Abstract Background Patients with congenital heart disease (CHD) represent a distinct subgroup of patients with infective endocarditis (IE) and exhibit better long-term outcomes compared to patients without CHD. However, comprehensive nationwide data on the clinical characteristics of IE during admission that may elucidate this disparity in outcomes remain scarce. Purpose To compare the clinical and microbiological characteristics of IE and associated outcomes in patients with and without CHD. Methods All patients with valvular infective endocarditis (IE) from the National Danish Endocarditis Studies Registry (NIDUS) (2016-2021) were included and stratified based on whether they had a diagnosis of congenital heart disease (CHD). Baseline characteristics, clinical and microbiological features of IE, and associated outcomes were compared between the two groups. Results Among 3,175 patients with IE, 162 (5.1%) had CHD. The most common CHD diagnosis was bicuspid aortic valve (47.5%), followed by tetralogy of Fallot (17.3%). Patients with versus without CHD were younger at IE diagnosis (median age 47.5 24.1-61.8 versus 74.1 IQR 65.1-80.8 years), had fewer comorbidities, and were less likely to smoke or consume alcohol. Prosthetic valve IE was more common in patients with CHD compared to those without (43.2% versus 23.9%). Additionally, right-sided IE was more common among those with CHD than those without (24.1% versus 2.8%). The microbiological profile differed significantly, with Streptococci being the most common pathogen in patients with CHD, while Staphylococcus aureus predominated in those without CHD, Figure 1. Patients with CHD were admitted for a longer period (median time 43 days IQR 29-49 versus 35 IQR 24-47), were more frequently admitted to the intensive care unit (26.5% versus 20.1%), and more often underwent surgery (53.1% versus 25.0%) compared to those without CHD. Yet, in-hospital mortality was significantly lower in those with versus without CHD (6.8% versus 18.5%). Conclusions Patients with CHD who develop IE exhibit distinct characteristics. Although they have more prolonged hospital admissions and are more likely to require intensive care and surgical intervention, they experience significantly lower in-hospital mortality compared to patients without CHD. These differences highlight that IE appears as a distinct disease entity in patients with CHD compared to those without.Figure 1:Distribution of microbiology
Havers-Borgersen et al. (Sat,) studied this question.