Infective endocarditis should be treated in experienced centres
Abstract number: P1358
Fernández-Hidalgo N., Almirante B., Tornos P., González-Alujas M.T., Planes A.M., Pahissa A.
Objectives: The aims of this study were: 1) to compare the characteristics of adult patients with left-sided infective endocarditis (IE) diagnosed and treated in a tertiary care hospital with those of patients referred from other centres because of the same diagnosis or suspicion; and 2) to establish the accuracy of diagnosis and treatment in referred patients and their influence in outcome.
Methods: A prospective, observational cohort study was conducted at Vall d'Hebron Hospital, Barcelona, Spain, a 1000-bed teaching hospital with all the medical and surgical services and a referral centre for cardiac surgery.
Results: Between January 2000 and September 2009, 337 episodes of left-sided IE in 334 patients were treated in our hospital. Of them, 114 (34%) were transferred from 35 hospitals. As compared with patients diagnosed in our hospital, transferred patients acquired IE less often in relation with health care system (16.7% vs 38.1%, p < 0.0005); were in better health before onset (Charlson index 1.44±1.65 vs 2.36±2.27, p < 0.0005); experienced more complications (94.7% vs 78.9%, p < 0.0005), including heart failure (68.4% vs 39%, p < 0.0005), myocardial abscess (38.6% vs 18.8%, p < 0.0005), and acute renal failure (69.3% vs 22.1%, p < 0.0005), underwent more surgeries (69.3% vs 22.1%, p < 0.0005) with a lower EuroSCORE (8.9±3.3 vs 10.6±3.7, p < 0.0005); and experienced a non-statistically different rate of in-hospital mortality (22.8% vs 31.4%, p=NS). Focused on the subgroup of 114 referred patients, only 52 (45.6%) initially received an antimicrobial regime included in the American, European or Spanish guidelines. In the remaining patients, the median days of incorrect treatment was 5 (IQR 310, range 142). Mortality was greater in patients without an appropriate antimicrobial regime than in the other group (32.3% vs 11.5%, OR 3.65, 95% CI 1.349.96, p = 0.009). Moreover, in 42 out of 114 patients (36.8%), an echocardiogram performed in our centre demonstrated a complication no diagnosed at origin. Although not statistically significant, this group of patients experienced greater in-hospital mortality than the other group (28% vs 18.8%, p = 0.24).
Conclusions: IE is a rare and severe condition that should be treated in experienced centres by multidisciplinary teams. Mistakes in the initial diagnosis and antimicrobial treatment are associated with greater mortality.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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