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.
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。