Impact of Setting up an “Endocarditis Team” on the Management of Infective Endocarditis

Ruch, Yvon
Mazzucotelli, Jean-Philippe
Lefebvre, François
Martin, Aurélie
Lefebvre, Nicolas
Douiri, Nawal
Riegel, Philippe
Minh, Tam Hoang
Petit-Eisenmann, Hélène
Hansmann, Yves
Argemi, Xavier

¹Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
²Department of Cardiovascular Surgery, Strasbourg University Hospital, Strasbourg, France
³Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
⁴Laboratory of Bacteriology, Strasbourg University Hospital, Strasbourg, France
⁵Department of Cardiology, Strasbourg University Hospital, Strasbourg, France

Correspondence: Y. Ruch, MD, Service de Maladies Infectieuses et Tropicales, NHC, Centre Hospitalo-Universitaire de Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France ([email protected]).

Received May 02, 2019; accepted June 25, 2019

Open Forum Infectious Diseases 6(9):p ofz308, September 2019. | DOI: 10.1093/ofid/ofz308

Background.

Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this “Endocarditis Team” (ET).

Methods.

We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality.

Results.

We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048).

Conclusions.

This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.