EVOLUTIONARY PROFILE OF INFECTIVE ENDOCARDITIS CASES IN A TERTIARY UNIVERSITY HOSPITAL IN BRAZIL OVER A DECADE

To describe cases of infective endocarditis (IE) diagnosed between 2012 and 2022 in a tertiary hospital in Brazil, analyzing their clinical, microbiological and outcome characteristics, and to retrospectively assess the potential impact of applying the 2023 Duke-ISCVID Criteria on diagnostic accuracy and disease prognosis. Observational, retrospective and descriptive study conducted by reviewing data recorded in electronic medical records and hospital charts of patients diagnosed with IE between 2012 and 2022. Data were analyzed using IBM SPSS Statistics (version 20.0). Cases were retrospectively re-evaluated in a hypothetical manner to estimate the possible positive impact of using the new diagnostic criteria. Of the 123 patients analyzed, 66 had a confirmed diagnosis of IE. Males accounted for 59%, and mean age was 55 years. The most common predisposing factor was valvular heart disease (75%), and left-sided endocarditis accounted for 84% of cases. The main risk factor was prosthetic valve use (16%). The most frequent etiologic agent was Staphylococcus aureus (25%); among emerging pathogens, Enterococcus faecalis (11%), coagulase-negative staphylococci (9%) and Candida spp. (6%) were observed, among others. Blood cultures were negative in 42% of cases. In 80% of cases, echocardiography was a diagnostic criterion. Complications related to IE were multifactorial and 50% of patients underwent surgery. Mean time between hospitalization and procedure was 29 days. Hospital mortality was 35%. In binary logistic regression analysis, variables associated with hospital mortality with statistically significant impact were age ≥60 years, new valvular regurgitation and thrombocytopenia. When re-evaluated retrospectively, cases showed a possible positive impact on outcomes with the new criteria, particularly regarding newly included predisposing factors such as previous IE and permanent pacemaker use (9%); new guidelines for blood culture collection (above), classification of “typical” microorganisms and splenic abscess (20%). Clinical patterns, etiologies and outcomes observed in IE cases changed over the last decade. Hospital mortality rate was high. Retrospective re-evaluation of cases based on the Duke-ISCVID 2023 Criteria indicated a probable positive impact on disease outcomes, which may improve clinical evolution, in agreement with recent evidence in the literature.