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Infective endocarditis is a life-threatening condition and is associated with embolic events. We aimed to evaluate the association of vegetation size, multiplicity, and position with cerebral embolism and late mortality in patients with infective endocarditis.We retrospectively reviewed patients with infective endocarditis who were admitted to a single institution between November 2005 and August 2017. A total of 419 patients with infective endocarditis were included in the study, 273 of whom had undergone surgery. The primary endpoint was all-cause mortality, and the secondary endpoint was cerebral embolism. Multivariate Cox regression and logistic regression analyses were performed to identify independent risk factors for 30-day mortality, late mortality, and cerebral embolism.Age (hazard ratio [HR] 1.02; 95% confidence interval [CI], 1.00 to 1.04), renal failure (HR 4.21; 95% CI, 2.67 to 6.65), surgery (HR 0.31; 95% CI, 0.21 to 0.46), and Acute Physiology and Chronic Health Evaluation II score (HR 1.08; 95% CI, 1.01 to 1.15) were associated with late mortality. Vegetation size, multiplicity, and position were not significantly associated with late mortality, but a mitral vegetation size of greater than 10 mm (odds ratio 2.25; 95% CI, 1.32 to 3.84) was an independent risk factor for cerebral embolism.A vegetation size of greater than 10 mm and the mitral position were found to be significant risk factors for cerebral embolism, and for this group, early surgery might be considered to prevent cerebral embolism.

Infective endocarditis (IE) is a severe and fatal infection with high in-hospital and overall mortality rates of approximately up to 30%. Valve culture positivity was associated with in-hospital mortality and postoperative complications; however, few studies have analyzed the relationship between valve cultures and overall mortality over a long observation period. This study aimed to compare the association of valve culture positivity with overall mortality in patients with IE who underwent valve surgery.A total of 416 IE patients admitted to a tertiary hospital in South Korea from November 2005 to August 2017 were retrospectively reviewed. A total of 202 IE patients who underwent valve surgery and valve culture were enrolled. The primary endpoint was long-term overall mortality. Kaplan-Meier curve and Cox proportional hazards model were used for survival analysis.The median follow-up duration was 63 (interquartile range, 38-104) months. Valve cultures were positive in 22 (10.9%) patients. The overall mortality rate was 15.8% (32/202) and was significantly higher in valve culture-positive patients (36.4%, p = 0.011). Positive valve culture [hazard ratio (HR) 3.921, p = 0.002], Charlson Comorbidity Index (HR 1.181, p = 0.004), Coagulase-negative staphylococci (HR 4.233, p = 0.001), new-onset central nervous system complications (HR 3.689, p 0.001), and new-onset heart failure (HR 4.331, p = 0.001) were significant risk factors for overall mortality.Valve culture positivity is a significant risk factor for long-term overall mortality in IE patients who underwent valve surgery. The importance of valve culture positivity needs to be re-evaluated, as the valve culture positivity rate increases with increasing early surgical intervention.

Background Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment. Methods This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment. Results 239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P < 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P < 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P < 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality Conclusion Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment. Disclosures All Authors: No reported disclosures.

Background Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment in patients with IE lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about renal toxicity and an increase in the incidence of resistant strains due to long-term use of antibiotics. In this study, we compare the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE for each group. Methods From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 239 IE patients who underwent valve surgery and appropriate antibiotics duration were enrolled. The primary endpoint was long-term overall mortality. The secondary endpoints were reoperation rate, recurrence rate, and postoperative complications, such as new-onset heart failure, paravalvular and embolic complications. Results The median follow-up duration was 71 (interquartile range, 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 67 patients (28.0%) and more than 2 weeks in 127 patients (72.0%). The median age was 53 years. The overall mortality was 13.0% (31/239). There were no statistical differences in overall mortality (13.4% vs. 12.8%, p=0.894), reoperation (6.0% vs. 4.1%, p=0.507), and recurrence (7.5% vs. 2.9%, p=0.148) between patients with postoperative antibiotic therapy for ≥2 weeks and less than 2 weeks. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.971). Conclusion In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. When surgery and recommended total antibiotics duration are properly performed according to guidelines, the effect of duration of postoperative antibiotic therapy on overall mortality, recurrence rate, and reoperation rate is reduced to a statistically insignificant extent. Disclosures All Authors: No reported disclosures.

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, pConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.