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Infective endocarditis in Rio de Janeiro, Brazil: a 5-year experience at two teaching hospitals.

P V Damasco1, J N Ramos, J C D Correal

  • 1Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil.

Infection
|June 18, 2014
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Summary

Infective endocarditis (IE) in Brazil shows high mortality, especially in older patients with renal failure. Streptococcus spp. caused community-acquired IE, while Staphylococcus aureus and Enterococcus spp. caused healthcare-acquired IE.

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Area of Science:

  • Infectious Diseases
  • Cardiology
  • Epidemiology

Background:

  • Infective endocarditis (IE) continues to have high mortality rates despite advances in treatment.
  • Limited data exist on IE prevalence, epidemiology, and etiology in developing countries.
  • This study addresses the 5-year experience of IE at two Brazilian teaching hospitals.

Purpose of the Study:

  • To describe the epidemiological and etiological characteristics of infective endocarditis (IE) in Brazil.
  • To identify risk factors associated with IE and its in-hospital mortality.
  • To provide insights into IE management in a developing country context.

Main Methods:

  • An observational, prospective cohort study was conducted.
  • Demographic, anamnestic, and microbiological data of 71 IE patients were collected from January 2009 to March 2013.
  • Statistical analysis was performed to identify risk factors and outcomes.

Main Results:

  • The mean age of patients was 49.8 years, with 57.7% males.
  • Community-acquired IE (CAIE) accounted for 43.6% and healthcare-acquired IE (HAIE) for 56.3%.
  • Staphylococcus aureus was the predominant cause of IE overall (30%), Streptococcus spp. for CAIE (45.1%), and S. aureus (32.5%) and Enterococcus spp. (27.2%) for HAIE. The mitral valve was most commonly affected (48.3%).
  • In-hospital mortality was high at 46.4%. Risk factors for mortality included age over 45 and chronic renal insufficiency.
  • HAIE was associated with more frequent tricuspid valve involvement and chronic renal insufficiency compared to CAIE.

Conclusions:

  • Streptococcus spp. is the primary cause of CAIE, while S. aureus and Enterococcus spp. are leading causes of HAIE in this Brazilian cohort.
  • IE remains a severe condition with a high in-hospital mortality rate, particularly in older patients and those with renal failure.
  • Early surgical intervention may improve outcomes for IE patients.