Endocarditis is a severe disease that accounts for a high mortality rate, varying between 10% and 40%, depending on the patient’s age, comorbidities, pathogen as well as type of infected valve (native or prosthetic) (1-6).
Clinical manifestations are highly variable. Acute presentations are characterised by a sustained fever, with or without chills, whereas chronic forms manifest mainly through weight loss, associated or not with fever (2, 5, 7). A newly detected cardiac murmur is frequently found at admission (>80% of cases), depending on valve damage. Secondary to valve destruction, heart failure may develop, requiring an urgent valve replacement as long as the patient’s clinical state allows for it. Embolic or immunological complications, involving either the central nervous system (ischemic brain stroke, mycotic aneurysm, brain haemorrhage), the lungs (pulmonary abscess), the musculoskeletal system (e.g., spondylodiscitis, psoas abscess) or the kidneys (glomerulonephritis) can also mark the initial clinical presentation (4, 5, 7).
Several factors have been linked to the patients’ prognosis (1-3, 5, 6):
- Patient-related factors: age, diabetes, or other comorbidities such as kidney failure or immunodeficiency.
- Clinical factors: cardiac or kidney failure, ischemic brain stroke, brain haemorrhage, or septic shock.
- Microbiological factors: Staphylococcus aureus, Gram-negative bacilli not belonging to the HACEK group infection, or fungal infection.
- Valvular factors: prosthetic valve, para-valvular abscess, severe valvular regurgitation, left ventricular dysfunction, pulmonary hypertension, large vegetations, or dysfunction of the prosthetic valve.
A rapid diagnosis is important to avoid local and/or systemic complications. Initial empiric antibiotic therapy, directed against the most frequently encountered germs, is subsequently switched to a targeted regimen based on blood cultures results and pathogen susceptibility (1-3, 5, 6, 8-11). Simultaneously, other therapeutic choices must be addressed, considering metastatic complications and the question of cardiac surgery (2-7, 12, 13). Urgent valve replacement is justified by heart failure, a high embolic risk (vegetation >10 mm), a paravalvular abscess, a
prosthetic valve infection, a high-virulence microorganism such as S. aureus, or the impossibility of containing the infection through antibiotic therapy alone (3-6, 9, 11-14).
It is now widely recognised that a multidisciplinary approach is associated with a better prognosis. Consequently, the European Society of Cardiology (ESC) recommends the implementation of an “Endocarditis Team” in every tertiary referral centre regrouping infectiologists, cardiologists (experts in TTE and TOE, if possible), cardiac surgeons and neurologists (2, 5-7, 14-16). Additionally, if necessary, specialists in nuclear medicine imaging and CT-Scan, in congenital heart defects as well as in electrophysiology and neurosurgery can be consulted (2, 5, 6-8, 14). The Centre Hospitalier Universitaire Vaudois (CHUV) Endocarditis Team was constituted to respond to the needs of the CHUV and peripheral centres.
The aim of this Master’s thesis is to retrospectively analyse clinical and microbiological characteristics of patients admitted to the CHUV for infective endocarditis (CIM-10: I33.0 code) between 1 April 2016 and 31 December 2017. Incidence of adverse clinical events during hospitalisation, defined as in-hospital death and/or need for cardiac surgery, will be calculated. We will determine clinical, biological, and microbiological variables on admission significantly correlated with the occurrence of an adverse clinical event, as defined above. Additionally, this work will describe the epidemiology of infective endocarditis at a university hospital over a two-year period.