[Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases].
OBJECTIVE
To assess the clinical characteristics and management of infective endocarditis at a teaching hospital without cardiac surgery facilities.


METHODS
Descriptive case-control study looking at trends. Risk factors, the occurrence of complications, the rate of referral for cardiac surgery, and the mortality rate were assessed.


RESULTS
The study included 120 patients referred between 1990 and 2004, with a mean age of 50.8 (17.8) years (67.6% men). Disease incidence did not change throughout the study. Some 55% of infective endocarditis cases were from the ordinary general population, 25% were intravenous drug users, and 20% were of nosocomial origin. The number in the last category had increased over time. The most commonly isolated microorganism was Staphylococcus aureus. Around 83% of patients presented with a severe complication, with cardiac failure and septic metastasis being the most common. The in-hospital mortality rate was 19.2%. Acute renal failure (odds ratio 6.7, 95% confidence interval, 1.9-24) and perivalvular abscess (odds ratio 9.2, 95% confidence interval, 1.6-54) were independent predictors of death. The introduction in 2002 of a multidisciplinary infective endocarditis team, which included a consultant cardiac surgeon, was associated with a significant increase in referrals for surgery, from 14.5% to 34.5% (P=.03), though in-hospital mortality was not significantly altered, decreasing from 20.9% to 13.8% (P=.4).


CONCLUSIONS
The occurrence of acute renal failure and perivalvular abscess worsen the prognosis of infective endocarditis. The introduction of a multidisciplinary infective endocarditis team altered management of the disease and increased referrals for cardiac surgery.
López-Dupla
Miguel
M
Servicio de Medicina Interna, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
Hernández
Sebastián
S
Olona
Montserrat
M
Mercé
Jordi
J
Lorenzo
Alfons
A
Tapiol
Josepa
J
Gómez
Frederic
F
Santamaría
Josep
J
García
Rosa
R
Auguet
Teresa
T
Richart
Cristóbal
C
Castells
Eduard
E
Bardají
Alfredo
A
Vidal
Francesc
F
D000328:Adult; D016022:Case-Control Studies; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged