Epidemiology of community acquired and health care assocİated infective endocarditis and 28 day mortality risk factors: a university hospital study.

backgroundAs the epidemiology of infective endocarditis (IE) evolves, updated antimicrobial management assessments are needed. This study aimed to evaluate the demographic, clinical, laboratory, and imaging characteristics, causative microorganisms, and antibiotic susceptibility of patients with healthcare-associated (HAIE) and community-acquired infective endocarditis (CAIE), as well as identify risk factors for 28-day mortality. The findings are intended to guide the treatment of both HAIE and CAIE.

methodsWe conducted a retrospective cohort study of 131 IE patients treated at Kocaeli University Hospital from December 2016 to December 2022. Data were extracted from hospital records and patients were classified into HAIE and CAIE groups. Comparative analyses were performed between the groups, and risk factors for 28-day mortality in IE patients were determined.

resultsAmong the 131 patients, 51.9% had CAIE and 48.1% had HAIE. Predisposing factors were present in 85.5% of cases, with degenerative heart valves most common in CAIE (30.9%) and hemodialysis (HD) in HAIE (60%). Chronic kidney disease (CKD) was more common as a comorbidity in HAIE than in CAIE (65.1% vs. 8.8%, p = 0.001). Elevated levels of C-reactive protein (CRP), procalcitonin (PCT), troponin, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) at admission correlated with increased 28-day mortality. Blood culture positivity was greater in HAIE (75%), with coagulase-negative staphylococci (CoNS) as the leading pathogen (38%). Mitral valve involvement was most common overall (38.9%), with aortic and mitral valve involvement higher in CAIE (p = 0.047 and p = 0.039, respectively). Complications such as valve insufficiency (64.1%), neurological events (33.6%), heart failure (27.5%), brain embolism (22.9%), and arrhythmia (8.4%) were associated with 28-day mortality, which was 11.5% across all IE patients.

conclusionsThe incidence of HAIE is increasing, particularly in non-nosocomial cases, with HD emerging as a significant risk factor. This highlights the need for tailored empirical treatment strategies based on patient risk profiles. In our study, the high rate of CoNS as a causative agent is noteworthy. Although all cases met diagnostic criteria, the predominance of CoNS may have been influenced by local clinical practices. Therefore, local microbiological data should be taken into account when planning treatment strategies.