Pathogen profiles and prognostic factors in infective endocarditis: a retrospective analysis

Background Infective endocarditis (IE) remains a serious condition with adverse clinical outcomes, influenced by the causative pathogen. This study evaluates the impact of specific pathogens on complications and in-hospital mortality in IE. Methods A retrospective cohort of 90 patients diagnosed with IE at a secondary care center over six years was analyzed. Pathogens were categorized into Staphylococcus spp., Streptococcus spp., Enterococcus spp., other agents, culture-negative cases, and multiple pathogens. Outcomes included sepsis, acute kidney injury (AKI), in-hospital mortality, and other clinical events. Results Patients with Enterococcus spp. were older than the cohort average (75.6 vs. 69.9 years, p=0.023), while patients with Other agents were younger (60.3 vs. 69.9 years, p=0.008). No significant diferences were noted for gender, hypertension, diabetes, atrial fibrilation, HIV, or immunosuppression. Native valve, prosthetic valve, or device infections did not show significant statistical diferences. Similarly, vegetation size >10 mm, local complications, embolic events, significant functional impact of IE (e.g., regurgitation/stenosis), vasopressor use, atrioventricular block, de novo heart failure, stroke, and surgical indication also showed no significant variation between groups. Sepsis occurred in 46.7% of patients, with significant diferences between pathogens (p=0.002). Staphylococcus spp. (66.7%, p=0.039) and multiple pathogens (100%, p=0.048) were associated with higher sepsis rates, while Streptococcus spp. showed lower rates (25.0%, p=0.005). Other pathogen groups showed no significant diferences. AKI occurred in 71.3% of patients, with rates higher in Staphylococcus spp. (90.5%, p=0.036) and lower in Streptococcus spp. (54.2%, p=0.008). In-hospital mortality was 32.5%, varying significantly by pathogen (p=0.014). Staphylococcus spp. (57.1%, p=0.017) and multiple pathogens (100%, p=0.011) were associated with increased mortality. Streptococcus spp. exhibited a trend toward reduced mortality (16.7%, p=0.07), while other groups showed no significant diferences. Conclusion This study highlights the significant impact of pathogen type on outcomes in infective endocarditis (IE), particularly regarding sepsis, AKI and mortality. However, further research is needed to understand the underlying mechanisms driving these diferences. Given the complexity of IE, including multi-pathogen infections, the establishment of dedicated IE teams could enhance early diagnosis and improve management. These teams are essential for implementing pathogen specific strategies, which may ultimately lead to be ter patient outcomes and reduced mortality.