A Systematic Review and Analysis of Brucella Endocarditis Cases

Area of Science:

• Infectious Diseases
• Cardiology
• Public Health

Background:

• Brucellosis endocarditis is a significant cause of mortality in brucellosis cases.
• Current management strategies are primarily based on limited case reports and series.
• Identifying risk factors for adverse outcomes in Brucella endocarditis is crucial.

Purpose of the Study:

• To identify independent risk factors associated with mortality and adverse outcomes in patients with Brucella endocarditis.
• To analyze treatment strategies and their impact on patient survival.
• To provide evidence-based recommendations for managing Brucella endocarditis.

Main Methods:

• Individual-patient data analysis of all reported Brucella endocarditis cases.
• Literature search using keywords "Brucella" and "endocarditis" on PubMed and ULAKBIM databases until July 2022.
• Inclusion of case reports/series with patients aged ≥17 years, data on antimicrobial or surgical treatment, and Brucella spp. as the causative agent.

Main Results:

• Analysis of 273 cases from 86 articles revealed male gender, Wright serum tube agglutination (STA) titer ≥1/1280, and heart failure as independent mortality risk factors.
• Aminoglycoside use and cardiac surgical intervention were associated with reduced mortality.
• An STA titer of ≥1/1280 may serve as a marker for increased mortality, potentially indicating advanced disease.

Conclusions:

• Aminoglycosides (streptomycin or gentamicin) and valve surgery may significantly benefit patients with Brucella endocarditis.
• High STA titers could indicate a higher risk of mortality.
• Further high-quality studies are needed to establish definitive diagnostic and treatment guidelines due to the current evidence limitations.