Epidemiological, Clinical, and Microbiological Features
Clinical and epidemiological aspects from the 167 patients who fulfilled the Duke’s criteria are described in Table 1. The median age was 60 years (Q1-Q3 50-71), and 66% were male. Previous structural heart disease was present in 34%, and 31% of patients had already been submitted to a cardiac surgery. The most prevalent comorbidities were arterial hypertension (56%), diabetes mellitus (29%), chronic kidney disease (21%), previous stroke (12%), chronic liver disease (6.6%), and chronic obstructive pulmonary disease (6%).
The median time from symptoms onset to hospital admission was 7 (Q1-Q3 3-10) days, and from hospital admission to definitive diagnosis 4 (Q1-Q3 1-7) days.
Fever was the most incident symptom at the time of hospital admission (84.3%), followed by decompensated heart failure (25.7%), and a new cerebral or peripheral embolic event (18% and 21%, respectively). New cardiac murmur was observed in 39.5% of the cases (Table 2).
Echocardiographic evaluation demonstrated the presence of one or more vegetations in 90.4%, and abscess in 9.6%. The valve most frequently compromised was the aortic valve (54.5%), and the majority of the cases involved native valves (73%) (Table 3).
A specific infective agent was identified in 76.6% of cases, with Staphylococcus aureus (19%), Enterococcus (12%), Coagulase- negative staphylococci (10.2%), and Viridans streptococci (9.6%) being the most microbiological agents (Table 4).