Infective endocarditis in adult patients with congenital heart disease

Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. 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...

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Published in:	International journal of cardiology Vol. 370; pp. 178 - 185
Main Authors:	van Melle, Joost P., Roos-Hesselink, Jolien W., Bansal, Manish, Kamp, Otto, Meshaal, Marwa, Pudich, Jiri, Luksic, Vlatka Reskovic, Rodriguez-Alvarez, Regino, Sadeghpour, Anita, Hanzevacki, Jadranka Separovic, Sow, Rouguiatou, Timóteo, Ana Teresa, Morgado, Marisa Trabulo, De Bonis, Michele, Laroche, Cecile, Boersma, Eric, Lancellotti, Patrizio, Habib, Gilbert
Format:	Journal Article Web Resource
Language:	English
Published:	Netherlands Elsevier B.V 01-01-2023 Elsevier
Subjects:	Adult Adult congenital heart disease Cardiovascular & respiratory systems Endocarditis Endocarditis - diagnosis Endocarditis - epidemiology Endocarditis - etiology Endocarditis, Bacterial - complications Endocarditis, Bacterial - diagnosis Endocarditis, Bacterial - epidemiology Endocarditis, Bacterial/diagnosis/epidemiology/complications Endocarditis/diagnosis/epidemiology/etiology Female Heart Defects, Congenital - complications Heart Defects, Congenital - diagnosis Heart Defects, Congenital - epidemiology Heart Defects, Congenital/complications/diagnosis/epidemiology Human health sciences Humans Life Sciences Male Middle Aged Prospective Studies Retrospective Studies Risk Factors Sciences de la santé humaine Systèmes cardiovasculaire & respiratoire Adult congenital heart disease Endocarditis
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Summary:	Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. 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. 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]). 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. •Despite improvements in health care, mortality from infective endocarditis (IE) is still high.•Patients with congenital heart disease (CHD) are at risk for developing IE.•Data about concomitant diseases, clinical presentation, site of infection, causative agents and prognosis after treatment is scarce, single-center oriented and retrospective.•This is the first international study and largest to date showing 1) that both short-term and long-term prognosis are better in CHD patients than in non-CHD IE patients and 2) predictors of outcome 3) that previous dental procedures in the 6 months before hospitalization were reported in 14% of the CHD patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 scopus-id:2-s2.0-85140449385
ISSN:	0167-5273 1874-1754 1874-1754
DOI:	10.1016/j.ijcard.2022.10.136