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Thorac Cardiovasc Surg 2023; 71(01): 02-11
DOI: 10.1055/s-0041-1740540
Original Cardiovascular

Bacterial Spectrum and Infective Foci in Patients Operated for Infective Endocarditis: Time to Rethink Strategies?

Shekhar Saha 
1   Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
2   Department of Cardiac Surgery, Ludwig-Maximilian-University of Munich, Munich, Germany
,
Anna Dudakova
3   Institute for Medical Microbiology, Georg-August-University, Göttingen, Germany
,
Bernhard C. Danner
1   Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
,
Ingo Kutschka
1   Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
,
Marco H. Schulze‡   *
3   Institute for Medical Microbiology, Georg-August-University, Göttingen, Germany
4   Institute of Infection Control and Infectious Diseases, Georg-August-University Göttingen, Germany
,
Heidi Niehaus‡   *
1   Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
5   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Abstract

Objective The rising incidence of infective endocarditis (IE) accompanied by the de-escalation of antibiotic prophylaxis and the complexity of surgical treatment makes IE a daunting foe. We reviewed all patients who underwent cardiac surgery for IE at our institution with a focus on causative organisms and infective foci.

Methods A review of 3,952 consecutive patients who underwent cardiac surgery at our institution between January 2013 and December 2017 revealed 160 patients (4%) who were operated for IE.

Results The predominantly affected valves were the aortic (30%) and mitral valve (26.9%) as well as a combination of both (8.8%). A total of 28.8% of patients suffered from prosthetic valve endocarditis (PVE). The most frequently identified causative organisms were Staphylococcus (45.7%), Streptococcus (27.5%), and Enterococcus species (16.7%), which was predominantly associated with PVE (p = 0.050). In 13.1% of patients, a causative organism has not been detected. The most frequent infective foci were dental (15%), soft-tissue infections (15%), spondylodiscitis (10%), and infected intravascular implants (8.8%). Relevant predisposing factors were immunosuppression (9.4%) and intravenous drug abuse (4.4%). Septic cerebral infarctions were diagnosed in 28.8% of patients. Postoperative mortality was 22.5%.

Conclusions As the bacterial spectrum and the infective foci are still the “old acquaintances,” and with regard to the increasing incidence of IE, current risk–benefit evaluations concerning antibiotic prophylaxis may need to be revisited.

Keywords

infective endocarditis - bacterial spectrum - Infective focus - antibiotic prophylaxis

Authors' Contributions

Shekhar Saha Data curation, formal analysis, visualization, writing – original draft and revisions

Anna Dudakova Data curation, methodology, validation

Bernd Danner Project administration, validation

Ingo Kutschka Project administration, validation

Marco Schulze* Conceptualization, formal analysis, investigation, methodology, writing – original draft and revisions

Heidi Niehaus* Conceptualization, formal analysis, investigation, methodology, writing – original draft and revisions


* M. H. S. and H. N. contributed equally to the manuscript.




Publication History

Received: 31 January 2021

Accepted: 25 October 2021

Article published online:
08 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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