BACKGROUND:Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT).METHODS:Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed.RESULTS:A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission.CONCLUSIONS:OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.

Aim: To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery. Methods and results: From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p < 0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99-5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04-3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p = 0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53-5.98) were independently associated with fatal outcome during the first year. Conclusions: The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention. (c) 2019 Elsevier B.V. All rights reserved.

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:< 65 years, 65 to 80 years, and >= 80 years. The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years; 1291 65-80 years; 502 >= 80 years) were enrolled. Fever and heart failure were the most common presentations of IE, with no differences among age groups. Patients >= 80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, >= 80 years). In-hospital mortality was lower in the< 65-year group (20.3%,< 65 years; 30.1%, 65-79 years; 34.7%, >= 80 years; p < 0.001) as well as 1-year mortality (3.2%,< 65 years; 5.5%, 65-80 years; 7.6%, >= 80 years; p= 0.003). Independent predictors of mortality were age >= 80 years (hazard ratio [HR]: 2.78; 95% confidence interval [CI]: 2.32-3.34), CCI >= 3 (HR: 1.62; 95% CI: 1.39-1.88), and non-performed surgery (HR: 1.64; 95% CI: 11.16-1.58). When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged< 65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age >= 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE. CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the< 65-year group.

OBJECTIVES. To describe the epidemiological, clinical, and prognostic characteristics of patients with left-sided native valve endocarditis (LNVE) caused by coagulase-negative staphylococci (CONS). PATIENTS AND METHOD. Prospective multicenter study of endocarditis cases reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2005. RESULTS. Among 470 cases of LNVE, 39 (8.3%) were caused by CONS, a number indicating a 30% increase in the incidence of this infection over the last decade. The mean age of affected patients was 58.32+/-15 years and 27 (69.2%) were men. Twenty-one patients (53.8%) had previous known valve disease and half the episodes were considered nosocomial (90% of them from vascular procedures). Median time interval from the onset of symptoms to diagnosis was 14 days (range: 1-120). Renal failure (21 cases, 53.8%), intracardiac damage 0 1 cases, 28.2%), and central nervous system involvement (10 cases, 25.6%) were the most frequent complications. There were only 3 cases (7.7%) of septic shock. Surgery was performed in 18 patients (46.2%). Nine patients (23.1%) died, overall. Factors associated with higher mortality in the univariate analysis were acute renal failure (P = 0.023), left-sided ventricular failure (P = 0.047), and time prior to diagnosis less than 21 days (P = 0.018). As compared to LNVE due to other microorganisms, the patients were older (P = 0.018), had experienced previous nosocomial manipulation as the source of bacteremia (P < 0.001), and developed acute renal failure more frequently (P = 0.001). Mortality of LNVE due to CoNS was lower than mortality in Staphylococcus aureus infection, but higher than in Streptococcus viridans infection. CONCLUSIONS. Left-sided native valve endocarditis due to CONS is now increasing because of the ageing of the population. This implies more frequent invasive procedures (mainly vascular) as a consequence of the concomitant disease. Nonetheless, the mortality associated with LNVE due to CoNS does not seem to be greater than infection caused by other pathogens.

Describir las características epidemiológicas, clínicas y pronósticas de la endocarditis sobre válvula nativa izquierda (EVNI) por estafilococos coagulasa negativos (ECN). Estudio prospectivo multicéntrico de las endocarditis recogidas en la Cohorte Andaluza para el Estudio de las Infecciones Cardiovasculares en los años 1984-2005. De las 470 EVNI recogidas, 39 (8,3%) fueron causadas por ECN con un aumento del 30% de incidencia en la última década. La edad media fue 58,32 15 años, 27 pacientes (69,2%) eran varones y 21 (53,8%) tenían valvulopatía previa. En la mitad de los casos el origen seconsideró nosocomial (el 90% tras manipulaciones vasculares). La mediana del intervalo entre la aparición de síntomas y el diagnóstico fue de 14 días (rango: 1-120). Las complicaciones más frecuentes fueron: insuficiencia renal (53,8%), complicaciones cardíacas (28,2%), afectación del sistema nervioso central (25,6%) y shock séptico (7%). La cirugía fue necesaria en 18 pacientes (46,2%) y 9 (23,1%) fallecieron. Los factores que se asociaron con una mortalidad mayor fueron la insuficiencia renal aguda (p = 0,023), el fallo ventricular izquierdo (p ó 0,047) y un tiempo de evolución previo al diagnóstico inferior a 21 días (p = 0,018). La EVNI por ECN ocurre en pacientes más ancianos (p = 0,018), es con mayor frecuencia de origen nosocomial (p < 0,001) y desarrolla más fracaso renal agudo (p = 0,001). La mortalidad es menor que la EVNI producida por Staphylococcus aureus (47,7%), pero mayorque la EVNI por Streptococcus viridans (10,6%). La EVNI por ECN es una entidad cuya incidencia está aumentando a expensas de una población de edad avanzada, que requiere frecuentemente maniobras diagnósticas o terapéuticas cruentas como consecuencia de sus enfermedades concomitantes. A pesar de ello, la mortalidad no parece ser mayor que en las EVNI causadas por otros patógenos. To describe the epidemiological, clinical, and prognostic characteristics of patients with left-sided native valve endocarditis (LNVE) caused by coagulase-negative staphylococci (CoNS). Prospective multicenter study of endocarditis cases reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2005. Among 470 cases of LNVE, 39 (8.3%) were caused by CoNS, a number indicating a 30% increase in the incidence of this infection over the last decade. The mean age of affected patients was 58.32 ± 15 years and 27 (69.2%) were men. Twenty-one patients (53.8%) had previous known valve disease and half the episodes were considered nosocomial (90% of them from vascular procedures). Median time interval from the onset of symptoms to diagnosis was 14 days (range: 1-120). Renal failure (21 cases, 53.8%), intracardiac damage (11 cases, 28.2%), and central nervous system involvement (10 cases, 25.6%) were the most frequent complications. There were only 3 cases (7.7%) of septic shock. Surgery was performed in 18 patients (46.2%). Nine patients (23.1%) died, overall. Factors associated with higher mortality in the univariate analysis were acute renal failure (P = 0.023), left-sided ventricular failure (P = 0.047), and time prior to diagnosis less than 21 days (P = 0.018). As compared to LNVE due to other microorganisms, the patients were older (P = 0.018), had experienced previous nosocomial manipulation as the source of bacteremia (P < 0.001), and developed acute renal failure more frequently (P = 0.001). Mortality of LNVE due to CoNS was lower than mortality in Staphylococcus aureus infection, but higher than in Streptococcus viridans infection. Left-sided native valve endocarditis due to CoNS is now increasing because of the ageing of the population. This implies more frequent invasive procedures (mainly vascular) as a consequence of the concomitant disease. Nonetheless, the mortality associated with LNVE due to CoNS does not seem to be greater than infection caused by other pathogens.