Few population-based studies have evaluated the epidemiology of infective endocarditis (IE). Changes in population demographics and guidelines on IE may have affected both the incidence and outcomes of IE. Therefore, the aim of our study is to provide contemporary population-based epidemiological data of IE in Spain. Retrospective nationwide observational study using data from the Spanish National Health System Discharge Database. We included all patients hospitalized with IE from January 2000 to December 2019. A total of 64,550 IE episodes were included. The incidence of IE rose from 5.25 cases/100,000 person-year in 2000 to 7.21 in 2019, with a 2% annual percentage change (95% CI 1.3-2.6). IE incidence was higher among those aged 85 or older (43.5 cases/100.000 person-years). Trends across the study period varied with sex and age. Patients with IE were progressively older (63.9 years in 2000-2004 to 70.0 in 2015-2019, p < 0.001) and had more frequent comorbidities and predispositions, including, previous valvular prosthesis (12.1% vs 20.9%, p < 0.001). After adjustment, a progressive reduction in mortality was noted including in 2015-2019 compared to 2010-2014 (adjusted odds ratio 0.93, 95% confident interval 0.88-0.99, p = 0.023)., which was associated with more frequent cardiac surgery in recent years (15.1% in 2010-2014 vs 19.9% in 2015-2019). In Spain, the incidence of IE has increased during the XXI century, with a more pronounced increase in elderly individuals. Adjusted-mortality decreased over the years, which could be related to a higher percentage of surgery. Our results highlight the changing epidemiology of IE.

Purpose: Staphylococcus aureus prosthetic valve endocarditis (SAPVE) is a serious infection with high mortality. The main objective of this study was to identify factors associated with in-hospital mortality. Methods: From January 2008 to December 2021, consecutive patients from a Spanish cohort of infective endocarditis with a definitive diagnosis of SAPVE were analyzed. Results: During the study period, 219 cases of definitive SAPVE were diagnosed, which accounted for 16.7% of a total of 1309 cases of definitive prosthetic valve endocarditis (PVE). Patients presented advanced age and marked comorbidity. There was a higher incidence of persistent bacteremia, septic shock, stroke, and acute kidney injury than in cases of PVE caused by other microorganisms. Methicillin resistance was not associated with differences in clinical presentation, echocardiographic findings, or mortality. Only 50.6% of the patients with surgical indications (88 patients) underwent surgery. Overall, in-hospital mortality was 47.9%. The variables associated with in-hospital mortality were age (OR:1.03, 95% CI: 1.00-1.05; p = 0.016), heart failure (OR:2.86, 95% CI: 1.53–5.32; p = 0.001), acute kidney injury (OR:2.42, 95%CI:1.28–4.58; p = 0.006), stroke (OR:3.53, 95%CI:1.79–6.96; p < 0.001) and surgery indicated but not performed (OR:2.01, 95%CI:1.06–3.8; p = 0.030). On the other hand, the performance of surgery per se in patients with SAPVE, regardless of whether there was a surgical indication according to the guidelines, was not associated with a reduction in in-hospital mortality. Conclusions: SAPVE is characterized by high mortality, which is more marked in patients who present a surgical indication but do not undergo surgery.

We aimed to describe clinical characteristics, risk factors and prognosis in patients with Klebsiella spp. bacteremia according to their beta-lactam resistance profile. Single-centre prospective cohort, including all adults patients with a first episode of Klebsiella spp. bacteriemia from January 2021 to December 2023. Patients were divided into 2 groups: Klebsiella spp. susceptible to carbapenems (CS-K)); and carbapenem-resistant Klebsiella spp. (CR-K). The primary endpoint for prognosis was 30-day mortality. Of the 186 patients included, 156 (83.9 %) were CS-K, and 30 (16.1 %) CR-K. The only factor independently associated with CR-K was previous known colonization (aOR 353.7, 95 %CI 39.8-3142.5). Thirty-day mortality was higher for CR-K than CS-K (40.0 % vs 10.9 %, p < 0.001). An adequate initial antibiotic was used more frequently in CS-K vs CR-K (75.6 % vs 36.7 %, p < 0.001). After adjusting for possible cofounding factors, CR-K was associated with higher mortality (aOR 3.97, 95 % CI 1.40-9.12). Among CR-K, receiving new beta-lactams/betalactamase inhibitors was independently associated with lower 30-day mortality (aOR 0.10, 95 % CI 0.01-0.91). Those patients had similar mortality than those with carbapenem-susceptible Klebsiella spp. bacteremia (10.9 % vs 16.7 %, p = 0.680) CONCLUSIONS: CR-K bacteremia was associated with worse outcomes. Prior colonization was the most important factor associated with this infection. The use of active new betalactam/betalactamase inhibitor antibiotic in patients with CR-K bacteremia was associated with a better prognosis, matching the 30-day mortality observed in carbapenem-susceptible Klebsiella spp. strains.

Patients with COVID-19 may develop a hypercoagulable state due to tissue and endothelial injury, produced by an unbalanced immune response. Therefore, an increased number of thromboembolic events has been reported in these patients. The aim of this study is to investigate the presence of antiphospholipid antibodies (aPL) in COVID-19 patients, their role in the development of thrombosis and their relationship with the severity of the disease. In this retrospective study, serum samples from 159 COVID-19 patients and 80 healthy donors were analysed for the presence of aPL. A total of 29 patients (18.2%) and 14 healthy donors (17.5%) were positive for aPL. Nineteen COVID-19 patients (12%) but no healthy donor presented a positive percentage of the IgA isotype aPL. IgA anti-β2-glycoprotein I antibodies (anti-β2GPI) were the most frequent type (6.3%) in patients but was not detected in any healthy donor. The positivity of this antibody was found to be significantly elevated in patients with thromboembolic events (25% vs. 5%, p = 0.029); in fact, patients with positive IgA anti-β2GPI had an incidence of thrombosis over six times higher than those who had normal antibody concentrations [OR (CI 95%) of 6.67 (1.5–30.2), p = 0.014]. Additionally, patients with moderate-severe disease presented a higher aPL positivity than patients with mild disease according to the Brescia (p = 0.029) and CURB-65 (p = 0.011) severity scales. A multivariate analysis showed that positivity for IgA anti-β2GPI is significantly associated with disease severity measured by CURB-65 [OR (CI 95%) 17.8 (1.7–187), p = 0.0016]. In conclusion, COVID-19 patients have a significantly higher positive percentage of the IgA isotype aPL than healthy donors. IgA anti-β2GPI antibodies were the most frequently detected aPL in COVID-19 patients and were associated with thrombosis and severe COVID-19 and are thus proposed as a possible marker to identify high-risk patients.

Preliminary evidence suggests that patients with Enterococcus faecalis bacteremia and infective endocarditis, particularly those without an identifiable source, may have an increased prevalence of colorectal neoplasia. Whether systematic colonoscopy should be recommended in this population remains unresolved. EnteroColonus is a multicenter, prospective, observational matched cohort study that will recruit adults aged 50 years or older with E. faecalis bacteremia and/or infective endocarditis from 22 Spanish centers, together with asymptomatic controls undergoing colorectal cancer screening. Cases will be stratified into E. faecalis bacteremia/endocarditis of unknown origin (EFBEUO) and with suspected source (EFBESS). The original planned sample size initially was 414 participants: 276 cases and 138 matched controls. Under the amended protocol, the current confirmatory sample-size target is 165 participants (110 cases and 55 matched controls; 2:1 case-to-control allocation). Core procedures include colonoscopy, histopathology, clinical and microbiological phenotyping of colonic samples, fecal microbiome profiling by shotgun metagenomics, detection of E. faecalis genetic material in colorectal biopsy specimens using 16S sequencing and species-specific qPCR, and whole-genome, SNP, and phylogenetic analyses of clinical isolates. Secondary endpoints include microbiome profiles, biopsy positivity for E. faecalis, genomic traits of bloodstream isolates, mortality, relapse/recurrence, and development of a colorectal neoplasia risk score. This protocol is designed to clarify which patients with E. faecalis bloodstream infection might benefit from systematic colonoscopy evaluation and to explore host–microbe mechanisms underlying the observed association with colorectal neoplasia.

Background: Infective endocarditis (IE) carries a significant risk of recurrence. European clinical guidelines recommend performing follow-up blood cultures (BCs), although evidence regarding their utility is limited. We aimed to assess the yield of follow-up BCs in these patients. Methods: Single-center post hoc analysis of a prospective cohort including IE survivors diagnosed between 2012 and 2023 with at least 12 months of follow-up. Results: Among 225 patients included, follow-up BCs were performed in 153 (68.0%). Recurrence was diagnosed in 19 patients (8.4%). Patients with recurrence had higher mortality during follow-up (15.8% vs 4.4%, P = .025). Among patients with follow-up BCs, there was 1 contaminant (0.7%) and 2 true-positive results (1.3%), both of them representing IE reinfections due to different microorganisms. One of them had fever at BC extraction. The 1-year recurrence rate and IE-associated mortality (including complications or recurrences) were similar in patients with and without BCs (7.8% vs 9.7%, P = .789 and 1.4% vs 0.7%, P = .538, respectively). In the index IE episode, patients with recurrence more frequently presented with previous IE (21.1% vs 5.3%, P = .035), fungal etiology (10.5% vs 1.5%, P = .010), and mycotic aneurysms (15.8% vs 1.0%, P = .004), while they had a lower frequency of native-valve (31.6% vs 54.6%, P = .049) and Staphylococcus aureus (5.3% vs 23.2%, P = .012) endocarditis. Conclusions: Follow-up BC after an IE episode appears to have low utility, with similar rates of true positives and contaminants. Patients with follow-up BCs did not have more recurrences diagnosed or lower mortality during follow-up.