Impact of an Infective Endocarditis Team on Management and Outcomes: A Retrospective Cohort Study.

Abstract

Purpose: Multidisciplinary team approaches have been reported to improve the management of infective endocarditis (IE). This study evaluated changes in management and outcomes after the establishment of an IE team at a tertiary care facility in Japan.

Patients and methods: A retrospective study was conducted on inpatients aged ≥18 years with definite IE between November 2015 and October 2023. The primary outcome was 90-day all-cause mortality. Secondary outcomes included in-hospital mortality, unplanned cardiac surgery, new cerebral embolism, bacteremia relapse within 90 days of admission, and duration of antibiotic therapy. Outcomes were compared between patients admitted before (control period) and after (intervention period) the implementation of the IE team in November 2019.

Results: Characteristics were comparable between the two periods. No significant differences were found in 90-day mortality (15.2% vs 17.0%, P > 0.99), in-hospital mortality (19.6% vs 12.8%, P = 0.54), or new cerebral embolism (8.7% vs 2.1%, P = 0.20). The rate of unplanned cardiac surgery was lower in the intervention period (17.4% vs 2.1%, P = 0.02), while the duration of antibiotic therapy was longer (6.0 weeks vs 7.5 weeks, P = 0.02). No bacteremia relapse occurred.

Conclusion: Although no significant differences were observed in 90-day mortality, the rate of unplanned surgery was significantly lower in the intervention period, supporting the usefulness of an IE team. The longer duration of antibiotic therapy in the intervention period may reflect a higher prevalence of complicated infections including muscle abscesses.