Sümeyye KAZANCIOĞLU, Esragül AKINCI, Burcu ÖZDEMİR, Aliye BAŞTUĞ, Adalet AYPAK, Hurrem BODUR

Enfektif Endokardit Hastalarının Klinik ve Laboratuvar Özellikleri: Tek Merkez Deneyimi

Amaç: Bu çalışmada, Türkiye'de üçüncü basamak bir hastanede yatan enfektif endokardit (EE) tanılı hastaların klinik özelliklerini, sonuçlarını ve sekiz yıllık dönemdeki değişiklikleri değerlendirmek ve mortalite risk faktörlerini belirlemek amaçlandı. Gereç ve Yöntemler: Çalışmaya kesin EE tanısıyla yatırılarak takip edilen tüm erişkin hastalar dahil edildi. Çalışma verileri toplu şekilde ve iki ardışık dört yıllık dönem şeklinde (2010-2013 ve 2014-2017) analiz edildi. Bulgular: Çalışmada 72 EE hastası mevcuttu. Erkek/kadın cinsiyet oranı 1,57:1 (44 erkek, 28 kadın) idi. Hastaların ortalama yaşı 48,5±17,6 yıldı. Stafilokoklar en yaygın etken olarak bulundu (%44). Kalp yetmezliği, EE öncesi girişimsel işlem varlığı ve düşük trombosit seviyesi, mortalite için bağımsız risk faktörü olarak bulundu. EE öncesi artan girişimsel işlem varlığı ve enterokokal endokardit, son dönemde (2014-2017) anlamlı olarak daha yüksek bulundu. Sonuç: EE, 21. yüzyılda hala ciddi ve ölümcül bir hastalıktır. Verilerimiz, enfektif endokardit tanısı öncesinde girişimsel işlem varlığının artmakta olduğunu ve bu durumun kötü prognozla ilişkili olduğunu göstermektedir.

Anahtar Kelimeler:

Endokardit, Epidemiyoloji, Mortalite

Clinical and Laboratory Characteristics of Patients with Infective Endocarditis: A single-center experience

Objective: This study aimed to evaluate the clinical presentations, outcomes, and changes over 8 years period of infective endocarditis (IE) patients in a tertiary hospital in Turkey and to identify predictors of mortality. Materials and Methods: All adult patients who were hospitalized with a diagnosis of definite IE were included in the study. The data were analyzed both collectively and separately in two consecutive four-year periods i.e. 2010-2013 and 2014-2017. Results: There were 72 IE cases in the study. Male/female ratio was 1.57:1 (44 males,28 females). The mean age of the patients was 48.5±17.6 years. Staphylococci were the most common agents (44%). Independent predictors of mortality were heart failure, the invasive procedure before IE, and lower platelet level. Increased invasive procedures before IE and enterococcal endocarditis were found significantly to be higher during the last period (2014-2017). Conclusions: IE is still a serious and deadly disease in the 21st century. Our data indicate that invasive procedures have been increasing before IE and this increase with associated poor prognosis.

Keywords:

Endocarditis, Epidemiology, Mortality,

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1Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovascular diagnosis and therapy. 2017;7(1):27.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal. 2015;36(44):3075-128.
Bentata Y. Physiopathological approach to infective endocarditis in chronic hemodialysis patients: left heart versus right heart involvement. Renal failure. 2017;39(1):432-9.
Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: a systematic review. PloS one. 2013;8(12):e82665.
Cabell CH, Heidenreich PA, Chu VH, Moore CM, Stryjewski ME, Corey GR, et al. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. American heart journal. 2004;147(4):582-6.
Vogkou CT, Vlachogiannis NI, Palaiodimos L, Kousoulis AA. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases. European journal of clinical microbiology & infectious diseases. 2016;35(8):1227-45.
Lamas CC, Fournier P-E, Zappa M, Brandão TJ, Januário-da-Silva CA, Correia MG, et al. Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases. Infection. 2016;44(4):459-66.
Chu VH, Cabell CH, Benjamin Jr DK, Kuniholm EF, Fowler Jr VG, Engemann J, et al. Early predictors of in-hospital death in infective endocarditis. Circulation. 2004;109(14):1745-9.
Letaief A, Boughzala E, Kaabia N, Ernez S, Abid F, Chaabane TB, et al. Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study. International Journal of Infectious Diseases. 2007;11(5):430-3.
Rasmussen RV, Snygg-Martin U, Olaison L, Andersson R, Buchholtz K, Larsen CT, et al. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis. Scandinavian journal of infectious diseases. 2009;41(6-7):456-61.
Leblebicioglu H, Yilmaz H, Tasova Y, Alp E, Saba R, Caylan R, et al. Characteristics and analysis of risk factors for mortality in infective endocarditis. European journal of epidemiology. 2006;21(1):25-31.
Toyoda N, Chikwe J, Itagaki S, Gelijns AC, Adams DH, Egorova NN. Trends in infective endocarditis in California and New York State, 1998-2013. Jama. 2017;317(16):1652-60.
Delahaye F, Alla F, Béguinot I, Bruneval P, Doco-Lecompte T, Lacassin F, et al. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scandinavian journal of infectious diseases. 2007;39(10):849-57.
Zhu W, Zhang Q, Zhang J. The changing epidemiology and clinical features of infective endocarditis: a retrospective study of 196 episodes in a teaching hospital in China. BMC cardiovascular disorders. 2017;17(1):113.
Tuğcu A, Yildirimtürk O, Baytaroğlu C, Kurtoğlu H, Köse O, Sener M, et al. Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey. Turk Kardiyol Dern Ars. 2009;37(1):9-18.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis–Prospective Cohort Study. Archives of internal medicine. 2009;169(5):463-73.
Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A, et al. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. International Journal of Infectious Diseases. 2015;30:106-14.
Hıv/aids nedir? Available at: http://www.hatam.hacettepe.edu.tr/AIDS_web-2017.pdf [Last accessed February,2020]
Wurcel AG, Anderson JE, Chui KK, Skinner S, Knox TA, Snydman DR, et al., editors. Increasing infectious endocarditis admissions among young people who inject drugs. Open forum infectious diseases. 2016; Vol. 3. No. 3. Oxford University Press.
Cooper HL, Brady JE, Ciccarone D, Tempalski B, Gostnell K, Friedman SR. Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clinical Infectious Diseases. 2007;45(9):1200-3.
Elbey MA, Akdağ S, Kalkan ME, Kaya MG, Sayın MR, Karapınar H, et al. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg. 2013;13(6):523-7.
Sucu M, Davutoğlu V, Özer O, Aksoy M. Epidemiological, clinical and microbiological profile of infective endocarditis in a tertiary hospital in the South-East Anatolia Region. Congestive heart failure. 2010;23:31.9.
Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, et al. Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992–2001. International journal of cardiology. 2005;98(2):253-60. Xu H, Cai S, Dai H. Characteristics of infective endocarditis in a tertiary hospital in East China. PloS one. 2016;11(11):e0166764.
Barrau K, Boulamery A, Imbert G, Casalta J-P, Habib G, Messana T, et al. Causative organisms of infective endocarditis according to host status. Clinical microbiology and infection. 2004;10(4):302-8.
Cetinkaya Y, Akova M, Akalın H, Aşçıoğlu S, Hayran M, Uzuns Ö, et al. A retrospective review of 228 episodes of infective endocarditis where rheumatic valvular disease is still common. International journal of antimicrobial agents. 2001;18(1):1-7.
Kayaaslan B, Bastug A, Aydin E, Akinci E, But A, Aslaner H, et al. A long-term survey of brucellosis: Is there any marker to predict the complicated cases? Infectious Diseases. 2016;48(3):215-21.
Gursul NC, Vardar I, Demirdal T, Gursul E, Ural S, Yesil M. Clinical and microbiological findings of infective endocarditis. The Journal of Infection in Developing Countries. 2016;10(05):478-87.
Central Asian and European Surveillance of Antimicrobial Resistance. Annual report 2019. https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2019/central-asian-and-european-surveillance-of-antimicrobial-resistance.-annual-report-2019. [Last accessed February 2020]
Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015: CIR. 0000000000000296.
Roca B, Marco JM. Presentation and outcome of infective endocarditis in Spain: a retrospective study. International Journal of infectious diseases. 2007;11(3):198-203.
Wallace S, Walton B, Kharbanda R, Hardy R, Wilson A, Swanton R. Mortality from infective endocarditis: clinical predictors of outcome. Heart. 2002;88(1):53-60.
Khanal B, Harish BN, Sethuram KR, Srinivasan S. Infective endocarditis: report of a prospective study in an Indian hospital. Trop. Doct. 2002;32(2):83-5.
Siegman-Igra Y, Koifman B, Porat R, Porat D, Giladi M. Healthcare associated infective endocarditis: a distinct entity. Scandinavian journal of infectious diseases. 2008;40(6-7):474-80.