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Specific Pathogens and Prognostic Outcomes in Infective Endocarditis: A Retrospective Analysis
Session:
SESSÃO DE POSTERS 12 - ENDOCARDITE INFECIOSA 1
Speaker:
Carolina Pereira Mateus
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Carolina Pereira Mateus; Rodrigo Brandão; Inês Miranda; Mara Sarmento; Filipa Gerardo; David Roque
Abstract
<p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Background:</strong><br /> Infective endocarditis (IE) remains a serious condition with adverse clinical outcomes, influenced by the causative pathogen. This study evaluates the impact of specific pathogens on complications and in-hospital mortality in IE.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods:</strong></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">A retrospective cohort of 90 patients diagnosed with IE at a secondary care center over six years was analyzed. Pathogens were categorized into Staphylococcus spp., Streptococcus spp., Enterococcus spp., other agents, culture-negative cases, and multiple pathogens. Outcomes included sepsis, acute kidney injury (AKI), in-hospital mortality, and other clinical events. </span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results:</strong></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">Patients with Enterococcus spp. were older than the cohort average (75.6 vs. 69.9 years, p=0.023), while patients with Other agents were younger (60.3 vs. 69.9 years, p=0.008). No significant differences were noted for gender, hypertension, diabetes, atrial fibrillation, HIV, or immunosuppression.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">Native valve, prosthetic valve, or device infections did not show significant statistical differences. Similarly, vegetation size >10 mm, local complications, embolic events, significant functional impact of IE (e.g., regurgitation/stenosis), vasopressor use, atrioventricular block, de novo heart failure, stroke, and surgical indication also showed no significant variation between groups.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">Sepsis occurred in 46.7% of patients, with significant differences between pathogens (p=0.002). Staphylococcus spp. (66.7%, p=0.039) and multiple pathogens (100%, p=0.048) were associated with higher sepsis rates, while Streptococcus spp. showed lower rates (25.0%, p=0.005). Other pathogen groups showed no significant differences.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">AKI occurred in 71.3% of patients, with rates higher in Staphylococcus spp. (90.5%, p=0.036) and lower in Streptococcus spp. (54.2%, p=0.008).</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">In-hospital mortality was 32.5%, varying significantly by pathogen (p=0.014). Staphylococcus spp. (57.1%, p=0.017) and multiple pathogens (100%, p=0.011) were associated with increased mortality. Streptococcus spp. exhibited a trend toward reduced mortality (16.7%, p=0.07), while other groups showed no significant differences.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion:</strong></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif">This study highlights the significant impact of pathogen type on outcomes in infective endocarditis (IE), particularly regarding sepsis, AKI and mortality. However, further research is needed to understand the underlying mechanisms driving these differences. Given the complexity of IE, including multi-pathogen infections, the establishment of dedicated IE teams could enhance early diagnosis and improve management. These teams are essential for implementing pathogen-specific strategies, which may ultimately lead to better patient outcomes and reduced mortality.</span></span></p>
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