Three Years' Experience of the Infective Endocarditis Team in a University Hospital/Bir Universite Hastanesinde Uc Yillik Infektif Endokardit Ekibi Deneyimi
Objective: Infective endocarditis is a serious disease with high morbidity and mortality due to serious embolic complications. The follow-up of the patients requires multidisciplinary evaluation. We aimed to share the experience of the infective endocarditis team in our hospital and to guide the wor...
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| Published in: | KLIMIK dergisi Vol. 36; no. 3; p. 216 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
DOC Design and Informatics Co. Ltd
01-09-2023
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Objective: Infective endocarditis is a serious disease with high morbidity and mortality due to serious embolic complications. The follow-up of the patients requires multidisciplinary evaluation. We aimed to share the experience of the infective endocarditis team in our hospital and to guide the work of the teams to be formed in the future. Methods: Our study was planned as descriptive, cross-sectional, and observational. The patients were diagnosed by the modified Duke criteria. The National Infective Endocarditis Consensus Report was considered during the diagnosis, follow-up, and treatment process. Results: Fifty (45.4%) of 110 patients followed by the team were diagnosed with endocarditis. Thirty of the patients (51.8%) were male, the median age was 63.5 (18-87) days, and the median duration of symptoms was 35.7 (1-180) days. 76% of the diagnoses were definite endocarditis, 46% of the cases had an acute course, aortic valve involvement was 38%, and native valve involvement was 60%; the most isolated agent was Stapyhylococcus aureus. Community-acquired infection was 46%. The most common predisposing factors were prosthetic heart valve (38%) and hemodialysis (46%). Fever was observed in 64% of the patients and dyspnea in 58%. The rate of detection of vegetation by transesophageal echocardiography was 68%. Brain, pulmonary embolisms, and spondylodiscitis were the most common complications. The median time for blood culture to become negative was 3 (3-15) days, the operation time for 15 patients was 8 (1-30) days, and the 30-day hospital mortality was 28%. A statistically significant correlation was found between mortality and the presence of previous endocarditis, ejection fraction below 50%, complication development, hospitalization in the intensive care unit, presence of thrombocytopenia, Charlson comorbidity index [greater than or equal to]5, and vegetation size [greater than or equal to]1 cm (p<0.05). We determined that the presence of previous endocarditis increased the risk of mortality 14 times (p=0.025). Conclusion: Mortality and morbidity rates can be reduced by detecting underlying diseases, controlling complications, applying early effective antibiotic and anticoagulant treatment, surgical interventions at the right time, and rapid supportive treatments for sepsis by teams formed with a multidisciplinary approach. Keywords: team, infective endocarditis, experience Amac: Infektif endokardit ciddi embolik komplikasyonlar sonucu morbidite ve mortalitesi yuksek olabilen bir hastaliktir; hastalarin izlemi icin multidisipliner bir degerlendirme gereklidir. Calisma kapsaminda hastanemizde olusturulan infektif endokardit ekibinin deneyimlerini paylasmak ve ilerde olusturulacak ekiplerin calismalari icin yol gosterici olmak amaclandi. Yontemler: Tanimlayici, kesitsel ve gozlemsel olarak gerceklestirilen calismada duzenli takip edilen hastalarin verileri retrospektif olarak degerlendirildi. Hastalarin tanisi modifiye Duke kriterlerine uygun olarak konuldu; tani, izlem ve tedavi surecinde Ulusal Infektif Endokardit Uzlasi Raporu dikkate alindi. Bulgular: Ekip tarafindan izlenen 110 hastanin 50 (%45.4)'sine infektif endokardit tanisi konulmustu. Hastalarin 30 (%51.8)'u erkekti; yas ortalamasi medyan 63.5 (18-87) yil ve semptomlarin ortalama suresi medyan 35.7 (1-180) gun olarak saptandi. Kesin endokardit %76 ve akut seyir %46 oranlarinda goruldu. En sik olarak %38 oraniyla aort kapak ve %60 oraniyla dogal kapak tutulumu tespit edildi. En fazla izole edilen etken Stapyhylococcus aureus (%29.5) idi. Toplum kaynakli infeksiyon %46 oranindaydi. Protez kalp kapagi (%38) ve hemodiyaliz (%46) en sik karsilasilan predispozan faktorlerdi. Hastalarin %64'unde ates, %58'inde nefes darligi goruldu. Transozafagial ekokardiyografide vejetasyonun saptanma orani %68 olarak tespit edildi. En fazla karsilasilan komplikasyonlar akciger ve beyin embolisinin yani sira spondilodiskitti. Kan kulturu negatiflesme suresi medyan 3 (3-15) gun ve 15 hastanin opere edilme suresi medyan 8 (1-30) gundu; 30 gunluk hastane mortalitesi %28 olarak saptandi. Gecirilmis endokardit varligi, ejeksiyon fraksiyonun %50 altinda olmasi, bir komplikasyon gelismis olmasi, yogun bakimda yatis, trombositopeni varligi, Charlson komorbidite indeksinin [greater than or equal to]5 olmasi ve vejetasyon buyuklugunun [greater than or equal to]1 cm olmasi ile mortalite arasinda istatistiksel olarak anlamli duzeyde iliski bulundu (p<0.05). Daha once gecirilmis endokardit varliginin mortalite gelisme riskini 14 kat artirdigi tespit edildi (p=0.025). Sonuc: Multidisipliner bir yaklasimla olusturulan ekipler tarafindan altta yatan hastaliklarin tespit edilmesi, komplikasyonlarin kontrol altina alinmasi, erken etkin antibiyotik ve antikoagulan tedavinin uygulanmasi, dogru zamanda yapilacak cerrahi girisimlerle ve sepsis hizli destek tedavileri ile mortalite ve morbidite oranlarinda azalma mumkun olabilecektir. Anahtar Kelimeler: ekip, infektif endokardit, deneyim |
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| ISSN: | 1301-143X |
| DOI: | 10.36519/kd.2023.4725 |