Impact of multidisciplinary Endocarditis Team on management of infective endocarditis

Fourré, Nicolas; Zimmermann, Virgile; Guery, Benoit; Ianculescu, Nicoleta; Tozzi, Piergiorgio; Kirsch, Matthias; Monney, Pierre; Papadimitriou-Olivgeris, Matthaios

doi:10.1016/j.bjid.2024.103870

person Nicolas Fourré

collected the patients' data · wrote the manuscript · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Infectious Diseases Service, Lausanne, Switzerland 1 Nicolas Fourré and Virgile Zimmermann contributed equally to this work.

0009-0006-1660-9365

person Virgile Zimmermann

collected the patients' data · wrote the manuscript · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Infectious Diseases Service, Lausanne, Switzerland 1 Nicolas Fourré and Virgile Zimmermann contributed equally to this work.

person Benoit Guery

collected the patients' data · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Infectious Diseases Service, Lausanne, Switzerland

person Nicoleta Ianculescu

collected the patients' data · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Department of Cardiology, Lausanne, Switzerland

person Piergiorgio Tozzi

collected the patients' data · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Department of Cardiac Surgery, Lausanne, Switzerland

person Matthias Kirsch

collected the patients' data · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Department of Cardiac Surgery, Lausanne, Switzerland

person Pierre Monney

conceived the idea · supervised the project · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Department of Cardiology, Lausanne, Switzerland

person Matthaios Papadimitriou-Olivgeris *

conceived the idea · collected the patients' data · performed the analysis · interpreted the results · manuscript revision · read · approved the submitted version

schoolLausanne University Hospital and University of Lausanne, Infectious Diseases Service, Lausanne, SwitzerlandschoolCantonal Hospital of Sion and Institut Central des Hôpitaux (ICH), Infectious Diseases Service, Sion, Switzerland

0000-0003-0565-5105

person* Corresponding author.
E-mail address:Matthaios.Papadimitriou-Olivgeris@hopitalvs.ch (M. Papadimitriou-Olivgeris).

¹

Nicolas Fourré and Virgile Zimmermann contributed equally to this work.

Conflicts of interest

The authors declare no conflicts of interest.

	Pre-ET (n = 187)		Post-ET (n = 318)		p
Demographics
Male sex	145	78 %	238	75 %	0.520
Age (years)	65	50‒75	68	53‒77	0.068
Age > 60-years	110	59 %	217	68 %	0.034
Co-morbidities
Congestive heart failure	11	6 %	45	14 %	0.005
Chronic obstructive pulmonary disease	26	14 %	36	11 %	0.402
Cirrhosis	10	5 %	22	7 %	0.573
Diabetes mellitus	39	21 %	85	27 %	0.164
Chronic kidney disease (moderate or severe)	29	16 %	61	19 %	0.336
Malignancy (solid organ or haematologic)	9	5 %	40	13 %	0.005
Obesity	39	21 %	77	24 %	0.443
Immunosuppression	19	10 %	28	9 %	0.636
Charlson Comorbidity Index	3	1‒6	5	2‒7	0.007
Charlson Comorbidity Index > 4	69	37 %	160	50 %	0.004
Transfer from other hospital (within 4-days from diagnosis)	52	28 %	108	34 %	0.166
Setting of infection onset
Community or non-nosocomial healthcare-associated	164	88 %	278	87 %
Nosocomial	23	12 %	40	13 %	1.000
Cardiac predisposing factors	95	51 %	155	49 %	0.712
Cardiac implantable electronic devices	26	14 %	70	22 %	0.026
Microbiological data
S. aureus	77	41 %	126	40 %	0.778
Coagulase negative staphylococci	12	6 %	25	8 %	0.600
Streptococci	45	24 %	84	26 %	0.598
Enterococci	27	14 %	39	12 %	0.496
Other Gram-positive	5	3 %	12	4 %	0.615
HACEK	10	5 %	8	3 %	0.134
Other Gram-negative	3	2 %	9	3 %	0.549
Intracellular pathogens	1	1 %	4	1 %	0.656
Fungi	3	2 %	3	1 %	0.675
Polymicrobial infection	6	3 %	7	2 %	0.564
No identification	10	5 %	15	5 %	0.832
Manifestations
Fever	155	83 %	252	79 %	0.352
Heart murmur	119	64 %	183	58 %	0.189
New heart murmur	77	41 %	135	42 %	0.852
Immunologic phenomena	14	7 %	28	9 %	0.462
Sepsis	78	42 %	142	45 %	0.577
Septic shock	35	19 %	49	15 %	0.386
Embolic event	115	61 %	168	53 %	0.064
Embolic event after introduction of antibiotic treatment	65	35 %	95	30 %	0.276
Embolic event after establishment of operative indication (n = 268)	26	23 %	19	12 %	0.033
Cardiac imaging
TTE	176	94 %	290	91 %	0.301
TOE	148	79 %	256	81 %	0.730
¹⁸F-FDG PET/CT	26	14 %	88	28 %	<0.001
Cardiac-CT	10	5 %	21	7 %	0.702
Non-cardiac imaging studies
Thoracoabdominal imaging	147	79 %	257	81 %	0.566
Thoracoabdominal imaging in asymptomatic patients	65	35 %	156	49 %	0.002
Cerebral imaging	114	61 %	206	65 %	0.391
Cerebral imaging in asymptomatic patients	48	26 %	102	32 %	0.132
Site of infection
Aortic valve	93	50 %	160	50 %	0.927
Mitral valve	75	40 %	132	42 %	0.779
Other left-side site of infection	4	2 %	0	0 %	0.018
Tricuspid valve	19	10 %	28	9 %	0.636
Pulmonary valve	5	3 %	6	2 %	0.546
Multivalvular	16	9 %	36	11 %	0.365
CIED-IE	14	7 %	39	12 %	0.100
Type of valve
Native	129	69 %	215	68 %	0.768
Prosthetic	48	26 %	79	25 %	0.833
Type of intracardiac lesions
Vegetation	133	71 %	201	63 %	0.080
Vegetation ≥ 10 mm	72	39 %	114	36 %	0.567
Abscess	31	17 %	66	21 %	0.293
Other intracardiac lesionsa	8	4 %	10	3 %	0.620
Intervention
Valvular surgery in presence of operative indication (n = 268)
Operative indication with surgery	76	66 %	119	78 %	0.038
Operative indication without surgery	39	34 %	34	22 %
Operative indication not retained by cardiac surgeon (n = 73)	12	31 %	2	6 %	0.013
Timing from operative indication to surgery (days; n = 195)	5	2‒8	3	1‒7	0.239
CIED extraction (n = 54 patients with CIED-IE or operated valvular IE)	16	94 %	38	76 %	0.158
Duration of IV antibiotic treatment (n = 274)b
4-weeks	16	15 %	73	45 %
More than 4-weeks	94	85 %	91	55 %	<0.001
30-day mortality	28	15 %	42	13 %	0.595
1-year mortality	54	29 %	83	26 %	0.534

[1] Data are depicted as number/percentage or median/Q₁‒Q₃.

[2] ¹⁸F-FDG PET/CT ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography; CIED, Cardiac Implantable Electronic devices; ET, Endocarditis Team; HACEK, Haemophilus spp, Aggregatibacter spp, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae; IE, Infective Endocarditis; TTE, Transthoracic Echocardiography; TOE, Transesophageal Echocardiography.

[TFN1] ^a
Perforation, dehiscence of prosthetic valve, fistula, aneurysm, pseudoaneurysm.

[TFN2] ^b
After excluding patients with prosthetic valve IE, CIED-IE only, enterococcal IE treated with amoxicillin-ceftriaxone combination, other infectious complication warranting IV antimicrobial treatment > 4-weeks, and those deceased before 4-weeks.