Infective endocarditis: a Hunter New England perspective

Abstract

Background: Infective endocarditis (IE) is a severe infection conferring significant morbidity and mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner.

Aim: To evaluate the presentation, treatment and outcomes of patients with IE in the Hunter New England Local Health District (HNELHD).

Methods: A total of 112 patients with definite IE admitted to hospitals within the HNELHD between 2011 and 2015 was retrospectively analysed.

Results: The mean age of patients was 56.8 (standard deviation 20.3) and 62.5% were male. The most common valve affected was the mitral valve, in 41% of patients, and the most common organism was Staphylococcus aureus, in 47.7% of patients. A history of IE was present in 10% of patients and 19.6% presented with prosthetic valve IE. Survival among patients treated surgically was 100% at 30 days, 92% at 1 year and 83% at 3 years, versus 82% at 30 days, 65% at 1 year and 51% at 3 years for those not operated (P = 0.004). Valve type, organism and Australian Standard Geographical Classification remoteness area did not have a statistically significant effect on mortality (P-value 0.095, 0.456 and 0.186, respectively). Factors associated with improved survival by univariate analysis included surgery and multidisciplinary team review.

Conclusion: IE in the HNELHD affects a relatively young cohort of patients and is associated with a high mortality. Outcomes could be improved by implementation of a multidisciplinary team approach and inpatient cardiac surgery.

Keywords: cardiac surgery; infectious disease; infective endocarditis.