Análisis Retrospectivo de los casos de Endocarditis Infecciosa a lo largo de 31 años (1985-2016) en un Hospital Terciario (Ramón y Cajal)
DOI:
https://doi.org/10.37536/RIECS.2018.3.1.73Keywords:
Endocarditis infecciosa, Cambios epidemiológicos, MortalidadAbstract
La Endocarditis Infecciosa (EI) es una enfermedad infrecuente, de alta mortalidad. En las últimas décadas ha habido cambios relevantes tanto en las técnicas de diagnóstico por imagen como en la epidemiología de la población a la que afecta, que son el objeto de nuestro trabajo. Como método de trabajo se ha realizado un estudio observacional retrospectivo. Se han revisado las historias clínicas de los pacientes diagnosticados de Endocarditis Infecciosa en el Hospital Ramón y Cajal en los últimos 31 años (1985-2016), a partir de un registro del Servicio de Enfermedades Infecciosas. Se ha obtenido como resultado, que el número de casos de Endocarditis Infecciosa se ha mantenido estable a lo largo de los 31 años del estudio. La mayor frecuencia en varones (67%) se mantuvo constante, mientras que la edad de los pacientes ha ido aumentando progresivamente. Se ha apreciado cambios en los microorganismos causales, entre los cuales los más frecuentemente aislados han sido Staphylococcus aureus (37,3%), seguido de estafilococos coagulasa-negativo (14,3%) y Streptococcus viridans (13,2%). De modo llamativo, disminuyeron significativamente los casos de EI asociada al uso de drogas inyectadas y aumentaron proporcionalmente los de EI sobre válvula natural (39,5%) y sobre válvula protésica (31.5%). También aumentaron el empleo del ecocardiograma transesofágico en el diagnóstico (43,7%) y los casos que se sometieron a cirugía (28,9%). La cifra de endocarditis nosocomial sigue siendo un problema importante (12,4%). La mortalidad se ha mantenido elevada sin cambios (20%). Como conclusión podemos señalar que se han encontrado cambios significativos en la epidemiología de la enfermedad a lo largo de los 31 años del estudio, en parte asociado a la disminución del uso de drogas inyectadas y al aumento de los procedimientos quirúrgicos sobre el corazón. Pese a los avances en el manejo diagnóstico y terapéutico la enfermedad sigue teniendo una mortalidad elevada.
References
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13. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European. Eur Heart J [Internet]. 2009 Oct [cited 2013 Sep 19];30(19):2369–413. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19713420
14. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr [Internet]. 2010/03/13. 2010;11(2):202–19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20223755
15. Juneau D, Golfam M, Hazra S, Erthal F, Zuckier LS, Bernick J, et al. Molecular Imaging for the diagnosis of infective endocarditis: A systematic literature review and meta-analysis. Int J Cardiol. Netherlands; 2018 Feb;253:183–8.
16. Nunes MCP, Guimaraes-Junior MH, Murta Pinto PHO, Coelho RMP, Souza Barros TL, Faleiro Maia N de PA, et al. Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis. Int J Infect Dis. Canada; 2018 Jan;68:102–7.
17. Erbay AR, Erbay A, Canga A, Keskin G, Sen N, Atak R, et al. Risk factors for in-hospital mortality in infective endocarditis: five years’ experience at a tertiary care hospital in Turkey. J Heart Valve Dis. England; 2010 Mar;19(2):216–24.
18. Elbey MA, Kalkan ME, Akdag S, Ozbek K, Eren NK, Demirtas S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J [Internet]. 2013/06/22. 2013;20(3):323–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23788308
19. Fernandez-Hidalgo N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis [Internet]. 2008/10/07. 2008;47(10):1287–97. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18834314
20. DeSimone DC, Tleyjeh IM, Correa de Sa DD, Anavekar NS, Lahr BD, Sohail MR, et al. Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN. Am Hear J [Internet]. 2015/09/21. 2015;170(4):830–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26386808
21. Muñoz P, Kestler M, De Alarcón A, Miro JM, Bermejo J, Rodríguez-Abella H, et al. Current epidemiology and outcome of infective endocarditis: A multicenter, prospective, cohort study. Med (United States). 2015;94(43).
22. Carrasco F, Anguita M, Ruiz M, Castillo JC, Delgado M, Mesa D, et al. Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987-2013). Europace [Internet]. 2015/12/26. 2016;18(6):836–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26705558
23. Li L, Wang H, Wang L, Pu J, Zhao H. Changing profile of infective endocarditis: a clinicopathologic study of 220 patients in a single medical center from 1998 through 2009. Texas Hear Inst J. United States; 2014 Oct;41(5):491–8.
24. Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis [Internet]. 2013 Jan [cited 2013 Sep 30];56(2):209–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23074311
25. Fournier P-E, Gouriet F, Casalta J-P, Lepidi H, Chaudet H, Thuny F, et al. Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools. Medicine (Baltimore). United States; 2017 Nov;96(47):e8392.
26. Fournier P-E, Thuny F, Richet H, Lepidi H, Casalta J-P, Arzouni J-P, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis [Internet]. 2010 Jul 15 [cited 2013 Sep 17];51(2):131–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20540619
27. Daniel WG, Mugge A. Transesophageal echocardiography. N Engl J Med [Internet]. 1995/05/11. 1995;332(19):1268–79. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7708072
28. Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, et al. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis [Internet]. 2005/07/20. 2005;41(4):507–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16028160
29. Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, Fraile J, de Gorgolas M. Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. Medicine (Baltimore). United States; 2009 Jan;88(1):1–22.
2. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med [Internet]. 2002/01/17. 2001;345(18):1318–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11794152
3. Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ [Internet]. 2006 Aug 12 [cited 2013 Oct 3];333(7563):334–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1539065&tool=pmcentrez&rendertype=abstract
4. Hoen B, Duval X. Clinical practice. Infective endocarditis. N Engl J Med [Internet]. 2013/04/12. 2013;368(15):1425–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23574121
5. Alonso-Valle H, Farinas-Alvarez C, Bernal-Marco JM, Garcia-Palomo JD, Gutierrez-Diez F, Martin-Duran R, et al. The changing face of prosthetic valve endocarditis at a tertiary-care hospital: 1986-2005. Rev Esp Cardiol [Internet]. 2010/01/22. 2010;63(1):28–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20089223
6. 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 [Internet]. 2013/12/19. 2013;8(12):e82665. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24349331
7. Castillo JC, Anguita MP, Ruiz M, Pena L, Santisteban M, Puentes M, et al. Cambios epidemiológicos de la endocarditis infecciosa sobre válvula nativa [Changing epidemiology of native valve infective endocarditis]. Rev Esp Cardiol [Internet]. 2011/06/07. 2011;64(7):594–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21641100
8. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler Jr. VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev [Internet]. 2015/05/29. 2015;28(3):603–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26016486
9. Lomas JM, Martinez-Marcos FJ, Plata A, Ivanova R, Galvez J, Ruiz J, et al. Healthcare-associated infective endocarditis: an undesirable effect of healthcare universalization. Clin Microbiol Infect [Internet]. 2009/09/08. 2010;16(11):1683–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19732086
10. Fowler VG, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, et al. Staphylococcus aureus Endocarditis. 2005;293(24).
11. Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler Jr. VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med [Internet]. 2009/03/11. 2009;169(5):463–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19273776
12. Ferraris L, Milazzo L, Ricaboni D, Mazzali C, Orlando G, Rizzardini G, et al. Profile of infective endocarditis observed from 2003 - 2010 in a single center in Italy. BMC Infect Dis [Internet]. 2013/11/19. 2013;13:545. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24238215
13. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European. Eur Heart J [Internet]. 2009 Oct [cited 2013 Sep 19];30(19):2369–413. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19713420
14. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr [Internet]. 2010/03/13. 2010;11(2):202–19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20223755
15. Juneau D, Golfam M, Hazra S, Erthal F, Zuckier LS, Bernick J, et al. Molecular Imaging for the diagnosis of infective endocarditis: A systematic literature review and meta-analysis. Int J Cardiol. Netherlands; 2018 Feb;253:183–8.
16. Nunes MCP, Guimaraes-Junior MH, Murta Pinto PHO, Coelho RMP, Souza Barros TL, Faleiro Maia N de PA, et al. Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis. Int J Infect Dis. Canada; 2018 Jan;68:102–7.
17. Erbay AR, Erbay A, Canga A, Keskin G, Sen N, Atak R, et al. Risk factors for in-hospital mortality in infective endocarditis: five years’ experience at a tertiary care hospital in Turkey. J Heart Valve Dis. England; 2010 Mar;19(2):216–24.
18. Elbey MA, Kalkan ME, Akdag S, Ozbek K, Eren NK, Demirtas S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J [Internet]. 2013/06/22. 2013;20(3):323–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23788308
19. Fernandez-Hidalgo N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis [Internet]. 2008/10/07. 2008;47(10):1287–97. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18834314
20. DeSimone DC, Tleyjeh IM, Correa de Sa DD, Anavekar NS, Lahr BD, Sohail MR, et al. Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN. Am Hear J [Internet]. 2015/09/21. 2015;170(4):830–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26386808
21. Muñoz P, Kestler M, De Alarcón A, Miro JM, Bermejo J, Rodríguez-Abella H, et al. Current epidemiology and outcome of infective endocarditis: A multicenter, prospective, cohort study. Med (United States). 2015;94(43).
22. Carrasco F, Anguita M, Ruiz M, Castillo JC, Delgado M, Mesa D, et al. Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987-2013). Europace [Internet]. 2015/12/26. 2016;18(6):836–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26705558
23. Li L, Wang H, Wang L, Pu J, Zhao H. Changing profile of infective endocarditis: a clinicopathologic study of 220 patients in a single medical center from 1998 through 2009. Texas Hear Inst J. United States; 2014 Oct;41(5):491–8.
24. Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis [Internet]. 2013 Jan [cited 2013 Sep 30];56(2):209–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23074311
25. Fournier P-E, Gouriet F, Casalta J-P, Lepidi H, Chaudet H, Thuny F, et al. Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools. Medicine (Baltimore). United States; 2017 Nov;96(47):e8392.
26. Fournier P-E, Thuny F, Richet H, Lepidi H, Casalta J-P, Arzouni J-P, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis [Internet]. 2010 Jul 15 [cited 2013 Sep 17];51(2):131–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20540619
27. Daniel WG, Mugge A. Transesophageal echocardiography. N Engl J Med [Internet]. 1995/05/11. 1995;332(19):1268–79. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7708072
28. Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, et al. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis [Internet]. 2005/07/20. 2005;41(4):507–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16028160
29. Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, Fraile J, de Gorgolas M. Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. Medicine (Baltimore). United States; 2009 Jan;88(1):1–22.
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