Infective Endocarditis in Septic Shock: Results From an Observational Multicenter Study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Cardiology

Background:

• Infective endocarditis (IE) in patients with septic shock presents diagnostic challenges due to overlapping symptoms and comorbidities.
• Early recognition of IE in septic shock is crucial for improving patient outcomes and guiding management strategies in emergency settings.

Purpose of the Study:

• To characterize the clinical features, diagnostic findings, and outcomes of IE in patients experiencing septic shock.
• To identify key factors for early recognition and inform management strategies in critical care and emergency settings.

Main Methods:

• A multicenter observational study involving 300 adult patients with confirmed IE and septic shock across three tertiary hospitals in Pakistan.
• Data collection included demographics, clinical characteristics, imaging (echocardiography), blood cultures, inflammatory markers, and outcomes.
• Multivariate analysis was used to identify independent predictors of adverse outcomes, with multiple imputations addressing missing data.

Main Results:

• Echocardiography (96.33%) and blood cultures (92.67%) showed high positivity rates for IE.
• Common pathogens included Staphylococcus aureus (50%) and Streptococcus species (30%).
• Adverse outcome predictors included older age, prior cardiovascular disease, echocardiographic/blood culture positivity, embolic events, and elevated inflammatory markers.

Conclusions:

• Early identification of IE in septic shock is essential for improving outcomes.
• Echocardiography and blood cultures are highly valuable for confirming IE.
• Prior cardiovascular disease, embolic events, and inflammatory markers are significant predictors of adverse outcomes, guiding timely intervention.