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Título

EVOLVING TRENDS IN INFECTIVE ENDOCARDITIS (IE) AT A UNIVERSITY HOSPITAL (1978-2021)

Resumo

Introduction
Progress in medicine has contributed to the increase in the incidence and lethality of endocarditis. This is due to the greater number of individuals with degenerative valve diseases, comorbidities, health-related infections and implants of prosthetic valves and intracardiac electronic devices that occurred with the aging of population, in addition to the growing use of intravenous recreational drugs.

Objectives
The aim of this study is to describe changes in clinical and demographical patterns of IE cases in patients admitted to a tertiary teaching hospital

Methods
Retrospective cohort of IE cases diagnosed at a tertiary university hospital in Rio de Janeiro between 1978 and 2021. Patient records were systematically reviewed to collect demographic and clinical data. Descriptive statistics were employed to summarize the demographic and clinical characteristics of the cohort. Differences between groups were analyzed with chi-squared, fisher’s exact or a non-parametric test.

Results
708 episodes of IE were diagnosed among the 639 patients. Of these, 500 were classified as definitive and 208 as possible. The ages of the individuals ranged between 18 and 93 years, with an average of 45.5 ± 17.5. There is an aging trend in the studied population over the years - between 1978 and 1999, an average of 41.3 ± 16.6 years and between 2000 and 2021, 51.7 ± 17 (p<0.001). In 251 (35.5%) of the episodes, patients had comorbidities (chronic kidney disease on hemodialysis in 75 (10.6%) and diabetes mellitus in 67 (9.5%). In 412 (58.2%) episodes, the patients had some previous predisposing cardiac condition. The most affected valve was the mitral valve, 190 (26.8%) cases. Of the 416 (58.8%) episodes in which blood cultures were positive, the microorganisms most frequently were Staphylococcus aureus (122 (29.3%)), viridans-group Streptococcus (99 (23.8%)) and Enterococcus spp. (43 (10.3%)). Most episodes were acquired in the community 482 (68.1%). In 230 (32.5%) of the episodes the patient underwent valve replacement. 35.5% of cases led to patient death. There was a significant increase in deaths in the last two decades (p = 0.02).

Conclusions
IE is a serious infection whose mortality is increasing. This outcome may be associated with the aging of patients and a higher prevalence of comorbidities.

Palavras Chave

Endocardite infecciosa; Epidemiologia