Infective Endocarditis: Review of All Cases in an Internal Medicine Department Over a 6 Year Period

Abstract

Introduction: Despite an improvement in diagnostic and the- rapeutic procedures, infective endocarditis still carries a high mortality and morbidity that has been unchanged for the last 30 years. There has been a recent epidemiological shift trans- lated by an increase of prevalence in older patients, without the characteristic risk factors. This audit aims at analysing the characteristics of the patients admitted to the Internal Medi- cine wards due to infective endocarditis in a six year period. Methods: We selected all the cases coded as infective endo- carditis admitted to the Internal Medicine ward in the period from 01/01/2009 to 31/12/2014. Clinical data was obtained from the electronic medical records.

Results: We identified 40 cases (in 39 patients-32 men and seven women, medium age 62.3 years), which fulfilled the modified Duke’s criteria. Twenty-eight (70.0%) patients had native-valve endocarditis, five (12.5%) had prosthetic-valve involvement and two (5.0%) had vegetations elsewhere. Blood cultures were positive in 31 (77.5%) patients. Twenty-eight (70.0%) patients had complications, with valvular regurgitation in 15 (53.5%). Surgical intervention was required in 16 (40.0%) patients. Medium-time to diagnosis was 8.1 days. The avera- ge duration of in-hospital stay was 24.37 ± 31.68 days, with an in-hospital mortality of 17.5% (seven patients).

Conclusion: Our analysis reflects the reported epidemiologic shift with an increased incidence in older patients with a more severe presentation at admission. There was an increased in- cidence in an older population, which had more co-morbidi- ties and a more serious clinical presentation.