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Microbiological Etiology in Patients with IE Undergoing Surgery and for Patients with Medical Treatment Only: A Nationwide Study from 2010 to 2020
by Peter Laursen Graversen 1,*ORCID,Lauge Østergaard 1,Marianne Voldstedlund 2ORCID,Malthe Faurschou Wandall-Holm 3ORCID,Morten Holdgaard Smerup 4,Lars Køber 1,5 andEmil Loldrup Fosbøl 1,5
1
Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
2
Department of Data Integration and Analysis, Statens Serum Institut, 2300 Copenhagen, Denmark
3
Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen—Rigshospitalet, 2600 Glostrup, Denmark
4
Department of Cardiothoracic Surgery, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
5
Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
*
Author to whom correspondence should be addressed.
Microorganisms 2023, 11(10), 2403; https://doi.org/10.3390/microorganisms11102403
Original submission received: 10 July 2023 / Revised: 21 September 2023 / Accepted: 23 September 2023 / Published: 26 September 2023
(This article belongs to the Special Issue The Infective Endocarditis)
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Abstract
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 and examined the microbiological etiology of IE according to treatment choice. To identify factors associated with surgery during initial admission, we used the Aalen–Johansen estimator and an adjusted cause-specific Cox model. One-year mortality stratified by microbiological etiology and treatment choice was assessed using unadjusted Kaplan–Meier estimates and an adjusted Cox proportional hazard model. A total of 6255 patients were included, of which 1276 (20.4%) underwent surgery during admission. Patients who underwent surgery were younger (65 vs. 74 years) and less frequently had cerebrovascular disease, cardiovascular disease, diabetes, and chronic kidney disease. Patients with Staphylococcus aureus IE were less likely to undergo surgery during admission (13.6%) compared to all other microbiological etiologies. One-year mortality according to microbiological etiology in patients who underwent surgery was 7.0%, 5.3%, 5.5%, 9.6%, 13.2, and 11.2% compared with 24.2%, 19.1%, 27,6%, 25.2%, 21%, and 16.9% in patients who received medical therapy for Staphylococcus aureus, Streptococcus spp., Enterococcus spp., coagulase-negative Staphylococci, “other microbiological etiologies”, and blood culture-negative infective endocarditis, respectively. Patients with IE who underwent surgery differed in terms of microbiology, more often having Streptococci than those who received medical therapy. Contrary to expectations, Staphylococcus aureus was more common among patients who received medical therapy only.
Keywords: microorganism; infective endocarditis; surgery; microbiological etiology; microbiological characteristics