Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis

Abstract

BackgroundDespite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE.MethodsA computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests.ResultsTwenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively.ConclusionIrrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0729-5) contains supplementary material, which is available to authorized users.

Associação entre endocardite bacteriana e procedimento de cirurgia e traumatologia bucomaxilofacial

“…Levando-se em consideração as diferentes cardiopatias existentes e as suas estreitas relações com a EB, a American Heart Association (AHA) as classificou em fatores de alto, moderado e baixo risco e vem realizando constantes atualizações em seu protocolo profilático, que ocorreram em 1955, 1965, 1972, 1977, 1984, 1990, 1997, 2007 e, mais recentemente, em 2017 (Quadro 1). Até 2007, era recomendado realizar profilaxia antibiótica nos pacientes portadores fatores de alto e moderado risco 6, No entanto, a partir da atualização das diretrizes em 2007, a profilaxia para endocardite infecciosa é indicada para pacientes portadores de condições cardíacas consideradas de alto risco [1][2][3][4][5][6][7][8][9][10][11][12][13] . Recomendações essas baseadas em vários estudos retrospectivos que sugerem maior morbidade nesses grupos de pacientes 6,7 .…”

“…Bacteremias transitórias podem ocorrer, por sua vez, mesmo na ausência de procedimentos odontológicos frente à higienização dental ou periodontal inadequada, assim como infecções periapicais, periodontais e da mucosa bucal. Por isso, muitos autores defendem que o risco estimado de EI relacionado a procedimentos odontológicos esporádicos é baixo [4][5][6][7] .…”

“…: doença cardíaca reumática) Cardiomiopatia hipertrófica Prolapso da válvula mitral com regurgitação valvular Baixo risco (profilaxia não recomendada) Defeito septal atrial secundário isolado Reparo cirúrgico de defeito do septo atrial, do septo ventricular ou duto arterial persistente (sem resíduos além de seis meses) Cirurgia com enxerto para derivação da artéria coronária Prolapso da válvula mitral sem regurgitação valvular Sopro cardíaco fisiológico, funcional ou inocente Doença de Kawasaki prévia sem disfunção valvular Febre reumática prévia sem disfunção valvular Marcapasso cardíaco (intravascular ou epicárdico) e desfibriladores implantados. *Fator de risco incluído após atualização em junho de 2017 **A profilaxia antibiótica não é recomendada para nenhuma outra DCC que não esteja listada no quadro *** A endotelização do material protético só ocorre num período de Aspectos importantes relacionados ao uso de antibióticos são os efeitos que tais drogas podem gerar e a preocupação com a resistência bacteriana aos antibióticos na prática clínica 6,10 . Estudos sugeriram que o risco de reação anafilática fatal à penicilina é consideravelmente maior que o de contrair endocardite infecciosa 11 .…”

Correction to: Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis

“…Unfortunately, after publication of this article [ 1 ], it was noticed that the name of the second author was incorrectly displayed as Akshaya Srikanth Bahagavathula. The correct name is Akshaya Srikanth Bhagavathula and can be seen in the corrected author list above.…”

Commentary: The toll of complicated endocarditis and septic sequela: Old wives' tales and dogma

“…There are surprisingly few randomized trials or even systematic reviews that deal with managing multifaceted, associated lesions in patients with complex endocarditis. 2 Arguably, no part of cardiac surgery is more in need of an evidence base than the surgical treatment of complicated endocarditis. Despite optimal care for patients with endocarditis, 1-year mortality approaches 30%.…”