Contemporary cohort study in adult patients with infective endocarditis

Abstract Background Infective endocarditis (IE) is a severe disease with a high mortality rate. Our aim was to describe a case series of adult patients with definite IE treated at a reference centre for cardiac surgery in Brazil, highlighting their specific characteristics.Methods A retrospective analysis of a prospectively implemented endocarditis database was conducted, including adult patients with definite IE according to the modified Duke criteria from January 2006 to June 2023. The analysis used the International Collaboration on Endocarditis case report form. Statistical analysis was performed using Jamovi®, version 1.2.2.Results There were 502 episodes of IE; the mean patient age ± SD was 48.4 ± 17.2 years. Community-acquired IE occurred in 64.7% of the patients, previous heart surgery was performed in 40.6%, and 39.0% of the patients had previous congestive heart failure (CHF). The main predisposing factors were rheumatic valve disease (RVD, 30.7%), valve prostheses (31.5%), and congenital heart disease (13.9%). Transthoracic and transoesophageal echocardiograms were performed in 85% and 78% of the patients, respectively. Left-sided IE was predominant. Fever occurred in 90.6% of patients, new murmurs in 50.7%, and embolism in 45%. Blood cultures were negative in 33.1% of the patients. The most common pathogens were oral streptococci (15.6%), Staphylococcus aureus (10.0%), and enterococci (12.8%). The main complications were CHF (58%), acute renal failure (32.8%), and splenic embolization (35.2%). Surgery was performed in 83.6% of the patients, and the in-hospital mortality rate was 25%.Conclusions In this centre, left-sided IE predominated, with negative blood cultures. Oral streptococci were the most frequently encountered pathogens and RVD was the main predisposing factor. Surgery was performed frequently, and the mortality rate was higher than that in developed countries but lower than that in developing countries.