Mural Endocarditis: The GAMES Registry Series and Review of the Literature
Andrea Gutiérrez-Villanueva1, Patricia Muñoz2,3,4,5, Antonia Delgado-Montero6
1Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
Introduction:
Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis.
Methods:
Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series.
Results:
Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar.
Conclusion:
MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.
Insights
Mural infective endocarditis (MIE) is a rare condition, often linked to catheter use in patients on hemodialysis. Fungal causes are common, but mortality rates are similar to other forms of infective endocarditis.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Mural infective endocarditis (MIE) is a rare form of endovascular infection.
- This study presents a comprehensive analysis of MIE cases.
Purpose of the Study:
- To characterize the clinical features, risk factors, and outcomes of MIE.
- To compare MIE patients with other forms of infective endocarditis (IE).
Main Methods:
- Prospective data collection from 35 Spanish hospitals (GAMES registry, 2008-2017).
- Comparison of MIE cases with valvular IE (VIE) and device-associated IE (DIE).
- Literature review of MIE cases (1979-2019) for comparison with the GAMES series.
Main Results:
- MIE patients were younger and more frequently had a history of transplantation, hemodialysis, and catheter use.
- Candida species were a common cause of MIE (22.2%).
- Literature data showed younger patients, lower comorbidity, higher prevalence of IV drug use, and S. aureus as the most frequent pathogen.
Conclusions:
- MIE is a rare entity, frequently associated with catheter use, especially in immunocompromised and hemodialysis patients.
- Fungal etiology is notable in MIE.
- Mortality for MIE is comparable to other forms of IE.
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