Table 1.
Comparison of clinical characteristics and outcomes of 226 patients with definite infective endocarditis treated at 26 Spanish referral centres between 14 March and April 13 2019 and 2020
| 2019 (n = 136) | 2020 (n = 90)a | p | |
|---|---|---|---|
| Demographics | |||
| Age in years, median (IQR) | 69.6 (60.2–79.4) | 70.3 (62.5–78.2) | 0.645 |
| Male sex | 88 (64.7) | 59 (65.6) | 0.896 |
| Comorbidities | |||
| Charlson comorbidity index, median (IQR) | 2 (1–3) | 2 (1–4) | 0.635 |
| Calendar admission | |||
| From 14 March to 31 March | 103 (75.7) | 70 (77.8) | 0.723 |
| From 1 April to 13 April | 33 (24.3) | 20 (22.2) | |
| Transferred from another hospital | 45 (33.1) | 30 (33.3) | 0.969 |
| Transfer from 14 March to 31 March | 33/45 (73.3) | 29/30 (96.7) | 0.009 |
| Transfer from 1 April to 13 April | 12/45 (26.7) | 1/30 (3.3) | |
| n = 45 | n = 30 | ||
| Days from admission to transfer, median (IQR) | 7 (2–11) | 8 (2–12) | 0.922 |
| Type of IE | |||
| Native valve IE | 77 (56.6) | 45 (50) | 0.329 |
| Prosthetic valve IE | 50 (36.8) | 41 (45.6) | 0.187 |
| Intracardiac electronic device | 9 (6.6) | 4 (4.4) | 0.492 |
| Type of acquisition | |||
| Community acquired | 94 (69.1) | 62 (68.9) | 0.971 |
| Nosocomial healthcare-associated infection | 30 (22.1) | 17 (18.9) | 0.565 |
| Non-nosocomial healthcare-associated infection | 12 (8.8) | 11 (12.2) | 0.408 |
| Aetiology | |||
| Oral streptococci | 31 (22.8) | 20 (22.2) | 0.920 |
| Staphylococcus aureus | 29 (21.3) | 11 (12.2) | 0.079 |
| MSSA | 25/29 (86.2) | 10/11 (90.9) | |
| MRSA | 4/29 (13.8) | 1/11 (9.1) | |
| Enterococci | 26 (19.1) | 13 (14.4) | 0.363 |
| Coagulase-negative staphylococci | 21 (15.4) | 18 (20) | 0.375 |
| Streptococcus gallolyticus (formerly S. bovis) | 6 (4.4) | 5 (5.6) | 0.757 |
| HACEK group | 5 (3.7) | 0 | 0.160 |
| Non-HACEK Gram-negative bacilli | 4 (2.9) | 5 (5.6) | 0.489 |
| Candida albicans | 0 | 1 (1.1) | 0.398 |
| Otherb | 13 (9.6) | 9 (10) | 0.913 |
| Unknown aetiology | 1 (0.7) | 8 (8.9) | 0.003 |
| Performance of TEE | 126 (92.7) | 80 (88.9) | 0.330 |
| Local cardiac complications (some patients had >1 complication) | 68 (50) | 42 (46.7) | 0.624 |
| Perivalvular abscess | 35 (51.5) | 22 (52.4) | 0.926 |
| Valve perforation | 25 (36.8) | 13 (31) | 0.533 |
| Pseudoaneurysm | 11 (16.2) | 8 (19.1) | 0.699 |
| Fistula | 7 (10.3) | 3 (7.1) | 0.739 |
| Prosthetic dehiscence | 6 (8.8) | 6 (14.3) | 0.530 |
| Prosthetic leak | 3 (4.4) | 3 (7.1) | 0.673 |
| Peripheral emboli (some patients had embolisms in >1 location) | 60 (44.1) | 45 (50) | 0.385 |
| Central nervous system | 29 (50.9) | 24 (54.6) | 0.714 |
| Spleen | 17 (29.8) | 19 (43.2) | 0.165 |
| Osteoarticular | 13 (22.8) | 8 (18.2) | 0.570 |
| Kidney | 6 (10.5) | 6 (13.6) | 0.632 |
| Lung | 6 (10.5) | 0 | 0.034 |
| Vessels | 5 (8.8) | 3 (6.8) | 1 |
| SARS-CoV-2 infection | NA | 11 (12.2) | |
| Duration of antibiotic treatment, days, median (IQR) | |||
| n = 132 | n = 86 | ||
| Overall (n = 218)c | 42 (32–48.5) | 41.5 (29–46) | 0.275 |
| n = 102 | n = 67 | ||
| Survivors (n = 169)d | 43 (36–52) | 42 (34–48) | 0.347 |
| n = 102 | n = 61 | ||
| Survivors excluding 6 patients who received dalbavancin (N = 163) | 43 (36–52) | 44 (37–48) | 0.752 |
| Use of dalbavancin as continuation treatment | 0 | 6 (6.7) | 0.004 |
| Surgery indicated according to 2015 ESC guidelines | 108 (79.4) | 65 (72.2) | 0.212 |
| Indications for surgery (some patients had > 1 indication) | |||
| Heart failure | 54/108 (50) | 32/65 (49.2) | 0.922 |
| Uncontrolled infection | 49/108 (45.4) | 35/65 (53.8) | 0.280 |
| Prevention of embolism | 20/108 (18.5) | 8/65 (12.3) | 0.283 |
| Intracardiac electronic device infection | 9/108 (8.3) | 4/65 (6.2) | 0.769 |
| Surgery performed, if indicated | 85/108 (78.7) | 42/65 (64.6) | 0.042 |
| Indications for surgery in not operated patients (some patients had > 1 indication) | |||
| Heart failure | 9/23 (39.1) | 9/23 (39.1) | 1 |
| Uncontrolled infection | 11/23 (47.8) | 15/23 (65.2) | 0.234 |
| Prevention of embolism | 4/23 (17.4) | 1/23 (4.3) | 0.346 |
| Intracardiac electronic device infection | 2/23 (8.7) | 0 | 0.489 |
| Reasons for no surgery, if indicated | |||
| High-risk patient | 11/23 (47.8) | 12/23 (52.2) | 0.768 |
| Poor vital prognosis due to comorbidities | 6/23 (26.1) | 7/23 (30.4) | 0.743 |
| Good outcome without surgery | 4/23 (17.4) | 4/23 (17.4) | 1 |
| Patient's rejection | 2/23 (8.7) | 0 | 0.489 |
| In-hospital mortality (n = 224)e | 28/136 (20.6) | 18/88 (20.4) | 0.981 |
| No indication for surgery | 3/28 (10.7) | 1/25 (4) | 0.613 |
| Surgery indicated and performed | 16/85 (18.8) | 10/42 (23.8) | 0.512 |
| Surgery indicated and not performed | 9/23 (39.1) | 7/21 (33.3) | 0.690 |
| N = 108 | N = 70 | ||
| Length of stay in survivors, days, median (IQR) (n = 178)f | 41 (30–54.5) | 34 (24–45) | 0.018 |
| Hospital discharge (n = 178)f | |||
| Home | 66/108 (61.1) | 33/70 (47.1) | 0.067 |
| Outpatient parenteral antimicrobial therapy | 25/108 (23.2) | 22/70 (31.4) | 0.221 |
| Transferred to the hospital from which the patient was referred | 10/108 (9.3) | 10/70 (14.3) | 0.300 |
| Transferred to a rehabilitation clinic | 7/108 (6.5) | 5/70 (7.1) | 1 |
| Control blood culture performed during follow-up (n = 166)g | 78/99 (78.8) | 41/67 (61.2) | 0.014 |
| n = 99 | n = 67 | ||
| Number of samples taken on separated days (n = 166)g | 1 (1–2) | 1 (0–1) | <0.001 |
| n = 108 | n = 70 | ||
| Duration of follow-up of survivors at hospital discharge, days, median (IQR) (n = 178)f | 304.5 (216.5–368) | 44.5 (28–60) | <0.001 |
| Number of patients followed-up ≥30 days (n = 178)f | 104/108 (96.3) | 50/70 (71.4) | <0.001 |
| Mortality during first month of follow-up (after hospital discharge) (n = 154) | 10/104 (9.6) | 2/50 (4) | 0.339 |
| Mortality during follow-up (after hospital discharge) (n = 178)f | 13/108 (12) | 3/70 (4.3) | 0.077 |
| Relapse during follow-up for survivors (n = 169)d | 2/102 (2)h | 3/67 (4.5)i | 0.386 |
Data are expressed as n (%) or median (IQR) as appropriate. IQR, interquartile range; MSSA, methicillin-sensitive Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; HACEK, Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella spp.; TEE, transoesophageal echocardiogram; NA, not applicable.
One patient in the series had been reported in a previous article [3].
2019: Gemella morbillorum in 3, Corynebacterium striatum in 2, Aerococcus sanguinicola in 1, Bartonella henselae 1, Coxiela burnetii in 1, Finegoldia magna in 1, Ganulicatella adicens in 1, Lactococcus garviae in 1, Rothia dentocariosa in 1, Enterococcus faecalis and Staphylococcus aureus in 1.2020: Abiotrophia defectiva in 2, Cutibacterium acnes in 2, Aerococcus urinae in 1, Lactobacillus jensenii in 1, Paenibacillu pabuli in 1, Staphylococcus epidermidis and Staphylococcus hominis in 1, and Streptococcus gallolyticus and Streptococcus oralis in 1.
Eight patients were not included in the analysis. 2019: 2 with suppressive treatment (a native IE due to S. oralis with local cardiac complications not operated due to patient rejection, and an intracardiac device infection due to E. faecalis not operated due to high surgical risk), and 2 still on treatment due to infective endocarditis caused due to B. henselae and C. burnetii, respectively. 2020: 4 with suppressive treatment (a native IE due to S. gordonii with local cardiac complications not operated due to high surgical risk, a prosthetic IE due to S. gallolyticus with local cardiac complications not operated due to comorbidities, a prosthetic IE due to S. epidermidis with local cardiac complications not operated due to comorbidities, and a prosthetic IE due to E. coli not operated due to favourable outcome with medical treatment).
Fifty-seven patients were excluded from the analysis. 2019: 30 who died during infective endocarditis antimicrobial treatment (28 during hospitalization and 2 after discharge), 2 who underwent suppressive treatment, and 2 were still on treatment for infective endocarditis caused by B. henselae and C. burnetii, respectively. 2020: 19 who died during infective endocarditis antimicrobial treatment (18 during hospitalization and 1 after discharge) and 4 who underwent suppressive treatment.
Two patients from the 2020 period were not included because they had not been discharged at the time of the analysis.
Forty-eight patients were excluded from the analysis. 2019: 28 patients who died during hospitalization. 2020: 18 patients who died during hospitalization and 2 patients who had finished endocarditis treatment but were still hospitalized were not included in the analysis.
Sixty patients were excluded from the analysis: 2019: 28 patients who died during hospitalization, 3 patients from which it was not possible to obtain this information, 2 who underwent suppressive treatment, 2 who died after discharge during endocarditis treatment, 1 patient with C. burnetii endocarditis, and 1 patient with B. henselae endocarditis. 2020: 18 patients who died during hospitalization, 4 who underwent suppressive treatment, and 1 who died after discharge during endocarditis treatment.
One relapse 151 days after antimicrobial treatment (an operated S. epidermidis prosthetic endocarditis) and one relapse 27 days after antimicrobial treatment (an A. sanguinicola native endocarditis not operated although indicated).
One relapse 42 days after finishing antimicrobial treatment (an operated P. aeruginosa prosthetic endocarditis), one relapse 37 days after finishing antimicrobial treatment (an operated E. faecalis native endocarditis), and one relapse 16 days after finishing antimicrobial treatment (a prosthetic endocarditis due to S. epidermidis with surgical indication but not operated due to comorbidities).