Infective endocarditis in adult patients with congenital heart disease
Joost P. van Melle, Jolien W Roos-Hesselink, Manish Bansal, Otto Kamp, Marwa Meshaal, Jiří Pudich, Vlatka Rešković Lukšić, Regino Rodríguez, Anita Sadeghpour, Jadranka Šeparović Hanževački, Rouguiatou Sow, Ana Teresa Timóteo, Marisa Trabulo Morgado, Michele De Bonis, Cécile Laroche, Eric Boersma, Patrizio Lancellotti, Gilbert Habib, Gilbert Habib, Patrizio Lancellotti, Bernard Cosyns, Erwan Donal, Paola Anna Erba, Gilbert Habib, Bernard Iung, Aldo P. Maggioni, Bogdan A. Popescu, Bernard Prendergast, Pilar Tornos, Nora Nabila Ali Tatar-Chentir, Mouaz H. Al‐Mallah, Meriam Åström Aneq, George Athanassopoulos, Luigi P. Badano, S. Benyoussef, Erick Calderón-Aranda, Nuno Cardim, Kwan‐Leung Chan, Bernard Cosyns, Ines Cruz, Thor Edvardsen, Georg Goliasch, Gilbert Habib, Andreas Hagendorff, Krasimira Hristová, Bernard Iung, Otto Kamp, Duk‐Hyun Kang, William Kong, С.Т. Мацкеплишвили, Marwa Meshaal, M Mirocevic, Aleksandar Nešković, Michal Pazderník, Edyta Płońska‐Gościniak, Bogdan A. Popescu, Bernard Prendergast, Maha Raissouni, Ricardo Ronderos, Leyla Elif Sade, Anita Sadeghpour, Antonia Sambola, Shantanu P. Sengupta, Jadranka Šeparović Hanževački, Masaaki Takeuchi, Edwin S. Tucay, Ana Clara Tude Rodrigues, Albert Varga, Jolanta Justina Vaškelytė, Kentaro Yamagata, Kyriakos Yiangou, Hosam Zaky, Ricardo Ronderos, Gustavo Avegliano, P. Fernandez Oses, E. Filipini, Isabel Granada, Ana Iribarren, M. Mahia, Francisco Nacinovich, S. Ressi, R Obregon, M. Bangher, J. Dho, Luis R Cartasegna, María Laura Plastino, V Novas, C. Shigel, Graciela Reyes, M. De Santos, N. Gastaldello, M Granillo Fernandez, M. Potito, G. Streitenberger, P Velazco, José Casabé, C. Cortes, Eduardo Guevara, Fabián Salmo, M. Seijo
Abstract
BACKGROUND: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.