do not propose tailoring the treatment approach to the patient’s functional state and comorbid conditions. A multicenter research study was designed as a retrospective study of hospitalized patients with infective endocarditis, aiming to examine the characteristics of elderly patients over 65 years old with infective endocarditis in relation to the antibiotic and antifungal treatments administered, as well as to quantify the incidence of treatment resistance, adverse effects, and mortality in comparison to patients younger than 65. Based on a convenience sampling method, we included in the analysis a total of 78 patients younger than 65 and 131 patients older than 65 years. A total of 140 patients had endocarditis on native valves and 69 patients had endocarditis on prosthetic valves. A significantly higher proportion of elderly patients had signs of heart failure on admission, and the mortality rate was significantly higher in the elderly population. A majority of infections had a vascular cause, followed by dental, maxillo-facial, and ENT interventions. The most common complications of IE were systemic sepsis (48.1% of patients older than 65 years vs. 30.8% in the younger group). The most frequent bacterium involved was Staphylococcus aureus, followed by Streptococcus spp. in a total of more than 50% of all patients. The most commonly used antibiotics were cephalosporins in 33.5% of cases, followed by penicillin in 31.2% and glycopeptides in 28.7%, while Fluconazole was the initial option of treatment for fungal endocarditis in 24.9% of cases. Heart failure at admission (OR = 4.07), the development of septic shock (OR = 6.19), treatment nephrotoxicity (OR = 3.14), severe treatment complications (OR = 4.65), and antibiotic resistance (OR = 3.24) were significant independent risk factors for mortality in the elderly patients. Even though therapeutic management was initiated sooner in the older patients, the associated complications and mortality rate remained significantly greater than those in the patients under 65 years old.

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Section: Discussionmentioning

confidence: 99%