Epidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study

Background As the epidemiology of infective endocarditis (IE) changes, updated antimicrobial management assessments are needed. This study aimed to evaluate patients with healthcare-associated (HAIE) and community-acquired infective endocarditis (CAIE), as well as identify risk factors for 28-day mortality. The findings are intended to guide the treatment of both HAIE and CAIE. Methods We conducted a retrospective cohort study of 131 IE patients treated at Kocaeli University Hospital from December 2016 to December 2022. Data were extracted from hospital records, and patients were categorized into HAIE and CAIE groups. Comparative analyses were performed between the groups, and risk factors for 28-day mortality in IE patients were determined. Results Among the 131 patients, 51.9% had CAIE and 48.1% had HAIE. Predisposing factors were present in 85.5% of cases, with degenerative heart valves most common in CAIE (30.9%) and hemodialysis in HAIE (60%). Chronic kidney disease was more common in HAIE than in CAIE (65.1%)(p = 0.001). Elevated levels of C-reactive protein, prokalsitonin, troponin, and N-terminus pro-B-type natriuretic peptide at admission correlated with increased 28-day mortality. Blood culture positivity was greater in HAIE (75%), with coagulase-negative staphylococci as the leading pathogen (38%). Aortic and mitral valve involvement higher in CAIE compared to HAIE (p = 0.047 and p = 0.039,respectively). Complications such as valve insufficiency (64.1%), neurological events (33.6%), heart failure (27.5%), brain embolism (22.9%), and arrhythmia (8.4%) were associated with 28-day mortality. Conclusions Cases of HAIE, particularly non-nosocomial are rising with hemodialysis being a significant risk factor. This trend requires specific planning for empirical treatment in affected patients.