{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:51:05Z","timestamp":1782276665617,"version":"3.54.5"},"reference-count":42,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T00:00:00Z","timestamp":1726876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Despite enormous developments in medicine, infective endocarditis (IE) remains an ongoing issue for physicians due to increased morbidity and persistently high mortality. Our goal was to assess clinical outcomes in patients with IE and identify determinants of in-hospital mortality. Material and methods: The analysis was retrospective, single-centered, and comprised 270 patients diagnosed with IE from 2005 to 2021 (median age 65 (51\u201374), male 177 (65.6%). Native IE (NVIE) was observed in 180 (66.7%), prosthetic IE (PVIE) in 88 (33.6%), and cardiac device-related IE (CDRIE) in 2 (0.7%), with non-survivors having much higher rates. Healthcare-associated IE (HAIE) was 72 (26.7%), Staphylococci were the most prevalent pathogen, and the proportion of Gram-negative bacteria (GNB) non-HACEK was significantly greater in non-survivors than survivors (11 (15%) vs. 9 (4.5%), p = 0.004). Overall, 54 (20%) patients underwent early surgery, with a significant difference between dead and alive patients (3 (4.5%) vs. 51 (25.1%, p = 0.000). The overall in-hospital mortality rate was 24.8% (67). Logistic regression was conducted on the total sample (n = 270) for the period 2005\u20132021, as well as the sub-periods 2005\u20132015 (n = 119) and 2016\u20132021 (n = 151), to identify any differences in the trend of IE. For the overall group, the presence of septic shock (OR-83.1; 95% CI (17.0\u2013405.2), p = 0.000) and acute heart failure (OR\u201424.6; 95% CI (9.2\u201365.0), p = 0.000) increased the risk of mortality. Early surgery (OR-0.03, 95% CI (0.01\u20130.16), p = 0.000) and a low Charlson comorbidity index (OR-0.85, 95% CI (0.74\u20130.98, p = 0.026) also lower this risk. Between 2005 and 2015, the presence of septic shock (OR 76.5, 95% CI 7.11\u2013823.4, p = 0.000), acute heart failure (OR-11.5, 95% CI 2.9\u201346.3, p = 0.001), and chronic heart failure (OR-1.3, 95% CI 1.1\u20131.8, p = 0.022) enhanced the likelihood of a fatal outcome. Low Charlson index comorbidity (CCI) lowered the risk (OR-0.7, 95% CI 0.5\u20130.95, p = 0.026). For the period 2016\u20132021, the variable with the major influence for the model is the failure to perform early surgery in indicated patients (OR-240, 95% CI 23.2\u20142483, p = 0.000) followed by a complication of acute heart failure (OR-72.2, 95% CI 7.5\u2013693.6. p = 0.000), septic shock (OR-17.4, 95% CI 2.0\u2013150.8, p = 0.010), previous stroke (OR-9.2, 95% CI 1.4\u201359.4, p = 0.020) and low ejection fraction (OR-1.1, 95% CI 1.0\u20131.2, p = 0.004). Conclusions: Knowing the predictors of mortality would change the therapeutic approach to be more aggressive, improving the short- and long-term prognosis of IE patients.<\/jats:p>","DOI":"10.3390\/microorganisms12091919","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T04:45:28Z","timestamp":1727066728000},"page":"1919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Infective Endocarditis\u2014Predictors of In-Hospital Mortality, 17 Years, Single-Center Experience in Bulgaria"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0295-7434","authenticated-orcid":false,"given":"Bistra","family":"Dobreva-Yatseva","sequence":"first","affiliation":[{"name":"Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University\u2014Plovdiv, UMBAL \u201cSt. Georgi\u201d EAD, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fedya","family":"Nikolov","sequence":"additional","affiliation":[{"name":"Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University\u2014Plovdiv, UMBAL \u201cSt. Georgi\u201d EAD, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralitsa","family":"Raycheva","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Public Health, Faculty of Public Health, Medical University\u2014Plovdiv, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariya","family":"Tokmakova","sequence":"additional","affiliation":[{"name":"Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University\u2014Plovdiv, UMBAL \u201cSt. Georgi\u201d EAD, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4322\/acr.2013.033","article-title":"Infective endoarditis: A history of the development of its undestanding","volume":"3","author":"Geller","year":"2013","journal-title":"Autops. Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3222","DOI":"10.1093\/eurheartj\/ehz620","article-title":"Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study","volume":"40","author":"Habib","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_3","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","volume":"169","author":"Murdoch","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ejim.2019.03.006","article-title":"Role of age and comorbidities in mortality of patients with infective endocarditis","volume":"64","author":"Zarauza","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.jacc.2021.02.014","article-title":"Infective Endocarditis in Patients on Chronic Hemodialysis","volume":"77","author":"Llopis","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/eurheartj\/ehl318","article-title":"Diabetes mellitus and infective endocarditis: The insulin factor in patient morbidity and mortality","volume":"28","author":"Duval","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1161\/01.CIR.0000124719.61827.7F","article-title":"Early Predictors of In-Hospital Death in Infective Endocarditis","volume":"109","author":"Chu","year":"2004","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s40520-019-01314-3","article-title":"Infective endocarditis in elderly and very elderly patients","volume":"32","author":"Boix","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_9","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_10","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_11","doi-asserted-by":"crossref","first-page":"263","DOI":"10.31083\/j.rcm.2020.02.68","article-title":"Infective endocarditis after TAVI: A meta-analysis and systematic review of epidemiology, risk factors and clinical consequences","volume":"21","author":"Tinica","year":"2020","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/cid\/ciad464","article-title":"Infective Endocarditis after Transcatheter versus Surgical Aortic Valve Replacement","volume":"78","author":"Panagides","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jacc.2022.11.028","article-title":"Infective Endocarditis after Transcatheter Aortic Valve Replacement","volume":"81","author":"Panagides","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"891","DOI":"10.2217\/fca-2021-0155","article-title":"Outcomes in Cardiac Implantable Electronic device-related Infective Endocarditis: A Systematic Review of Current Literature","volume":"18","author":"Sanghavi","year":"2022","journal-title":"Future Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijcard.2016.11.029","article-title":"Device-related infective endocarditis in cardiac resynchronization therapy recipients\u2014Single center registry with over 2500 person-years follow up","volume":"227","author":"Mazurek","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1086\/592576","article-title":"Contemporary Epidemiology and Prognosis of Health Care\u2014Associated Infective Endocarditis","volume":"47","author":"Almirante","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","first-page":"1683","article-title":"Healthcare\u2014Associated Infective Endocarditis. An Undesirable Effect of Health Care Universalization","volume":"26","author":"Lomas","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e003016","DOI":"10.1161\/JAHA.115.003016","article-title":"Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis","volume":"5","author":"Park","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/0002-9343(94)90143-0","article-title":"New criteria for diagnosis of infective endocarditis: Utilization of specific echocardiographic findings. Duke Endocarditis Service","volume":"96","author":"Durack","year":"1994","journal-title":"Am. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sunder, S., Grammatico-Guillon, L., Lemaignen, A., Lacasse, M., Gaborit, C., Boutoille, D., Tattevin, P., Denes, E., Guimard, T., and Dupont, M. (2019). Incidence, characteristics, and mortality of infective endocarditis in France in 2011. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0223857"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019","volume":"76","author":"Roth","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"02208-17","DOI":"10.1128\/AAC.02208-17","article-title":"Risk Factors and Outcomes of Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Data from the Prospective Multicenter Italian Endocarditis Study Cohort","volume":"62","author":"Falcone","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejim.2021.04.021","article-title":"Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort","volume":"92","author":"Alvarez","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/23744235.2023.2226212","article-title":"Non-HACEK gram-negative bacilli endocarditis: A multicentre retrospective case-control study","volume":"55","author":"Sebillotte","year":"2023","journal-title":"Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1093\/cid\/ciab098","article-title":"Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock","volume":"73","author":"Goenaga","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s40121-021-00563-y","article-title":"Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016\u20132018)","volume":"11","author":"Mir","year":"2022","journal-title":"Infect. Dis. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1002\/ejhf.2525","article-title":"Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: A substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry","volume":"24","author":"Bohbot","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"ofab119","DOI":"10.1093\/ofid\/ofab119","article-title":"Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study","volume":"8","author":"Reviejo","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Sousa, C., Nogueira, P., and Pinto, F.J. (2021). Insight into the epidemiology of infective endocarditis in Portugal: A contemporary nationwide study from 2010 to 2018. BMC Cardiovasc. Disord., 21.","DOI":"10.1186\/s12872-021-01937-3"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.ijid.2022.02.022","article-title":"Clinical, Microbiological, and Imaging Characteristics of Infective Endocarditis in Latin America: A Systematic Review","volume":"117","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3855\/jidc.10056","article-title":"Pooled analysis of 1270 infective endocarditis cases in Turkey","volume":"13","author":"Vahabi","year":"2019","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e20230441","DOI":"10.36660\/abc.20230441","article-title":"Desempenho do Escore SHARPEN e do \u00cdndice de Comorbidade de Charlson para Predi\u00e7\u00e3o de Mortalidade durante a Interna\u00e7\u00e3o Hospitalar e ap\u00f3s a Alta na Endocardite Infecciosa","volume":"120","author":"Alves","year":"2023","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5243","DOI":"10.1016\/j.ijcard.2013.08.023","article-title":"Age adjusted Charlson Co-morbidity Index is an independent predictor of mortality over long-term follow-up in infective endocarditis","volume":"168","author":"Lu","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3892\/etm.2023.11998","article-title":"Age-adjusted Charlson comorbidity index and in-hospital mortality in critically ill patients with cardiogenic shock: A retrospective cohort study","volume":"25","author":"Wei","year":"2023","journal-title":"Exp. Ther. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1016\/S2214-109X(21)00400-9","article-title":"Epidemiology of infective endocarditis in Africa: A systematic review and meta-analysis","volume":"10","author":"Noubiap","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ijid.2015.01.003","article-title":"Profile of infective endocarditis at a tertiary-care hospital in Japan over a 14-year period: Characteristics, outcome and predictors for in-hospital mortality","volume":"33","author":"Hase","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"\u00c1lvarez-Zaballos, S., Gonz\u00e1lez-Ramallo, V., Quintana, E., Mu\u00f1oz, P., de la Villa-Mart\u00ednez, S., Fari\u00f1as, M.C., Arn\u00e1iz-de las Revillas, F., de Alarc\u00f3n, A., Rodr\u00edguez-Esteban, M.\u00c1., and Mir\u00f3, J.M. (2022). Multivalvular Endocarditis: A Rare Condition with Poor Prognosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164736"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1136\/heartjnl-2020-317265","article-title":"Infective endocarditis at a tertiary care hospital in South Korea","volume":"107","author":"Kim","year":"2021","journal-title":"Heart"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1016\/j.cjco.2021.07.014","article-title":"The Epidemiology of Endocarditis in Manitoba: A Retrospective Study","volume":"3","author":"Maguire","year":"2021","journal-title":"CJC Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1161\/CIRCULATIONAHA.108.773598","article-title":"Surgery for Infective Endocarditis","volume":"121","author":"Prendergast","year":"2010","journal-title":"Circulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ijcard.2020.10.029","article-title":"Temporal changes in the incidence of infective endocarditis in Denmark 1997\u20132017: A nationwide study","volume":"326","author":"Jensen","year":"2021","journal-title":"Int. J. Cardiol."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/9\/1919\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:01:33Z","timestamp":1760112093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/9\/1919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,21]]},"references-count":42,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["microorganisms12091919"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms12091919","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,21]]}}}