23 Microbiologic and valvular characteristics in patients with fulminant endocarditis from a UK distrcit general hospital

Introduction Infective Endocarditis (IE) remains a global health challenge, marked by substantial mortality and morbidity, with an estimated incidence of 13.8 cases per 100,000 population-years, resulting in 66,300 deaths worldwide. The gravity of this condition prompted our investigation into the characteristics of IE within a relatively deprived adult population in a district general hospital setting. Walsall is ranked amongst the top 10% most deprived districts in UK. Methods Data collection spanned from January 1, 2022, to June 30, 2023, involving a retrospective review of 652 patient's records whose medical coding included IE, valvular disease or septicemia. Scrutiny was also applied to 178 cases with positive blood cultures and 68 transoesophageal echocardiograms. Cases with confirmed IE, who met modified Duke Criteria, were included. Results Among 28 diagnosed and treated IE patients, 57.2% were male, with a median age of 69 years (range 19–92). Native valve infections constituted 79%, while prosthetic valve IE accounted for 21%. Mitral valves were predominantly affected (36%, n=10), followed by tricuspid and aortic valves (5 each). Two cases involved cardiac implantable devices (CIEDs). Predisposing conditions included; intravenous drug use (21%), prosthetic valves (21%), immunosuppression (21%), previous IE (14%), CIEDs (14%) and congenital heart disease (3.6%).Streptococci were isolated in 50% of patients, and Staphylococci in 39%. Of these 10 were Staphylococcus aureus, with 9 being methicillin sensitive and 1 borderline oxacillin-resistant. No methicillin resistant S. aureus was isolated. A Gram-negative bacillus (HACEK) was detected in one. No growth occurred in 7% (n=2) due to antibiotics use prior to sampling. 57% of prosthetic valve infections were caused by S. aureus. Most of the cultures (65%) showed growth within 24 hours (range 6.5 to16.7) while 21% showed growth in 24–48 hours. SARS-CoV-2 testing was available for 86%, with a 25% positivity rate. Rockwood clinical frailty score (CFS) averaged 4.8, 39% patients were moderate to severely frail and 28% mildly frail or vulnerable. The duration of hospital stay averaged 27.5 days, with 25% of patients requiring intervention, including 6 valve replacement surgeries and one CIED extraction. In-hospital mortality stood at 39%, with an average time from diagnosis to death of 14 days. Conclusion Hospitalisation with IE carries a grim prognosis, with an estimated local incidence of 8.9 cases per 100,000 and 43% mortality within 30 days, rising to 64% at 9 months. All patients had significant predisposing factors with frailty also contributing. Native mitral valves in individuals aged 60 and over were predominantly affected and streptococci were the most prevalent organisms. Notably, a quarter of patients, tested positive for SARS-CoV-2, with the impact on outcomes remaining unclear. Limitations include a small sample size, limited follow up, and potential selection bias. Conflict of Interest None