Fatores de risco para endocardite infecciosa precoce de valvas protéticas: estudo caso-controle
Fatores de risco para endocardite infecciosa precoce de valvas protéticas: estudo caso-controle
Data
2016
Autores
Garrido, Rafael Quaresma
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto NAcional de Cardiologia
Resumo
Introdução: A endocardite infecciosa de valvas protéticas (EIVP) precoce é uma doença incomum, mas sua ocorrência está associada a grande morbidade e mortalidade. A incidência estimada é de 1 a 6% e a mortalidade associada é de 15 a 80%. O objetivo deste trabalho foi avaliar quais fatores estão associados à aquisição de EIVP precoce. Metodologia: este é um estudo caso-controle realizado no Instituto Nacional de Cardiologia de 2006 a 2016. Os casos foram os pacientes que tiveram EIVP definitiva pelos critérios de Duke modificados até 12 meses do implante. Os controles foram pacientes que realizaram cirurgia de troca valvar e que não tiveram EIPV até 12 meses da cirurgia de implante valvar. Casos e controles (1:3) foram pareados pela idade no momento da cirurgia (+/- 10 anos), gênero, data da cirurgia (+/- 1 ano) e tipo de cirurgia realizada. O seguimento mínimo foi de 12 meses. A análise estatística foi feita utilizando o programa R e o odds ratio foi a medida de associação utilizada. Resultados: foram estudados 26 casos e 78 controles, em 2496 cirurgias de troca valvar. A ocorrência média de EIVP precoce no período foi de 1,04%. Das próteses implantadas, 53,8% eram biológicas e 46,2% eram mecânicas. Eram reumáticos 50,9 % dos pacientes. A mediana para o surgimento da EIVP precoce foi de 33 dias (IQR19,25-118,75). O principal microrganismo identificado foi Staphylococcus epidermidis 23,1% (n=6). Os fatores de risco relacionados a EIVP precoce foram identificados entre as variáveis do per e pós-operatório: uso de ≥ 2 unidades de criopreciptado, OR 5,95 (IC95% 1,31-27,0), infecção da corrente sanguínea, OR 14 (1,49-131,77), pneumonia, OR 4,38 (IC95% 1,21-15,84), qualquer infecção, OR 4,46(IC95% 1,63-12,21), uso de cateter venoso profundo > 2 semanas OR 5,33 (2,06-13,78), presença de cateter de diálise OR 3,22 (IC95% 1,15-9,03) e nova esternotomia, OR 3,89 (IC95% 1,28-11,78). Nos casos, a mediana do tempo de internação foi 67,5 dias (36,75-85) e nos controles 32 dias (24-44,75), p<0,001. A mortalidade em 12 meses foi respectivamente de 34,6% (n=9) nos casos e 6,41% (n=5) nos controles, com OR para óbito de 7,73 (IC 95% 2,3-26,0) e p=0,001. Conclusão: pacientes submetidos a troca valvar com pós-operatório complicado por infecções, maior invasão vascular e necessidade de nova cirurgia, tiveram maior chance de ocorrência de EIVP precoce, reforçando a importância dos cuidados de prevenção e controle de infecção. A mortalidade foi maior e o tempo de hospitalização mais longo em pacientes com EIPV precoce.
Introduction: Early onset prosthetic valves endocarditis (EO-PVE) is an uncommon disease but its occurrence is associated with high morbidity and mortality. Its estimated incidence is 1 to 6% and the associated mortality to EO-PVE is 15 to 80%. The objective of this study was to evaluate which factors are related to the acquisition of EO-PVE. Methodology: This is a case-control study conducted at the Instituto Nacional de Cardiologia from 2006 to 2016. The cases were patients who had definitive prosthetic endocarditis by the modified Duke criteria up to 12 months of valve implantation. The controls were patients who did not have EO-PVE until 12 months after valve replacement surgery. Cases and controls were matched (1:3) by age at surgery (+/- 10 years), sex, date of surgery (+/- 1 year) and type of surgery performed. Statistical analysis was done using the R program and the odds ratio was the measure of association utilized. Results: There were 26 cases and 78 controls, in 2496 valve replacement surgeries. The mean incidence of EO-PVE in this period was 1.04%. Bioprosthesis were used in 53.8 % and mechanical ones in 46.2 %. The median time to the onset of EO-PVE was 33 days (IQR19.25-118.75). The most commonly identified microorganism was Staphylococcus epidermidis, 23.1% (n = 6). Risk factors related to early EIVP were identified within the per and postoperative variables: use of ≥ 2 cryoprecipitate units, OR 5.95 (95% CI 1.31-27.0), bloodstream infection, OR 14 (1.49-131.77), pneumonia, OR 4.38 (95% CI 1.21-15.84), any infection, OR 4.46 (95% CI 1.63-12.21), presence of ≥ 2 weeks of deep intravenous access, OR 5,33 (2,06-13,78) and presence of dialysis catheter OR 3.22 (95% CI 1.15-9.03) and new open chest surgery, OR 3.89 (95% CI % 1.28-11.78). In the cases, the median hospitalization time was 67.5 days (36.75-85) and in the controls 32 days (24-44.75), p <0.001. Mortality at 12 months was respectively 34.6% (n = 9) in the cases and 6.41% (n = 5) in the controls, with an OR for death of 7.73 (2.3-26.06), p=0.001. Conclusion: Patients submitted to valve replacement surgery with postoperative infectious complications, use of intravenous lines and need for new open chest surgery were more likely to develop EO-PVE, reinforcing the importance of infection control and prevention practices. Mortality was higher and length of hospital stay longer in patients with EO-PVE.
Introduction: Early onset prosthetic valves endocarditis (EO-PVE) is an uncommon disease but its occurrence is associated with high morbidity and mortality. Its estimated incidence is 1 to 6% and the associated mortality to EO-PVE is 15 to 80%. The objective of this study was to evaluate which factors are related to the acquisition of EO-PVE. Methodology: This is a case-control study conducted at the Instituto Nacional de Cardiologia from 2006 to 2016. The cases were patients who had definitive prosthetic endocarditis by the modified Duke criteria up to 12 months of valve implantation. The controls were patients who did not have EO-PVE until 12 months after valve replacement surgery. Cases and controls were matched (1:3) by age at surgery (+/- 10 years), sex, date of surgery (+/- 1 year) and type of surgery performed. Statistical analysis was done using the R program and the odds ratio was the measure of association utilized. Results: There were 26 cases and 78 controls, in 2496 valve replacement surgeries. The mean incidence of EO-PVE in this period was 1.04%. Bioprosthesis were used in 53.8 % and mechanical ones in 46.2 %. The median time to the onset of EO-PVE was 33 days (IQR19.25-118.75). The most commonly identified microorganism was Staphylococcus epidermidis, 23.1% (n = 6). Risk factors related to early EIVP were identified within the per and postoperative variables: use of ≥ 2 cryoprecipitate units, OR 5.95 (95% CI 1.31-27.0), bloodstream infection, OR 14 (1.49-131.77), pneumonia, OR 4.38 (95% CI 1.21-15.84), any infection, OR 4.46 (95% CI 1.63-12.21), presence of ≥ 2 weeks of deep intravenous access, OR 5,33 (2,06-13,78) and presence of dialysis catheter OR 3.22 (95% CI 1.15-9.03) and new open chest surgery, OR 3.89 (95% CI % 1.28-11.78). In the cases, the median hospitalization time was 67.5 days (36.75-85) and in the controls 32 days (24-44.75), p <0.001. Mortality at 12 months was respectively 34.6% (n = 9) in the cases and 6.41% (n = 5) in the controls, with an OR for death of 7.73 (2.3-26.06), p=0.001. Conclusion: Patients submitted to valve replacement surgery with postoperative infectious complications, use of intravenous lines and need for new open chest surgery were more likely to develop EO-PVE, reinforcing the importance of infection control and prevention practices. Mortality was higher and length of hospital stay longer in patients with EO-PVE.
Description
Palavras-chave
Infectious endocarditis, Hospital infection, Cardiac surgery, Prosthetic valve, Infecção hospitalar, Cirurgia cardíaca, Prótese valvar, Endocardite infecciosa
Citação
Garrido RQ. Fatores de risco para endocardite infecciosa precoce de valvas protéticas: estudo caso-controle. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2016