Infective endocarditis in adult patients with congenital heart disease.

Male; Humans; Adult; Middle Aged; Female; Prospective Studies; Risk Factors; Endocarditis/diagnosis/epidemiology/etiology; Endocarditis, Bacterial/diagnosis/epidemiology/complications; Heart Defects, Congenital/complications/diagnosis/epidemiology; Retrospective Studies; Adult congenital heart disease; Endocarditis

Abstract :

[en] BACKGROUND: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

van Melle, Joost P; Center for Congenital Heart Diseases, Department of Cardiology, University

Roos-Hesselink, Jolien W; Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.

Bansal, Manish; Medanta, The Medicity, Gurgaon, Haryana 120001, India.

Kamp, Otto; Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiology, Amsterdam Cardiovascular

Meshaal, Marwa; Department of Cardiology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo

Pudich, Jiri; Department of Cardiovascular Diseases, University Hospital Ostrava, University of

Luksic, Vlatka Reskovic; Department of Cardiovascular Diseases, University of Zagreb, School of Medicine

Rodriguez-Alvarez, Regino; Infectious Diseases Unit, Cruces University Hospital, Barakaldo, Spain.

Sadeghpour, Anita; Echocardiography Research Center, Rajaie Cardiovascular Medical & Research

Hanzevacki, Jadranka Separovic; Department of Cardiovascular Diseases, University of Zagreb, School of Medicine

More authors (9 more)

Language :

English

Title :

Infective endocarditis in adult patients with congenital heart disease.

Publication date :

01 January 2023

Journal title :

International Journal of Cardiology

ISSN :

0167-5273

eISSN :

1874-1754

Publisher :

Elsevier, Nl

Volume :

370

Pages :

178-185

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 16 May 2023

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