Factors associated with delayed diagnosis of infective endocarditis

Patients with infective endocarditis (IE), have high mortality and morbidity, however, its early diagnosis is difficult. Few studies have examined the delayed diagnosis of IE. We aimed to investigate the factors associated with the diagnostic delay of IE.A retrospective cohort study was conducted for consecutive patients diagnosed with IE in an acute care teaching hospital in Japan from April 2006 to March 2018. Time-to-diagnosis was analyzed using a multivariate Cox hazard model for determining factors associated with days required for IE diagnosis. Factors analyzed in the model included age, gender, activities of daily living, Charlson comorbidity index, presence of internal device, chief complaint, inappropriate antibiotics use, shaking chill, fever >38°C, hypoxemia, serum C-reactive protein (CRP) 38°C (HR, 1.80; 95% CI, 1.11 to 2.90; P = .016), in patients with serum CRP level < 10 mg/dL (HR, 1.53; 95% CI, 1.01 to 2.33; P = .046), and in patients who did not use an ambulance for hospital arrival (HR, 3.18; 95% CI, 1.72 to 5.85; P < .001).Delay in considering IE diagnosis is associated with inappropriate prior antibiotics use, absence of high fever, absence of high CRP level, and use of a hospital arrival vehicle other than an ambulance. For earlier IE diagnosis, inappropriate use of antibiotics should be avoided and IE should not be excluded by relatively low level of temperature or serum CRP.