Outcome and prognostic factors of patients with right-sided infective endocarditis requiring intensive care unit admission

Background: Right-sided infective endocarditis (RSIE) is an uncommon diagnosis accounting for less than 10% of cases of infective endocarditis. Optimal management for severely ill patients with RSIE remains challenging because few studies reported on management and outcome. The goal of our study was to determine outcome and associated prognostic factors in a population of ICU patients with a diagnosis of definite, active and severe RSIE. Methods: We performed a retrospective study in 10 French ICUs between January 2002 and December 2012. Main outcome was mortality at 30 days after ICU admission. Significant variables associated with 30-days mortality in the bivariate analysis were included in a logistic regression analysis. Results: A total of 37 patients were studied. Mean age was 47.9 +/- 18.4 years. Mean SAPS II, SOFA score and Charlson comorbidity index were 32.4 +/- 17.4, 6.3 +/- 4.4 and 3.1 +/- 3.4, respectively. Causative pathogens, identified in 34 patients, were mainly staphylococci (n = 29). The source of endocarditis was a catheter related infection in 10 patients, intravenous drug abuse in 8 patients, cutaneous in 7 patients, urinary tract related in one patient and has an unknown origin in 7 patients. Vegetation size was higher than 20 mm for 14 patients. Valve tricuspid regurgitation was classified as severe in 11 patients. All patients received initial appropriate antimicrobial therapy. Aminoglycosides were delivered in combination with beta-lactam antibiotics or vancomycin in 22 patients. Surgical procedure was performed in 14 patients. Eight patients (21.6%) died within 30 days following ICU admission. One independent prognostic factor was identified: use of aminoglycosides was associated with improved outcome (OR = 0.1; 95% CI = 0.0017-0.650; p = 0.007). Conclusion: Mortality of patients with RSIE needing ICU admission is high. Aminoglycosides used in combination with beta-lactam or vancomycin could reduce 30 days mortality.