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Trend in Infective Endocarditis in Bulgaria: Characteristics and Outcome, 17-Years, Single Center Experience
Bistra Dobreva-Yatseva1, Fedya Nikolov1, Ralitsa Raycheva2
1Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University-Plovdiv, UMBAL "St. Georgi" EAD, 4000 Plovdiv, Bulgaria.
Background:
Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades.
Methods:
This study is retrospective, single-centered, and includes 270 patients diagnosed with IE for the period 2005-2021. We compared two periods, 2005-2015 (n = 119) and 2016-2021 (n = 151), to find the characteristics changes.
Results:
The study included 177 (65.5%) male patients. In the second period, there is a significant increase in age from 62 (44-73) to 67 (53-75), (p = 0.023); in the Charlson comorbidities index (CCI) from 3 (1-4) to 4 (2-6), (p = 0.000); in cases with chronic kidney diseases (CKDs) from 15 (12.6%) to 55 (36.9%), (p = 0.001); coronary arterial diseases (CADs) from 20 (16.85%) to 44 (29.1%), (p = 0.018); and atrial fibrillation (AF) from 13 (10.9%) to 36 (23.8%), (p = 0.006). Ejection fraction decreased significantly in the second period from 63 (56-70) to 59 (51-66), (p = 0.000). Almost half of the patients 123 (45.6%) had no known predisposing cardiac condition, and 125 (46.3%) had an unknown port of entry. IE was community-acquired in 174 (64.4%), healthcare-associated in 72 (26.7%), and injection-drug-use-related IE in 24 (8.9%). The study population included 183 (67.8%) native valve IE, 85 (31.5%) prosthetic IE, and 2 (0.74%) intracardiac-device-related IE. The hemocultures were positive in 159 (59.6%), and the most frequent pathogenic agent was staphylococci-89 (33.3%) (Staphylococcus aureus-44 (16.5%) and coagulase negative staphylococci-45 (16.8%)). Only 54 (20%) of patients underwent early surgery. The all-cause 30-day mortality rate was 67 (24.8%). There is no significant difference between the two periods in terms of the characteristics listed above.
Conclusions:
The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions, and entry door. The most common pathogen was the Staphylococcus spp. The 30-day mortality rate remains high.
Insights
Infective endocarditis in Bulgaria shows an aging patient population with more comorbidities. Despite changes in risk factors, the high 30-day mortality rate for this serious heart infection persists.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Infective endocarditis (IE) presents diagnostic and therapeutic challenges, with high mortality rates.
- Recent data on IE trends in Bulgaria is limited, necessitating updated epidemiological insights.
Purpose of the Study:
- To analyze changes in the epidemiological and clinical characteristics of IE in Bulgaria between 2005-2015 and 2016-2021.
- To identify shifts in patient demographics, comorbidities, and causative agents of IE.
Main Methods:
- Retrospective, single-center study of 270 patients diagnosed with IE from 2005-2021.
- Comparison of patient characteristics between two distinct time periods: 2005-2015 (n=119) and 2016-2021 (n=151).
Main Results:
- The patient population aged significantly, with increased prevalence of comorbidities like chronic kidney disease, coronary artery disease, and atrial fibrillation.
- A notable decrease in ejection fraction was observed in the later period.
- Staphylococcus species were the most frequent pathogens identified (33.3%), with a 30-day mortality rate of 24.8%.
Conclusions:
- The profile of infective endocarditis in Bulgaria has evolved, characterized by an older demographic and increased comorbidity burden.
- Staphylococcus spp. remains the predominant pathogen.
- The high 30-day mortality rate for IE continues to be a significant public health concern.
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