32 research outputs found
Temporal Changes, Patient Characteristics, and Mortality, According to Microbiological Cause of Infective Endocarditis:AÂ Nationwide Study
BACKGROUND: Monitoring of microbiological cause of infective endocarditis (IE) remains key in the understanding of IE; however, data from large, unselected cohorts are sparse. We aimed to examine temporal changes, patient characteristics, and inâhospital and longâterm mortality, according to microbiological cause in patients with IE from 2010 to 2017. METHODS AND RESULTS: Linking Danish nationwide registries, we identified all patients with firstâtime IE. Inâhospital and longâterm mortality rates were assessed according to microbiological cause and compared using multivariable adjusted logistic regression analysis and Cox proportional hazard analysis, respectively. A total of 4123 patients were included. Staphylococcus aureus was the most frequent cause (28.1%), followed by Streptococcus species (26.0%), Enterococcus species (15.5%), coagulaseânegative staphylococci (6.2%), and âother microbiological causesâ (5.3%). Blood cultureânegative IE was registered in 18.9%. The proportion of blood cultureânegative IE declined during the study period, whereas no significant changes were seen for any microbiological cause. Patients with Enterococcus species were older and more often had a prosthetic heart valve compared with other causes. For Streptococcus species IE, inâhospital and longâterm mortality (median followâup, 2.3âyears) were 11.1% and 58.5%, respectively. Compared with Streptococcus species IE, the following causes were associated with a higher inâhospital mortality: S aureus IE (odds ratio [OR], 3.48 [95% CI, 2.74â4.42]), Enterococcus species IE (OR, 1.48 [95% CI, 1.11â1.97]), coagulaseânegative staphylococci IE (OR, 1.79 [95% CI, 1.21â2.65]), âother microbiological causeâ (OR, 1.47 [95% CI, 0.95â2.27]), and blood cultureânegative IE (OR, 1.99 [95% CI, 1.52â2.61]); and the following causes were associated with higher mortality following discharge (median followâup, 2.9âyears): S aureus IE (hazard ratio [HR], 1.39 [95% CI, 1.19â1.62]), Enterococcus species IE (HR, 1.31 [95% CI, 1.11â1.54]), coagulaseânegative staphylococci IE (HR, 1.07 [95% CI, 0.85â1.36]), âother microbiological causeâ (HR, 1.45 [95% CI, 1.13â1.85]), and blood cultureânegative IE (HR, 1.05 [95% CI, 0.89â1.25]). CONCLUSIONS: This nationwide study showed that S aureus was the most frequent microbiological cause of IE, followed by Streptococcus species and Enterococcus species. Patients with S aureus IE had the highest inâhospital mortality
Prevalence and Mortality of Infective Endocarditis in Community-Acquired and Healthcare-Associated Staphylococcus aureus Bacteremia::A Danish Nationwide Registry-Based Cohort Study.
BACKGROUND: Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes. METHODS: First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30â
days) or healthcare-associated (SAB >48â
hours of hospital admission, hospitalization within 30â
days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis. RESULTS: We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86â2.41]). No difference in mortality was observed with 0â40â
days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83â1.37]), while with 41â365â
days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53â.95]). CONCLUSIONS: Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40â
days of survival, community-acquired SAIE was associated with a lower mortality
The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction
BACKGROUND: Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI.METHODS: We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission as well as estimated glomerular filtration rate (eGFR).RESULTS: Reduced eGFR was significantly associated with LV mass, LV ejection fraction, LV global strain (GLS) and E/e' ratio. After multivariable adjustment, E/e' ratio (P = .0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR <60 mL/min per 1.73 m(2) was significantly associated with outcome (HR, 1.71; 95% CI, 1.12-2.62; P = .0131) after adjustment for age, diabetes, hypertension, Killip class >1, multivessel disease and troponin. The prognostic impact of an eGFR <60 mL/min per 1.73 m(2) was only modestly altered by addition of LV mass or E/e' ratio whereas addition of LV ejection fraction or GLS attenuated its importance considerably.CONCLUSION: Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.</p