Comparative study of early and late prosthetic infective endocarditis
P Landin, D Gomez Ramirez, C Olmos, P Zulet, C Saez Bejar, M de Miguel, J Perez Serrano, D Perez Camargo, M Carnero, I Vilacosta, J A San RomanAbstract
Background
The aim of the study was to compare the epidemiological, microbiological, clinical, and prognostic profiles between patients with early prosthetic infective endocarditis (IE) and those with late prosthetic IE.
Methods
A total of 1,745 patients with left-sided IE were prospectively recruited from three tertiary hospitals between 1998 and 2024. Of the total sample, patients with prosthetic IE (n=711) were analysed and classified into two groups: Group I (n=229), patients with early prosthetic IE, and Group II (n=482), patients with late prosthetic IE.
Results
During the study period, the proportions of early and late prosthetic IE did not experience significant changes (p=0.184).
There were no significant differences in sex between both groups, but there was a higher frequency of nosocomial acquisition in Group I (55.9% vs 19.1%; p<0.001). There were no significant differences in the percentage of referred patients, in the prevalence of comorbidities, or in the forms of disease manifestation between both groups.
Regarding triggering factors, there was a higher frequency of unknown triggers in Group II (35.8% vs 56.9%; p<0.001), although in the latter group some factors such as dental manipulation (1.3% vs 5%; p=0.017) and gastrointestinal manipulation (1.8% vs 5%; p=0.038) were found more frequently.
From a microbiological standpoint, infections by Streptococcus viridans (3.9% vs 10%; p=0.006), Enterococcus spp. (9.2% vs 15.8%; p=0.017), and other streptococci (0.4% vs 3.7%; p=0.011) were more frequent in Group II, while coagulase-negative staphylococci infections (33.2% vs 19.5%; p<0.001) were more frequent in Group I.
There were no significant differences in the rates of in-hospital complications, cardiac surgery, or in-hospital mortality between both groups.
Conclusions
The percentage of late prosthetic IE has been higher than early prosthetic IE throughout the study period and their prevalences have remained stable. Nosocomial acquisition and the presence of a known triggering factor were more frequent in patients with early prosthetic IE, which conditions differences in the microbiological profile between both groups. We found no significant differences in prognosis or therapeutic approach between patients with early and late prosthetic IE.