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Abstract：
BACKGROUND: Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis.
METHODS: Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series.
RESULTS: Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar.
CONCLUSIONS: MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.
METHODS: Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series.
RESULTS: Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar.
CONCLUSIONS: MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.
摘要：
背景：壁感染性心内膜炎（MIE）是一种罕见的血管内感染。我们介绍了一系列全面的壁心内膜炎患者。
方法：2008年至2017年期间，来自35家西班牙医院的感染性心内膜炎（IE）患者被前瞻性纳入GAMES注册。将MIE与非MIE进行比较。我们还对1979年至2019年间发表的MIE案例进行了文献检索，并将其与GAME系列进行了比较。
结果：包括3676个IE中的27个MIE。当与瓣膜IE(VIE)或装置相关IE(DIE)相比时，MIE患者年龄较小（中位年龄59岁，p<0.01)。移植（18.5%对1.6%的VIE和2%的DIE，p<0.01),血液透析（18.5%对4.3%的VIE和4.4%的DIE，p=0.006),导管来源（59.3%对9.7%的VIE和8.8%的DIE，p<0.01）和念珠菌病因学（22.2%对2%DIE和1.2%VIE，p<0.01)在MIE中更常见，而Charlson指数较低(非MIE为4对5，p=0.006)。死亡率相似。文学中的MIE与游戏中的MIE具有许多特征，尽管患者较年轻(45岁vs.56年,p<0.001)，Charlson指数较低（1.3对4.3，p=0.0001)，导管来源较不常见(13.9%vs.59.3%），IVDU更多（25%与3.7%）。金黄色葡萄球菌是最常见的微生物(50%，p=0.035)。全身并发症更为常见，但死亡率相似。
结论：MIE是一种罕见的实体。这通常是导管使用的并发症，特别是在免疫功能低下和血液透析患者中。真菌病因很常见。死亡率与其他IE相似。
方法：2008年至2017年期间，来自35家西班牙医院的感染性心内膜炎（IE）患者被前瞻性纳入GAMES注册。将MIE与非MIE进行比较。我们还对1979年至2019年间发表的MIE案例进行了文献检索，并将其与GAME系列进行了比较。
结果：包括3676个IE中的27个MIE。当与瓣膜IE(VIE)或装置相关IE(DIE)相比时，MIE患者年龄较小（中位年龄59岁，p<0.01)。移植（18.5%对1.6%的VIE和2%的DIE，p<0.01),血液透析（18.5%对4.3%的VIE和4.4%的DIE，p=0.006),导管来源（59.3%对9.7%的VIE和8.8%的DIE，p<0.01）和念珠菌病因学（22.2%对2%DIE和1.2%VIE，p<0.01)在MIE中更常见，而Charlson指数较低(非MIE为4对5，p=0.006)。死亡率相似。文学中的MIE与游戏中的MIE具有许多特征，尽管患者较年轻(45岁vs.56年,p<0.001)，Charlson指数较低（1.3对4.3，p=0.0001)，导管来源较不常见(13.9%vs.59.3%），IVDU更多（25%与3.7%）。金黄色葡萄球菌是最常见的微生物(50%，p=0.035)。全身并发症更为常见，但死亡率相似。
结论：MIE是一种罕见的实体。这通常是导管使用的并发症，特别是在免疫功能低下和血液透析患者中。真菌病因很常见。死亡率与其他IE相似。
