Endocarditis: Who Is particularly at Risk and Why?

Objectives: Endocarditis is continuously increasing. Evidence exists that the prognosis is adversely affected by the extent of the disease. We looked at risk factors influencing early mortality.

Methods: Between 2010 and 2019, a total of 484 patients (338 males [69.8%], 146 females [30.2%], and mean age 66.1 years) were operated upon because of proven endocarditis. In a retrospective study, a risk factor analysis was performed.

Result: Overall early mortality (EM) was 30.17%. Significant influencing factors (odds ratios [OR] and p-values) for EM were age (p < 0.001), logES (p < 0.001), gender (OR = 1.64, p = 0.02), dialysis (OR = 2.64, p = 0.01), hepatic insufficiency (all Child-Pugh classes; OR = 2.17, p = 0.01), reoperation (OR =1.77, p = 0.01), previously implanted valve (OR = 1.97, p = 0.005), periannular abscess (OR = 1.88, p < 0.001), sepsis upon admission (OR = 12.81, p < 0.001), and number of involved valves (OR = 1.96, p = 0.003). Not significant but trending were peripheral septic emboli, history of malignant disease, and more than one germ. Development of a sepsis and EM were significantly lower if Streptococcus mitis was the main pathogen in contrast to other bacteria (p < 0.001). Staphylococcus aureus was significantly more often found in patients with a previously implanted prosthesis (p = 0.03) and in recurrent endocarditis (p = 0.02), while it significantly more often showed peripheral septic emboli than the other pathogens (p < 0.001). Staphylococcus epidermidis was found significantly more often than the other pathogens in patients with endoplastitis of preexisting electrophysiological devices (p = 0.004). More than one pathological germ was significantly more often found in patients with sepsis upon admission (p = 0.02) significantly increasing EM (p = 0.01).

Conclusion: Endocarditis remains life-threatening. Severe comorbidities adversely affected early outcome, particularly in the presence of periannular abscesses. Staphylococcus mitis was the least virulent germ, whereas Staphylococcus aureus infections were responsible for the worst outcome. Patients with suspected endocarditis should be admitted to a specialized heart center as early as possible. However, native valve endocarditis with proven Staphylococcus mitis as the only pathogen may be given a conservative trial in the first place with antibiotics alone provided the absence of abscesses, valvular insufficiency, or immediate risk of large embolization in view of the rather low virulence.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021