Table 1.
Comparison of Episodes With or Without Final Infective Endocarditis Diagnosis Among 2132 Patients With Suspected Infective Endocarditis
| No Infective Endocarditis (n = 1031) | Infective Endocarditis (n = 1101) | P Value | |||
|---|---|---|---|---|---|
| Demographics | |||||
| Male sex, n (%) | 695 | (67) | 828 | (75) | <.001 |
| Age (median years, IQR) | 67 | (55–77) | 65 | (50–75) | .01 |
| Charlson comorbidity index, (median, IQR) | 5 | (2–7) | 4 | (2–6) | <.001 |
| Cardiac predisposing factors | |||||
| IV drug use, n (%) | 48 | (5) | 222 | (10) | <.001 |
| Rheumatic heart disease/Hypertrophic cardiomyopathy, n (%) | 2 | (.2) | 16 | (2) | .001 |
| Congenital disease, n (%) | 24 | (2) | 207 | (19) | <.001 |
| Prosthetic valve, n (%) | 80 | (8) | 302 | (27) | <.001 |
| Prior endocarditis, n (%) | 34 | (3) | 140 | (13) | <.001 |
| Moderate or severe valve regurgitation/stenosis, n (%) | 101 | (10) | 251 | (23) | <.001 |
| Cardiac implantable electronic devices, n (%) | 100 | (10) | 353 | (32) | <.001 |
| Transcatheter aortic valve replacement, n (%) | 9 | (0.9) | 46 | (4) | <.001 |
| Minor predisposition criterion (Duke Li 2000), n (%) | 150 | (15) | 541 | (49) | <.001 |
| Minor predisposition criterion (ESC 2015), | 159 | (15) | 565 | (51) | <.001 |
| Minor predisposition criterion (ISCVID 2023), n (%) | 300 | (29) | 821 | (75) | <.001 |
| Microbiological data | |||||
| Bacteremia/fungemia, n (%) | 648 | (63) | 990 | (90) | <.001 |
| S. aureus, n (%) | 293 | (28) | 417 | (38) | <.001 |
| Coagulase-negative staphylococci, n (%) | 59 | (6) | 67 | (6) | .783 |
| S. lugdunensis, n (%) | 9 | (0.9) | 13 | (1) | .526 |
| Coagulase-negative staphylococci in the presence of intracardiac prosthetic material, n (%) | 30 | (3) | 34 | (3) | .920 |
| Coagulase-negative staphylococci isolated from 3 or more separate blood culture sets, n (%) | 17 | (2) | 42 | (4) | .281 |
| Streptococcus spp. | 115 | (11) | 290 | (26) | <.001 |
| S. gallolyticus, n (%) | 9 | (0.9) | 47 | (4) | <.001 |
| Viridans streptococci, n (%) | 65 | (6) | 183 | (17) | <.001 |
| Group B, C, or G streptococci, n (%) | 21 | (2) | 49 | (5) | .002 |
| S. pneumoniae or S. pyogenes isolated from 3 or more separate blood culture sets, n (%) | 2 | (0.2) | 4 | (0.4) | .688 |
| Enterococcus spp., n (%) | 80 | (8) | 130 | (12) | .002 |
| Community-acquired enterococci without known primary focus, n (%) | 17 | (2) | 103 | (9) | <.001 |
| E. faecalis, n (%) | 54 | (5) | 114 | (10) | <.001 |
| Enterococci other than E. faecalis isolated from 3 or more separate blood culture sets, n (%) | 8 | (1) | 14 | (1) | .290 |
| Gram-positive (other than staphylococci, streptococci, and enterococci), n (%) | 26 | (3) | 32 | (3) | .597 |
| Abiotrophia spp., n (%) | 1 | (0.1) | 5 | (0.5) | .220 |
| Granulicatella spp., n (%) | 3 | (0.3) | 2 | (0.2) | .678 |
| Gemella spp., n (%) | 0 | (0) | 1 | (0.1) | 1.000 |
| Cutibacterium acnes in the presence of intracardiac prosthetic material, n (%) | 1 | (0.1) | 11 | (1) | .007 |
| Corynebacterium spp. in the presence of intracardiac prosthetic material, n (%) | 1 | (0.1) | 5 | (0.5) | .220 |
| Gram-positive (other than staphylococci, streptococci, and enterococci) isolated from 3 or more separate blood culture sets, n (%) | 7 | (0.7) | 17 | (2) | .066 |
| HACEK, n (%) | 3 | (0.3) | 26 | (2) | <.001 |
| Gram-negative (other than HACEK), n (%) | 107 | (10) | 26 | (2) | <.001 |
| Pseudomonas aeruginosa in the presence of intracardiac prosthetic material, n (%) | 4 | (0.4) | 1 | (0.1) | .204 |
| Serratia marcescens in the presence of intracardiac prosthetic material, n (%) | 1 | (0.1) | 0 | (0) | .484 |
| Other gram-negative (other than HACEK) isolated from 3 or more separate blood culture sets, n (%) | 31 | (3) | 14 | (1) | .006 |
| Fungi, n (%) | 37 | (4) | 10 | (0.9) | <.001 |
| Candida spp. in the presence of intracardiac prosthetic material, n (%) | 5 | (0.5) | 6 | (0.5) | 1.000 |
| Fungi isolated from 3 or more separate blood culture sets, n (%) | 12 | (1) | 4 | (.4) | .043 |
| Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate blood culture sets, n (%) | 73 | (7) | 50 | (5) | .012 |
| Polymicrobial bacteremia, n (%) | 76 | (7) | 23 | (2) | <.001 |
| Culture negative investigations, n (%) | … | … | … | … | |
| Coxiella burnetii antiphase I IgG titer ≥1:800, n (%) | 2 | (0.2) | 8 | (0.7) | .110 |
| Positive blood PCR for C. burnetii, n (%) | 1 | (0.1) | 1 | (0.1) | 1.000 |
| Bartonella henselae or B. quintana IgG titer ≥1:800, n (%) | 7 | (.7) | 4 | (0.4) | .373 |
| Positive culture for an organism consistent with IE from a sterile body site other than cardiac tissue, cardiac prosthesis, or embolus, n (%) | 227 | (22) | 91 | (8) | <.001 |
| Major microbiological criterion (Li 2000), n (%) | 275 | (27) | 734 | (67) | <.001 |
| Major microbiological criterion (ESC 2015), n (%) | 275 | (27) | 734 | (67) | <.001 |
| Major microbiological criterion (ISCVID 2023), n (%) | 412 | (40) | 907 | (82) | <.001 |
| Minor microbiological criterion (Li 2000), n (%) | 165 | (16) | 72 | (7) | <.001 |
| Minor microbiological criterion (ESC 2015), n (%) | 165 | (16) | 72 | (7) | <.001 |
| Minor microbiological criterion (ISCVID 2023), n (%) | 188 | (18) | 61 | (6) | <.001 |
| Imaging data | |||||
| Positive echocardiography (either TTE or TOE) for vegetation, perforation, abscess, aneurysm, pseudoaneurysm, fistula, n (%) | 23 | (2) | 833 | (76) | <.001 |
| Abnormal metabolic activity in 18F-FDG PET/CT in native or prosthetic valve or CIED lead, n (%) | 5 | (1) | 109 | (10) | <.001 |
| Abnormal metabolic activity in 18F-FDG PET/CT in prosthetic valve, n (%) | 3 | (0.3) | 70 | (6) | <.001 |
| Positive cardiac-CT for vegetation, perforation, abscess, aneurysm, pseudoaneurysm, fistula, n (%) | 2 | (0.2) | 40 | (4) | <.001 |
| Significant new valvular regurgitation on echocardiography as compared to previous imaging, n (%) | 21 | (2) | 207 | (19) | <.001 |
| Major imaging criterion (Li 2000), n (%) | 41 | (4) | 852 | (77) | <.001 |
| Major imaging criterion (ESC 2015), n (%) | 25 | (2) | 877 | (80) | <.001 |
| Major imaging criterion (ISCVID 2023), n (%) | 44 | (4) | 913 | (83) | <.001 |
| Manifestations | … | … | … | … | |
| Minor fever criterion (all versions), n (%) | 788 | (76) | 860 | (78) | .379 |
| New heart murmur, n (%) | 160 | (16) | 410 | (37) | <.001 |
| Vascular phenomena (major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway's lesions), n (%) | 156 | (15) | 590 | (54) | <.001 |
| Cerebral abscess, n (%) | 8 | (0.8) | 3 | (0.3) | .134 |
| Splenic abscess, n (%) | 0 | (0) | 1 | (0) | 1.000 |
| Minor vascular criterion (Li 2000), n (%) | 156 | (15) | 590 | (54) | <.001 |
| Minor vascular criterion (ESC 2015), n (%) | 156 | (15) | 590 | (54) | <.001 |
| Minor vascular criterion (ISCVID 2023), n (%) | 161 | (16) | 591 | (54) | <.001 |
| Minor immunologic criterion (all versions), n (%) | 17 | (2) | 144 | (13) | <.001 |
| Data on surgery/CIED extraction/histopathology, n (%) | |||||
| Valve surgery performed, n (%) | 16 | (2) | 448 | (41) | <.001 |
| Major surgery criterion (ISCVID 2023), n (%) | 0 | (0) | 12 | (1) | .001 |
| CIED extraction (among 453 patients with CIED), n (%) | 17 | (17) | 109 | (31) | <.001 |
| Positive CIED-lead culture (without contact with infected pocket site), n (%) | 0 | (0) | 46 | (13) | <.001 |
| Macroscopic evidence of IE by inspection (surgery/autopsy), n (%) | 5 | (.5) | 297 | (27) | <.001 |
| Autopsy performed, n (%) | 14 | (1) | 17 | (2) | .857 |
| Histopathology compatible for IE or positive culture or of vegetation, abscess, or embolized lesion, n (%) | 0 | (0) | 285 | (26) | <.001 |
| Positive nucleic acid-based tests, n (%) | 0 | (0) | 42 | (4) | <.001 |
| Duke pathological criterion (Li 2000), n (%) | 0 | (0) | 285 | (26) | <.001 |
| Duke pathological criterion (ESC 2015), n (%) | 0 | (0) | 285 | (26) | <.001 |
| Duke pathological criterion (ISCVID 2023), n (%) | 0 | (0) | 345 | (31) | <.001 |
| Exclusion pathological criterion (all versions), n (%) | 25 | (2) | 0 | (0) | <.001 |
| Outcome | |||||
| Lack of recurrence despite antibiotic therapy for <4 d (absence of death within 7d), n (%) | 167 | (16) | 0 | (0) | <.001 |
| Lack of recurrence despite antibiotic therapy for <4 d among cases with infectious diagnoses (absence of death within 7d), n (%) | 33 | (4) | 0 | (0) | <.001 |
| Classifications | |||||
| Classification according to Duke Li 2000 clinical criteria | |||||
| Rejected, n (%) | 706 | (69) | 73 | (7) | |
| Possible, n (%) | 316 | (31) | 345 | (31) | |
| Definite, n (%) | 9 | (1) | 683 | (62) | <.001 |
| Classification according to Duke-ESC 2015 clinical criteria | |||||
| Rejected, n (%) | 715 | (69) | 59 | (5) | |
| Possible, n (%) | 312 | (30) | 351 | (32) | |
| Definite, n (%) | 4 | (0.4) | 691 | (63) | <.001 |
| Classification according to Duke-ISCVID 2023 clinical criteria | |||||
| Rejected, n (%) | 561 | (54) | 14 | (1) | |
| Possible, n (%) | 453 | (44) | 233 | (21) | |
| Definite, n (%) | 17 | (2) | 854 | (78) | <.001 |
In italics appear the characteristics that differ between the different versions of the Duke criteria.
TTE, TOE, 18F-FDG PET/CT, and cardiac CT were performed in 2037 (96%), 1237 (58%), 396 (19%), and 77 (4%) patients, respectively. In CHUV, thoracoabdominal and cerebral imaging for the research of embolic events were performed in 1169 (72%) and 641 (39%) patients, respectively. Valve surgery, CIED extraction, and autopsy were performed in 464 (22%) patients 31 (1%) and 126 (out of 453 patients with CIED; 28%) patients, respectively.
Abbreviations: 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computed tomography; CIED, cardiac implantable electronic devices; ESC, European Society of Cardiology; HACEK, Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella kingae; IE, infective endocarditis; IgG, immunoglobulin G; IQR, interquartile range; ISCVID, International Society of Cardiovascular Infectious Diseases.