Infect Chemother.  2018 Mar;50(1):21-28. 10.3947/ic.2018.50.1.21.

Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece

• Papakonstantinou PE
• Samonis G
• Andrianaki AM
• Christofaki M
• Dimopoulou D
• Papadakis
• Gikas A
• Kofteridis DP

• KMID: 2407964
• DOI: http://doi.org/10.3947/ic.2018.50.1.21

Abstract

BACKGROUND
This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance.
MATERIALS AND METHODS
Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included.
RESULTS
A total of 82 IE patients (median age 67 [range 21-86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorganisms had been identified, such as Gemella morbillorum in four cases (4.5%), Streptococcus lugdunensis in two (2.5%) and Streptococcus pneumoniae in one (1%). One patient was serologically positive for Coxiella burnetii (1%). All patients received empirical antimicrobial treatment, proven appropriate in 39 blood culture-positive patients (56.5%). Thirteen (16%) patients were classified as culture negative. Seven patients (8.5%) were surgically treated. In-hospital death occurred in 9 patients (11%).
CONCLUSION
Changes in IE profile requires continuous epidemiological updates. Staphylococcus and Streptococcus spp. remain the most common etiologic agents. However, the presence of uncommon and/or difficult to treat pathogens raise concerns on the appropriate prophylaxis as well as empirical treatment.

Keyword

Endocarditis; Epidemiology; Staphylococcus; Treatment outcome; Prosthetic valve endocarditis

MeSH Terms

Coxiella burnetii
Endocarditis*
Enterococcus
Epidemiology*
Gemella
Greece*
Humans
Medical Records
Retrospective Studies
Staphylococcus
Staphylococcus aureus
Streptococcus
Streptococcus pneumoniae
Systemic Inflammatory Response Syndrome
Treatment Outcome

Figure

• 

  Figure 1 Summary of 82 cases with infective endocarditis. IE, Infective endocarditis; PVE, prosthetic valve endocarditis; NVE, native valve endocarditis. aTwo patients had prosthetic valve along with permanent pacemaker bThree patients had two prosthetic valves affected.

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