Infective endocarditis in adult patients with congenital heart disease

Joost P. van Melle*, Jolien W. Roos-Hesselink, on behalf of the EURO-ENDO Investigators Group, Manish Bansal, Otto Kamp, Marwa Meshaal, Jiri Pudich, Vlatka Reskovic Luksic, Regino Rodriguez-Alvarez, Anita Sadeghpour, Jadranka Separovic Hanzevacki, Rouguiatou Sow, Ana Teresa Timóteo, Marisa Trabulo Morgado, Michele De Bonis, Cecile Laroche, Eric Boersma, Patrizio Lancellotti, Gilbert Habib

*Corresponding author for this work

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Abstract

Background: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. Methods: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. Results: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). Conclusions: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Original languageEnglish
Pages (from-to)178-185
Number of pages8
JournalInternational Journal of Cardiology
Volume370
DOIs
Publication statusPublished - 1 Jan 2023

Bibliographical note

Funding Information:
This work was supported by Abbott Vascular Int . (2011−2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011−2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc . (2014–2016), Menarini Int. Op . (2009–2012), MSD-Merck & Co . (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), Vifor (2019–2022).

Publisher Copyright:
© 2022 The Author(s)

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