Microbiology of Infective Endocarditis in United States Veterans — Association Between Causative Organism and Short- and Long-Term Outcomes
DOI:
https://doi.org/10.59958/hsf.6717Keywords:
infective endocarditis, causative organisms, veterans affairs, veterans health administrationAbstract
Background: Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010–2020. Methods: We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures – Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests. Results: Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20–3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07–3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14–5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05–2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35–13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01–1.91, p = 0.043). Conclusions: In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.
References
Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet (London, England). 2012; 379: 965–975.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European Heart Journal. 2015; 36: 3075–3128.
Correction to: 2020 ACC/AHA Guideline on the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2021; 143: e229.
Alkhouli M, Alqahtani F, Alhajji M, Berzingi CO, Sohail MR. Clinical and Economic Burden of Hospitalizations for Infective Endocarditis in the United States. Mayo Clinic Proceedings. 2020; 95: 858–866.
Talha KM, DeSimone DC, Sohail MR, Baddour LM. Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis. Heart (British Cardiac Society). 2020; 106: 1878–1882.
Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: a systematic review. PLoS ONE. 2013; 8: e82665.
McCarthy NL, Baggs J, See I, Reddy SC, Jernigan JA, Gokhale RH, et al. Bacterial Infections Associated With Substance Use Disorders, Large Cohort of United States Hospitals, 2012-2017. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America. 2020; 71: e37–e44.
Balda J, Alpizar-Rivas R, Elarabi S, Jaber BL, Nader C. Recent Trends in Infective Endocarditis Among Patients with and Without Injection Drug Use: An Eight-Year Single Center Study. The American Journal of the Medical Sciences. 2021; 362: 562–569.
Nagpal A, Baddour LM, Sohail MR. Microbiology and pathogenesis of cardiovascular implantable electronic device infections. Circulation. Arrhythmia and Electrophysiology. 2012; 5: 433–441.
Rodriguez DJ, Afzal A, Evonich R, Haines DE. The prevalence of methicillin resistant organisms among pacemaker and defibrillator implant recipients. American Journal of Cardiovascular Disease. 2012; 2: 116–122.
Tarakji KG, Ellis CR, Defaye P, Kennergren C. Cardiac Implantable Electronic Device Infection in Patients at Risk. Arrhythmia & Electrophysiology Review. 2016; 5: 65–71.
Veve MP, McCurry ED, Cooksey GE, Shorman MA. Epidemiology and outcomes of non-HACEK infective endocarditis in the southeast United States. PloS One. 2020; 15: e0230199.
Ambrosioni J, Martinez-Garcia C, Llopis J, Garcia-de-la-Maria C, Hernández-Meneses M, Tellez A, et al. HACEK infective endocarditis: Epidemiology, clinical features, and outcome: A case-control study. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases. 2018; 76: 120–125.
Di Mauro M, Dato GMA, Barili F, Gelsomino S, Santè P, Corte AD, et al. A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE. International Journal of Cardiology. 2017; 241: 97–102.
Clausen AN, Clarke E, Phillips RD, Haswell C, VA Mid-Atlantic MIRECC Workgroup, Morey RA. Combat exposure, posttraumatic stress disorder, and head injuries differentially relate to alterations in cortical thickness in military Veterans. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology. 2020; 45: 491–498.
Sachs-Ericsson N, Joiner TE, Cougle JR, Stanley IH, Sheffler JL. Combat Exposure in Early Adulthood Interacts with Recent Stressors to Predict PTSD in Aging Male Veterans. The Gerontologist. 2016; 56: 82–91.
Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Archives of Internal Medicine. 2000; 160: 3252–3257.
Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, et al. Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis. Journal of the American Heart Association. 2016; 5: e003016.
Pericart L, Fauchier L, Bourguignon T, Bernard L, Angoulvant D, Delahaye F, et al. Long-Term Outcome and Valve Surgery for Infective Endocarditis in the Systematic Analysis of a Community Study. The Annals of Thoracic Surgery. 2016; 102: 496–504.
Mostaghim AS, Lo HYA, Khardori N. A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary-care teaching hospital. SAGE Open Medicine. 2017; 5: 2050312117741772.
Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Annals of Surgery. 1999; 230: 414–432.
Massarweh NN, Kaji AH, Itani KMF. Practical Guide to Surgical Data Sets: Veterans Affairs Surgical Quality Improvement Program (VASQIP). JAMA Surgery. 2018; 153: 768–769.
Davis CL, Pierce JR, Henderson W, Spencer CD, Tyler C, Langberg R, et al. Assessment of the reliability of data collected for the Department of Veterans Affairs national surgical quality improvement program. Journal of the American College of Surgeons. 2007; 204: 550–560.
Romano G, Carozza A, Della Corte A, De Santo LS, Amarelli C, Torella M, et al. Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients. The Journal of Heart Valve Disease. 2004; 13: 200–209.
Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG, Jr. Infective endocarditis. Nature Reviews. Disease Primers. 2016; 2: 16059.
Baddour LM, Wilson WR, Bayer AS, Fowler VG, Jr, Tleyjeh IM, Rybak MJ, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015; 132: 1435–1486.
Barrau K, Boulamery A, Imbert G, Casalta JP, Habib G, Messana T, et al. Causative organisms of infective endocarditis according to host status. Clinical Microbiology and Infection: the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2004; 10: 302–308.
Ohbayashi T, Irie A, Murakami Y, Nowak M, Potempa J, Nishimura Y, et al. Degradation of fibrinogen and collagen by staphopains, cysteine proteases released from Staphylococcus aureus. Microbiology (Reading, England). 2011; 157: 786–792.
Chu VH, Woods CW, Miro JM, Hoen B, Cabell CH, Pappas PA, et al. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America. 2008; 46: 232–242.
Dickerman SA, Abrutyn E, Barsic B, Bouza E, Cecchi E, Moreno A, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). American Heart Journal. 2007; 154: 1086–1094.
Scheggi V, Merilli I, Marcucci R, Del Pace S, Olivotto I, Zoppetti N, et al. Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre. BMC Cardiovascular Disorders. 2021; 21: 28.
Becher PM, Goßling A, Fluschnik N, Schrage B, Seiffert M, Schofer N, et al. Temporal trends in incidence, patient characteristics, microbiology and in-hospital mortality in patients with infective endocarditis: a contemporary analysis of 86,469 cases between 2007 and 2019. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2022. (online ahead of print)
Sunder S, Grammatico-Guillon L, Lemaignen A, Lacasse M, Gaborit C, Boutoille D, et al. Incidence, characteristics, and mortality of infective endocarditis in France in 2011. PloS One. 2019; 14: e0223857.
Pericas JM, Falces C, Moreno A, Marco F, Mestres CA, Miro JM, et al. Neglecting enterococci may lead to a misinterpretation of the consequences of last changes in endocarditis prophylaxis American Heart Association guidelines. Journal of the American College of Cardiology. 2015; 66: 2156.
Chirouze C, Athan E, Alla F, Chu VH, Ralph Corey G, Selton-Suty C, et al. Enterococcal endocarditis in the beginning of the 21st century: analysis from the International Collaboration on Endocarditis-Prospective Cohort Study. Clinical Microbiology and Infection: the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2013; 19: 1140–1147.
Anderson DJ, Murdoch DR, Sexton DJ, Reller LB, Stout JE, Cabell CH, et al. Risk factors for infective endocarditis in patients with enterococcal bacteremia: a case-control study. Infection. 2004; 32: 72–77.
McDonald JR, Olaison L, Anderson DJ, Hoen B, Miro JM, Eykyn S, et al. Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database. The American Journal of Medicine. 2005; 118: 759–766.
Martínez-Marcos FJ, Lomas-Cabezas JM, Hidalgo-Tenorio C, de la Torre-Lima J, Plata-Ciézar A, Reguera-Iglesias JM, et al. Enterococcal endocarditis: a multicenter study of 76 cases. Enfermedades Infecciosas Y Microbiologia Clinica. 2009; 27: 571–579. (In Spanish)
Madsen KT, Skov MN, Gill S, Kemp M. Virulence Factors Associated with Enterococcus Faecalis Infective Endocarditis: A Mini Review. The Open Microbiology Journal. 2017; 11: 1–11.
Morpeth S, Murdoch D, Cabell CH, Karchmer AW, Pappas P, Levine D, et al. Non-HACEK gram-negative bacillus endocarditis. Annals of Internal Medicine. 2007; 147: 829–835.
Limonta S, Cambau E, Erpelding ML, Piau-Couapel C, Goehringer F, Plésiat P, et al. Infective Endocarditis Related to Unusual Microorganisms: A Prospective Population-Based Study. Open Forum Infectious Diseases. 2020; 7: ofaa127.
Saravolatz LD, Burch KH, Quinn EL, Cox F, Madhavan T, Fisher E. Polymicrobial infective endocarditis: an increasing clinical entity. American Heart Journal. 1978; 95: 163–168.
Sousa C, Botelho C, Rodrigues D, Azeredo J, Oliveira R. Infective endocarditis in intravenous drug abusers: an update. European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology. 2012; 31: 2905–2910.
García-Granja PE, López J, Vilacosta I, Ortiz-Bautista C, Sevilla T, Olmos C, et al. Polymicrobial Infective Endocarditis: Clinical Features and Prognosis. Medicine. 2015; 94: e2000.
Fournier PE, Gouriet F, Casalta JP, Lepidi H, Chaudet H, Thuny F, et al. Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools. Medicine. 2017; 96: e8392.
Wang W, Chen O, Liu W, Gan L, Li X, Ma Q, et al. Coxiella burnetii and Bartonella Endocarditis Diagnosed by Metagenomic Next-Generation Sequencing. Journal of Clinical Medicine. 2022; 11: 7150.
