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Review
. 2022 Aug 24;11(17):4957.
doi: 10.3390/jcm11174957.

Healthcare-Associated Infective Endocarditis-Surgical Perspectives

Tatjana Musci  1 , Herko Grubitzsch  1
Affiliations
Review

Healthcare-Associated Infective Endocarditis-Surgical Perspectives

Tatjana Musci et al. J Clin Med. .

Abstract

Health-care-associated infective endocarditis (HCA-IE), a disease with a poor prognosis, has become increasingly important. As surgical treatment is frequently required, this review aims to outline surgical perspectives on HCA-IE. We searched PubMed to identify publications from January 1980 to March 2022. Reports were evaluated by the authors against a priori inclusion/exclusion criteria. Studies reporting on surgical treatment of HCA-IE including outcome were selected. Currently, HCA-IE accounts for up to 47% of IE cases. Advanced age, cardiac implants, and comorbidity are important predispositions, and intravascular catheters or frequent vascular access are significant sources of infection. Staphylococci and enterococci are the leading causative microorganisms. Surgery, although frequently indicated, is rejected in 24-69% because of prohibitive risk. In-hospital mortality is significant after surgery (29-50%) but highest in patients rejected for operation (52-83%). Furthermore, the length of hospital stay is prolonged. With aging populations, age-dependent morbidity, increasing use of cardiac implants, and growing healthcare utilization, HCA-IE is anticipated to gain further importance. A better understanding of pathogenesis, clinical profile, and outcomes is paramount. Further research on surgical treatment is needed to provide more comprehensive information for defining the most suitable treatment option, finding the optimal time for surgery, and reducing morbidity and mortality.

Keywords: cardiac surgery; endocarditis; healthcare-associated infective endocarditis; infective endocarditis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evaluation of literature. After database search and cross-checking of bibliographies (see text), relevant studies were identified following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Figure 2
Figure 2
Operative risk in healthcare-associated infective endocarditis. The graphs show the calculated risk of mortality (EuroSCORE II) of isolated redo valve replacement due to prosthetic valve endocarditis (PVE) in female (red line) and male (blue line) patients (no further comorbidities) in comparison to isolated redo valve replacement not due to IE (interrupted lines) and isolated primary coronary artery bypass grafting (dotted lines) [http://www.euroscore.org/calc.html, accessed on 22 July 2022]. The insert lists patient- and cardiac-related factors leading to significantly increased risk. For example, in a 73-year-old female patient requiring urgent surgery due to PVE and presenting with end-stage renal failure and moderate LV dysfunction, the calculated risk of mortality is 17%. IDDM, insulin-dependent diabetes mellitus.
See this image and copyright information in PMC

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