{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T20:18:52Z","timestamp":1778271532243,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objectives: Infective endocarditis (IE) remains associated with high mortality, and real-world (RW) patients often differ from trial populations. We evaluated predictors of complications and mortality, the trial-eligibility gap, and temporal trends in guideline adherence across two periods (Period 1 [P1]: 2011\u20132016 vs. Period 2 [P2]: 2017\u20132025) in a Romanian county hospital. Materials and Methods: We conducted a retrospective analysis of consecutive adult patients with definite IE. Patients were categorized as trial-eligible (TE) or RW according to predefined criteria. The composite endpoint included acute heart failure, cardiogenic or septic shock, embolic events, infectious complications, need for renal replacement therapy, and in-hospital mortality. We evaluated guideline adherence using a predefined quality indicator (QI) score \u2265 3. We identified independent predictors of outcome using multivariable logistic regression. Results: Among 206 patients (mean age 63.0 \u00b1 14.8 years; 70.4% male), blood cultures were positive in 64.1%, with Staphylococcus aureus accounting for 14.1%. Vegetations were documented in 72.8%, and cardiac surgery was performed in 26.2%. Overall, at least one event from the composite endpoint occurred in 61.6%, and mortality was 32.5%. TE patients represented 63.1% of the cohort. Guideline adherence improved over time (QI \u2265 3: from 18.3% in P1 to 25.4% in P2, p = 0.32). In P2, the composite endpoint (66.8% vs. 42.9%, p = 0.002) and embolic events (31.8% vs. 8.2%, p &lt; 0.001) were more frequent, whereas mortality remained unchanged (31.8% vs. 34.7%, p = 0.844). Sepsis at admission and left ventricular ejection fraction (LVEF) &lt; 50% independently predicted adverse outcomes; model discrimination was acceptable, with an area under the curve (AUC) of 0.77. Conclusions: RW IE showed high complication rates and a persistent trial gap; improved guideline adherence was offset by greater clinical severity.<\/jats:p>","DOI":"10.3390\/jcm15103600","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:10:52Z","timestamp":1778267452000},"page":"3600","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Infective Endocarditis in a Regional Hospital: Clinical Severity, Guideline Adherence, and Determinants of In-Hospital Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0267-3199","authenticated-orcid":false,"given":"C\u0103lin","family":"Pop","sequence":"first","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"},{"name":"Faculty of Nursing and Health Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, Str. Louis Pasteur Nr. 4, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucian Liviu","family":"Pop","sequence":"additional","affiliation":[{"name":"Faculty of Nursing and Health Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, Str. Louis Pasteur Nr. 4, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rebeca","family":"Petru\u0219","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea Ioana","family":"Talpos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Hodas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lavinia","family":"Pop","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iulia","family":"Pop","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, Str. George Cosbuc Nr. 31, 430130 Baia Mare, Romania"},{"name":"Faculty of Nursing and Health Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, Str. Louis Pasteur Nr. 4, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the Management of Endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1007\/s40121-023-00898-8","article-title":"Correction: Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000\u20132012)","volume":"12","author":"Ambrosioni","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1093\/eurheartj\/ehv319","article-title":"2015 ESC Guidelines for the Management of Infective Endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)","volume":"36","author":"Habib","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2326366","DOI":"10.1001\/jamanetworkopen.2023.26366","article-title":"Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement","volume":"6","author":"McDonald","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.mayocp.2020.06.056","article-title":"Prevalence of Colorectal Neoplasms Among Patients with Enterococcus faecalis Endocarditis in the GAMES Cohort (2008\u20132017)","volume":"96","author":"Ambrosioni","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cimmino, G., Bottino, R., Formisano, T., Orlandi, M., Molinari, D., Sperlongano, S., Castaldo, P., D\u2019Elia, S., Carbone, A., and Palladino, A. (2023). Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life, 13.","DOI":"10.3390\/life13020377"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e183","DOI":"10.3346\/jkms.2025.40.e183","article-title":"Trends in Epidemiology, Clinical Characteristics, and Outcomes of Infective Endocarditis: A 16-Year Nationwide Cohort Study in Korea","volume":"40","author":"Ha","year":"2025","journal-title":"J. Korean Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s12471-025-01979-8","article-title":"ENDOCOR: A Nationwide Consortium of Endocarditis Teams\u2014Initiating a Registry for Infective Endocarditis within the Netherlands Heart Registration","volume":"33","author":"Peijster","year":"2025","journal-title":"Neth. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1056\/NEJMoa1808312","article-title":"Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis","volume":"380","author":"Iversen","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/cid\/ciad119","article-title":"Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study","volume":"77","author":"Freling","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","first-page":"ciaf452","article-title":"Should We Extend the Use of Oral Antibiotics in Infective Endocarditis? The ENDO-ORAL Study","volume":"82","author":"Rallet","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1136\/heart.89.5.577","article-title":"Injection Drug Use and Right Sided Endocarditis","volume":"89","author":"Moss","year":"2003","journal-title":"Heart"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Scheggi, V., Menale, S., Tonietti, B., Giovacchini, J., Del Pace, S., Zoppetti, N., Alterini, B., Stef\u00e0no, P.L., and Marchionni, N. (2023). Infective Endocarditis in Octogenarians. A Retrospective Study in a Single, High-Volume Surgical Centre. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04345-8"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Loghin, I.I., Surdu, A.E., Rusu, \u0218.A., Cecan, I., Dorob\u0103\u021b, V.D., Mih\u0103escu, A.A., and Dorob\u0103\u0163, C.M. (2025). Etiological Aspects of Infectious Endocarditis in a Tertiary Hospital in Northeastern Romania. Medicina, 61.","DOI":"10.3390\/medicina61010095"},{"key":"ref_15","first-page":"25","article-title":"Infective Endocarditis Etiologic Profile\u2014Still a Classic Distribution of Microorganisms?","volume":"126","author":"Buburuz","year":"2022","journal-title":"Med. Surg. J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nanu, A.-A., Laz\u0103r, D.\u0218., Popescu, C.P., Laz\u0103r, M.-I., Nica, M., and Florescu, S.A. (2025). Characteristics of Infective Endocarditis in Intravenous Drug Users vs. Non-Users: A Retrospective Study Conducted in Bucharest, Romania. Medicina, 61.","DOI":"10.3390\/medicina61101785"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Anton, C.-I., Buzil\u0103, C.A., Stanciu, S.M., Bucuric\u0103, S., Anghel, D., \u0218tefan, A.T., \u0218tefan, I., and Streinu-Cercel, A. (2024). Prosthetic Valve Endocarditis: A Retrospective Cohort Study Conducted at \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital in Bucharest. Microorganisms, 12.","DOI":"10.20944\/preprints202408.0466.v1"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Babe\u0219, E.E., Lucu\u021ba, D.A., Petche\u0219i, C.D., Zaha, A.A., Ilyes, C., Jurca, A.D., Vesa, C.M., Zaha, D.C., and Babe\u0219, V.V. (2021). Clinical Features and Outcome of Infective Endocarditis in a University Hospital in Romania. Medicina, 57.","DOI":"10.3390\/medicina57020158"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1161\/CIRCULATIONAHA.123.064527","article-title":"Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC)","volume":"148","author":"Waksman","year":"2023","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","article-title":"Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association","volume":"132","author":"Baddour","year":"2015","journal-title":"Circulation"},{"key":"ref_24","unstructured":"R Core Team (2023). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jordal, S., Kommedal, \u00d8., Haaverstad, R., Saeed, S., Davidsen, E.S., Salminen, P.-R., Hufthammer, K.O., and Kittang, B.R. (2024). Epidemiological and Microbial Trends of Infective Endocarditis in Western Norway: A 7-Year Prospective Observational Study. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09596-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.21037\/cdt.2016.08.09","article-title":"Epidemiological and Mortality Trends in Infective Endocarditis, a 17-Year Population-Based Prospective Study","volume":"7","author":"Cresti","year":"2017","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/IPC.0000000000001357","article-title":"Changing Paradigms in Epidemiology, Microbiology, and Outcomes of Infective Endocarditis","volume":"32","author":"Khardori","year":"2024","journal-title":"Infect. Dis. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105032","DOI":"10.1016\/j.cmicom.2024.105032","article-title":"Partial Oral Treatment of Infective Endocarditis in Real-World Settings\u2014An in-Depth Analysis of the Prospectively Evaluated German DERIVE Cohort","volume":"1","author":"Camp","year":"2024","journal-title":"CMI Commun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5095","DOI":"10.1093\/eurheartj\/ehad715","article-title":"Clinical Implementation of Partial Oral Treatment in Infective Endocarditis: The Danish POETry Study","volume":"44","author":"Hjulmand","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_30","first-page":"202","article-title":"The ESC-EORP EURO-ENDO (European Infective Endocarditis) Registry","volume":"5","author":"Habib","year":"2019","journal-title":"Eur. Heart J.-Qual. Care Clin. Outcomes"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Dobreva-Yatseva, B., Nikolov, F., Raycheva, R., and Tokmakova, M. (2024). Infective Endocarditis\u2014Predictors of In-Hospital Mortality, 17 Years, Single-Center Experience in Bulgaria. Microorganisms, 12.","DOI":"10.20944\/preprints202408.2089.v1"},{"key":"ref_32","first-page":"308","article-title":"Clinical Characteristics, Management and Outcomes of Enterococcal Infective Endocarditis: An Ancillary Study from the ESC-EORP EURO-ENDO Registry","volume":"12","author":"Philip","year":"2025","journal-title":"Eur. Heart J.-Qual. Care Clin. Outcomes"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00392-022-02100-4","article-title":"Temporal trends in incidence, patient characteristics, microbiology and in-hospital mortality in patients with infective endocarditis: A contemporary analysis of 86,469 cases between 2007 and 2019","volume":"113","author":"Becher","year":"2024","journal-title":"Clin. Res. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1001\/archinternmed.2008.603","article-title":"Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis\u2013Prospective Cohort Study","volume":"169","author":"Murdoch","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1001\/jama.2018.7596","article-title":"Management Considerations in Infective Endocarditis: A Review","volume":"320","author":"Wang","year":"2018","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.1056\/NEJMoa1112843","article-title":"Early Surgery versus Conventional Treatment for Infective Endocarditis","volume":"366","author":"Kang","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3012","DOI":"10.1001\/jama.293.24.3012","article-title":"Staphylococcus aureus Endocarditis: A Consequence of Medical Progress","volume":"293","author":"Fowler","year":"2005","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1016\/j.cmi.2021.05.051","article-title":"Prognostic Models for Mortality after Cardiac Surgery in Patients with Infective Endocarditis: A Systematic Review and Aggregation of Prediction Models","volume":"27","author":"Barca","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1093\/ejcts\/ezx428","article-title":"Mortality Risk Prediction in Infective Endocarditis Surgery: Reliability Analysis of Specific Scores","volume":"53","author":"Varela","year":"2018","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"131365","DOI":"10.1016\/j.ijcard.2023.131365","article-title":"Clinical Evaluation of Sepsis-1 and Sepsis-3 in Infective Endocarditis","volume":"393","author":"Wang","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1055\/a-2199-2344","article-title":"New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register","volume":"72","author":"Ostovar","year":"2024","journal-title":"Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3600\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:44:42Z","timestamp":1778269482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103600"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103600","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]}}}