180 Dramatic Reduction of Infective Endocarditis-Related Mortality Associated with a Management-Based Approach

BackgroundDespite improvements in medical and surgical therapy, infective endocarditis (IE) is still associated with a severe prognosis and remains a therapeutic challenge. We aimed to evaluate the impact of a standardized diagnostic and therapeutic protocol on mortality and to correlate the outcome with the compliance to our management-based protocol.MethodsObservational before-after study including 333 consecutive patients treated for IE at a referral center conducted from 1991 to 2006 and divided in two periods: period 1 (1991 to 2001), before implementation of our therapeutic protocol (n=173) and period 2 (2002 to 2006) after implementation of our protocol (n=160) created by a multidisciplinary task force including a sampling of biological specimens, the use of only four antimicrobials, a standardized duration of treatment, standardized surgical indications, and one year follow-up. Because our protocol was based on a local consensus by physicians and surgeons, it was impossible to randomize the study.ResultsThe one-year mortality significantly decreased from 18.5% during period 1 to 8.2% during period 2 (hazard ratio=0.41; 95% confidence interval, 0.21-0.79; p=0.0075). After multivariable analysis, the management during the period 2 remained a strong protective factor (adjusted hazard ratio=0.26; 95% confidence interval, 0.09-0.76; p=0.014). During period 2, we observed a significant better compliance in antimicrobial therapy and fewer cases of renal failure. Deaths by embolic events and multiple organ failure syndrome also significantly decreased during period 2.ConclusionsA dramatic reduction in mortality was observed during this study suggesting that a management-based approach has a significant impact on IE outcome