Epidemiological Identification of Pathogens and Their Role in Endocarditis Progression

Background: Endocarditis necessitating surgery is continuously increasing. An endocarditis registry allowing for further insights into epidemiological data are still absent in Germany. We thus initiated a multicenter endocarditis registry on a statewide basis for epidemiological identification of pathogens and their role in disease progression.

Method: B.E.R. was initiated in March 2020 after ethics vote, Entry in German Clinical Trial Registers and WHO as well as Brandenburg State Health Ministry approval. The collected data included baseline, comorbidities, risk profile, diagnostic finding in details. After one year, follow-up was performed for mortality, recurrences, long-term complications and adherence to guideline-based prophylaxis. The first 120 patients included were predominantly male (75.5%), mean age of 68.6 years, mean log EuroSCORE of 30.1%, mean EuroSCORE II of 15.1%, mean LVEF of 51%. Aortic valve was involved in 60.6% of cases, mitral valve in 26.6%, tricuspid valve in 2.1%, pulmonary valve in 1.1% and multiple valves in 9.6% of cases. In 29.8% of the cases, foreign bodies such as pacemakers or ports were implanted. 36.2% had aortic valve prosthesis, of which one-third were TAVI and 6.4% had mitral valve prosthesis. Microbiological and histopathological examination of infected heart valves and blood cultures were performed.

Results: Staphylococcus aureus increased the odds for early mortality (p = 0.029, odds ratio = 3.4), caused significantly more often sepsis and SIRS (p = 0.02), and was observed more frequently in dialysis dependent. Enterococcus faecalis was more often observed in prosthetic endocarditis (p = 0.06) and after urogenital infections (p = 0.03). Transesophageal as well as transthoracic echocardiography showed 100% (98%, respectively) true positive results, blood culture 90%, valve histology 82%, whereas intraoperative valve microbiology showed only 6%.

Conclusion: As expected, the classical Duke main criteria showed a high predictive value while histopathology of infected valves serves as valuable additional proof. In contrast, microbiological examination of infected heart valves has almost no predictive value and is thus superfluous. A more radical treatment for infection with Staphylococcus aureus is recommended because of the severity of the clinical course. Enterococcus faecalis is increasingly observed thus pointing toward meticulous alertness as well as hygiene in device carriers.

Publication History

Article published online:
03 February 2022