[Evolution of antimicrobial resistance and mortality in Staphylococcus aureus endocarditis during 15 years in a university hospital]. / Evolución de la resistencia antimicrobiana y mortalidad en la endocarditis por Staphylococcus aureus durante 15 años en un hospital universitario.

OBJECTIVE: One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS: Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS: Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS: We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.

Cumplimiento de las guías de la Sociedad Europea de Cardiología y morbimortalidad por endocarditis infecciosa / Compliance with the guidelines of the European Society of Cardiology and morbidity and mortality from infectious endocarditis

Objetivo. El tratamiento antibiótico recomendado para la endocarditis infecciosa (EI) tiene un nivel de evidencia bajo. Nuestro objetivo fue comprobar si la adherencia a las recomendaciones de la Sociedad Europea de Cardiología (ESC) se relaciona con una menor morbimortalidad intrahospitalaria de la enfermedad. Métodos. Estudio retrospectivo de 162 casos de EI diagnosticados entre 2005 y 2014. Se realizó un análisis de propensity score matching para determinar el efecto del tratamiento en la mortalidad intrahospitalaria. Resultados. No hubo diferencias en cuanto a complicaciones de la enfermedad entre los grupos de tratamiento. La mortalidad intrahospitalaria fue del 29,2% cuando el tratamiento fue ajustado a las guías, y del 28,2% cuando no lo fue (OR=1,048; IC95%: 0,442-2,484; p=0,916). Conclusión. El uso de las guías de la ESC no parece traducirse en una reducción de la morbimortalidad intrahospitalaria por EI cuando se compara con regímenes de tratamiento antibiótico alternativos (AU)

Objective. The antibiotic treatment recommended for infectious endocarditis (IE) has a low level of evidence. Our objective was to determine whether compliance with the recommendations of the European Society of Cardiology (ESC) was related to lower inhospital morbidity and mortality for this disease. Methods. A retrospective study was conducted on 162 cases of IE diagnosed between 2005 and 2014. A propensity score-matching analysis was performed to determine the effect of treatment on hospital mortality. Results. There were no differences in terms of disease complications between the treatment groups. Hospital mortality was 29.2% when the treatment was adjusted to the guidelines and 28.2% when the treatment was not adjusted (OR=1.048; 95%CI: 0.442-2.484; P=.916). Conclusion. The use of the ESC guidelines does not appear to translate into a reduction in hospital morbidity and mortality due to IE when compared with alternative antibiotic treatment regimens (AU)

Compliance with the guidelines of the European Society of Cardiology and morbidity and mortality from infectious endocarditis.

OBJECTIVE: The antibiotic treatment recommended for infectious endocarditis (IE) has a low level of evidence. Our objective was to determine whether compliance with the recommendations of the European Society of Cardiology (ESC) was related to lower inhospital morbidity and mortality for this disease. METHODS: A retrospective study was conducted on 162 cases of IE diagnosed between 2005 and 2014. A propensity score-matching analysis was performed to determine the effect of treatment on hospital mortality. RESULTS: There were no differences in terms of disease complications between the treatment groups. Hospital mortality was 29.2% when the treatment was adjusted to the guidelines and 28.2% when the treatment was not adjusted (OR=1.048; 95%CI: 0.442-2.484; P=.916). CONCLUSION: The use of the ESC guidelines does not appear to translate into a reduction in hospital morbidity and mortality due to IE when compared with alternative antibiotic treatment regimens.

Endocarditis infecciosa en la Unidad de Medicina Intensiva / Infectious endocarditis in the intensive care unit

Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Universitario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37%) ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002) y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041). La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011), así como la proporción de cirugías urgentes (45,8 vs 5,9%, p<0,001). Resultaron predictores de mortalidad la infección por Estafilococo aureus (OR= 3,49; IC 95%: 1,02-11,93; p=0,046), la insuficiencia cardiaca (OR=4,18; IC 95%: 1,17-14,94; p=0,028), el embolismo cerebral (OR= 8,45; IC 95%: 1,89-37,74; p=0,005) y la puntuación en el score SAPS II al ingreso (OR=1,09; IC 95% 1,04-1,15; p<0,001). Conclusiones: Una elevada proporción de pacientes con endocarditis requieren ingreso en la Unidad de Medicina Intensiva, presentando un pronóstico mucho más desfavorable. La infección por E. aureus, la insuficiencia cardiaca, el embolismo cerebral y la puntuación SAPS II resultan predictores de mortalidad intrahospitalaria (AU)

Objective: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. Design: A prospective, observational cohort study of patients admitted due to infectious endocarditis. Setting: Nuestra Señora de Candelaria University Hospital, a third - level center with a recruitment population of 493,145. Patients: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. Study variables: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. Results: Out of 102 patients diagnosed with endocarditis, 38 (37%) were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002) and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041). In turn, mortality was greater (42.1% vs 18.8%, p= 0.011), as was the proportion of emergency surgeries (45.8% vs 5.9%, p<0.001). The identified mortality predictors were Staphylococcus aureus infection (OR= 3.49; 95%CI 1.02-11.93; p=0.046), heart failure (OR=4.18; 95%CI: 1.17-14.94; p=0.028), cerebral embolism (OR= 8.45; 95%CI: 1.89-37.74; p=0.005) and the SAPS II upon admission (OR=1.09; 95%CI: 1.04-1.15; p<0.001). Conclusions: A large proportion of patients with endocarditis require admission to the Intensive Care Unit, presenting a much poorer prognosis. Staphylococcus aureus infection, heart failure, cerebral embolism and SAPS II scores are independent predictors of hospital mortality (AU)

[Infectious endocarditis in the intensive care unit]. / Endocarditis infecciosa en la Unidad de Medicina Intensiva.

OBJECTIVE: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. DESIGN: A prospective, observational cohort study of patients admitted due to infectious endocarditis. SETTING: Nuestra Señora de Candelaria University Hospital, a third - level center with a recruitment population of 493,145. PATIENTS: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. STUDY VARIABLES: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. RESULTS: Out of 102 patients diagnosed with endocarditis, 38 (37%) were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002) and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041). In turn, mortality was greater (42.1% vs 18.8%, p= 0.011), as was the proportion of emergency surgeries (45.8% vs 5.9%, p<0.001). The identified mortality predictors were Staphylococcus aureus infection (OR= 3.49; 95%CI 1.02-11.93; p=0.046), heart failure (OR=4.18; 95%CI: 1.17-14.94; p=0.028), cerebral embolism (OR= 8.45; 95%CI: 1.89-37.74; p=0.005) and the SAPS II upon admission (OR=1.09; 95%CI: 1.04-1.15; p<0.001). CONCLUSIONS: A large proportion of patients with endocarditis require admission to the Intensive Care Unit, presenting a much poorer prognosis. Staphylococcus aureus infection, heart failure, cerebral embolism and SAPS II scores are independent predictors of hospital mortality.