Causes of infective endocarditis in the Western Cape, South Africa: a prospective cohort study using a set protocol for organism detection and central decision making by an endocarditis team.
adult cardiology
diagnostic microbiology
epidemiology
microbiology
valvular heart disease
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
06 12 2021
06 12 2021
Historique:
entrez:
7
12
2021
pubmed:
8
12
2021
medline:
8
3
2022
Statut:
epublish
Résumé
Blood culture negative infective endocarditis (BCNIE) poses both a diagnostic and therapeutic challenge. High rates of BCNIE reported in South Africa have been attributed to antibiotic use prior to blood culture sampling. To assess the impact of a systematic approach to organism detection and identify the causes of infective endocarditis (IE), in particular causes of BCNIE. Prospective cohort study. The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and February 2021. A set protocol for organism detection with management of patients by an endocarditis team was employed. This prospective cohort was compared with a retrospective cohort of patients with IE admitted between January 2017 and December 2018. One hundred and forty patients with IE were included, with 75 and 65 patients in the retrospective and prospective cohorts, respectively. Baseline demographic characteristics were similar with a mean age of 39.6 years and male predominance (male sex=67.1%). The rate of BCNIE was lower in the prospective group (28/65 or 43.1%) compared with the retrospective group (47/75 or 62.7%; p=0.039). The BCNIE in-hospital mortality rate in the retrospective cohort was 23.4% compared with 14.2% in the prospective cohort (p=0.35). A cause was identified (including non-culture techniques) in 86.2% of patients in the prospective cohort, with The introduction of a set protocol for organism detection, managed by an endocarditis team, has identified
Sections du résumé
BACKGROUND
Blood culture negative infective endocarditis (BCNIE) poses both a diagnostic and therapeutic challenge. High rates of BCNIE reported in South Africa have been attributed to antibiotic use prior to blood culture sampling.
OBJECTIVES
To assess the impact of a systematic approach to organism detection and identify the causes of infective endocarditis (IE), in particular causes of BCNIE.
DESIGN
Prospective cohort study.
METHODS
The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and February 2021. A set protocol for organism detection with management of patients by an endocarditis team was employed. This prospective cohort was compared with a retrospective cohort of patients with IE admitted between January 2017 and December 2018.
RESULTS
One hundred and forty patients with IE were included, with 75 and 65 patients in the retrospective and prospective cohorts, respectively. Baseline demographic characteristics were similar with a mean age of 39.6 years and male predominance (male sex=67.1%). The rate of BCNIE was lower in the prospective group (28/65 or 43.1%) compared with the retrospective group (47/75 or 62.7%; p=0.039). The BCNIE in-hospital mortality rate in the retrospective cohort was 23.4% compared with 14.2% in the prospective cohort (p=0.35). A cause was identified (including non-culture techniques) in 86.2% of patients in the prospective cohort, with
CONCLUSION
The introduction of a set protocol for organism detection, managed by an endocarditis team, has identified
Identifiants
pubmed: 34873007
pii: bmjopen-2021-053169
doi: 10.1136/bmjopen-2021-053169
pmc: PMC8650472
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e053169Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
S Afr Med J. 2016 Apr 19;106(5):470-1
pubmed: 27138665
QJM. 2003 Mar;96(3):217-25
pubmed: 12615986
Cardiovasc Diagn Ther. 2020 Apr;10(2):252-261
pubmed: 32420108
Med Mal Infect. 2015 Jan-Feb;45(1-2):1-8
pubmed: 25480453
S Afr Med J. 2019 Jul 26;109(8):592-596
pubmed: 31456555
Heart Lung Circ. 2017 Aug;26(8):763-771
pubmed: 28372886
Am J Cardiol. 2001 Jun 15;87(12):1423-5
pubmed: 11397371
Eur Heart J. 2015 Nov 21;36(44):3075-3128
pubmed: 26320109
Am J Cardiol. 2013 Oct 15;112(8):1171-6
pubmed: 23831163
Lancet. 2016 Feb 27;387(10021):882-93
pubmed: 26341945
Medicine (Baltimore). 2017 Nov;96(47):e8392
pubmed: 29381916
J Clin Microbiol. 2015 Mar;53(3):824-9
pubmed: 25540398
Infect Dis (Lond). 2021 Oct;53(10):755-763
pubmed: 34038316
J Am Coll Cardiol. 2017 Jan 24;69(3):325-344
pubmed: 28104075
N Engl J Med. 2020 Jun 11;382(24):e95
pubmed: 32469479
Eur Heart J. 2020 Oct 1;41(37):3497-3499
pubmed: 33085965
Emerg Infect Dis. 2017 Aug;23(8):
pubmed: 28730981
Eur J Clin Microbiol Infect Dis. 2021 Sep;40(9):1873-1879
pubmed: 33829350