Post-SARS-CoV-2 Pandemic Changes in the Epidemiology and Severity of Infective Endocarditis

Following the SARS-COVID-19 pandemic the relaxation of non-pharmaceutical interventions (NPIs) and social restrictions has been associated with a notable increase in antibiotic-resistant bacteria. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on clinical severity of Infective Endocarditis (IE) among in-patients before, during, and after the pandemic. A retrospective population study was conducted from January 1, 2017, to January 1, 2025, involving consecutive patients diagnosed with endocarditis at a referral hospital in Tuscany, Italy. The patients were stratified into three groups: pre-pandemic (2017–2019), pandemic (2020–2021), and post-pandemic (2022–2025). During the study period, a total of 187 confirmed hospitalised cases of IE were diagnosed, temporally divided as follows: 86 pre-pandemic, 35 during the pandemic, and 67 post-pandemic. The incidence of S. Aureus-related IE admissions increased significantly (23.20% pre-pandemic vs. 29.40% during the pandemic vs. 44.7% post-pandemic, p=0.022). The incidence of MRSA-related IE admissions increased but not significantly (10.50% pre-pandemic vs. 33.30% during the pandemic vs. 20.0% post-pandemic, p=0.389). Sepsis shock was more frequent (34.9% pre-pandemic vs 55.9% during the pandemic vs 53.7% post-pandemic, p=0.044). "Mortality rates were notably elevated during the pandemic and remained higher in the post-pandemic period (29.40% and 32.80%, respectively) compared to the pre-pandemic period (18.60%; p=0.018). The increased incidence of systemic sepsis was identified as a strong independent predictor of in-hospital mortality. In conclusion in-hospital mortality from infective endocarditis has remained elevated post-pandemic, largely due to the increased systemic severity linked to a rise in more and resistant bacterial infections