Pathogenic spectrum of infective endocarditis and analysis of prognostic risk factors following surgical treatment in a tertiary hospital in China

BMC Infect Dis. 2024 Dec 18;24(1):1440. doi: 10.1186/s12879-024-10350-y.

Abstract

Background: This study aimed to summarize the pathogenic spectrum of infective endocarditis (IE) and analyze the risk factors for poor prognosis in surgical patients in a tertiary hospital in China.

Methods: We retrospectively included patients diagnosed with IE between January 2013 and January 2022. The pathogenic spectrum was summarized; the risk factors for early postoperative mortality and embolic events were analyzed using multivariate logistic regression.

Results: Among 630 patients who underwent blood cultures, the positivity rate was 56.83%. The most prevalent pathogens were viridans streptococci, Staphylococcus aureus, enterococci, and coagulase-negative staphylococci (CoNS). The prevalence of viridans streptococci significantly increased in the surgically treated group, compared to the medically treated group (50.80% vs. 27.78%, P < 0.001), while that of CoNS decreased (5.60% vs. 12.04%, P = 0.034). There has been a declining trend in the blood culture positivity in recent years compared to earlier years (2018-2022 vs. 2013-2017 = 60.95% vs. 47.30%, P = 0.037), with an increasing trend in viridans streptococci and a decreasing trend in CoNS. Multivariate logistic regression analysis identified male gender, coronary artery disease, platelet count < 100 × 109/L, albumin < 35 g/L, elevated creatinine, and prosthetic valve as independent risk factors for early postoperative mortality. Risk factors for embolic events included recent cerebral infarction within 3 months, history of peripheral vasculopathy, and hemoglobin (Hb) < 90 g/L.

Conclusions: Viridans streptococci predominates as the most common IE pathogen, with its incidence rising recently, especially among surgical patients. Blood culture positivity is decreasing. Understanding risk factors for early postoperative mortality and embolic events is crucial for optimizing patient management and prognosis.

Clinical trial number: Not applicable.

Keywords: Early postoperative mortality; Embolic events; Infective endocarditis; Pathogenic spectrum; Risk factors.

MeSH terms

  • Adult
  • Aged
  • China / epidemiology
  • Endocarditis / epidemiology
  • Endocarditis / microbiology
  • Endocarditis / mortality
  • Endocarditis / surgery
  • Endocarditis, Bacterial / epidemiology
  • Endocarditis, Bacterial / microbiology
  • Endocarditis, Bacterial / mortality
  • Endocarditis, Bacterial / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers* / statistics & numerical data
  • Viridans Streptococci / isolation & purification