Epidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study

Epidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study sonay arslan, birsen mutlu, müge toygar deniz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6135558/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background As the epidemiology of infective endocarditis (IE) changes, updated antimicrobial management assessments are needed. This study aimed to evaluate patients with healthcare-associated (HAIE) and community-acquired infective endocarditis (CAIE), as well as identify risk factors for 28-day mortality. The findings are intended to guide the treatment of both HAIE and CAIE. Methods We conducted a retrospective cohort study of 131 IE patients treated at Kocaeli University Hospital from December 2016 to December 2022. Data were extracted from hospital records, and patients were categorized into HAIE and CAIE groups. Comparative analyses were performed between the groups, and risk factors for 28-day mortality in IE patients were determined. Results Among the 131 patients, 51.9% had CAIE and 48.1% had HAIE. Predisposing factors were present in 85.5% of cases, with degenerative heart valves most common in CAIE (30.9%) and hemodialysis in HAIE (60%). Chronic kidney disease was more common in HAIE than in CAIE (65.1%)(p = 0.001). Elevated levels of C-reactive protein, prokalsitonin, troponin, and N-terminus pro-B-type natriuretic peptide at admission correlated with increased 28-day mortality. Blood culture positivity was greater in HAIE (75%), with coagulase-negative staphylococci as the leading pathogen (38%). Aortic and mitral valve involvement higher in CAIE compared to HAIE (p = 0.047 and p = 0.039,respectively). Complications such as valve insufficiency (64.1%), neurological events (33.6%), heart failure (27.5%), brain embolism (22.9%), and arrhythmia (8.4%) were associated with 28-day mortality. Conclusions Cases of HAIE, particularly non-nosocomial are rising with hemodialysis being a significant risk factor. This trend requires specific planning for empirical treatment in affected patients. Infectious Diseases endocarditis healthcare-associated community-acquired infections complications mortality Background Infective endocarditis (IE) refers to the infection of the endocardial surface of the heart 1 . It most commonly affects the heart valves (either native or prosthetic) but can also involve the mural endocardium and intracardiac devices such as permanent pacemakers and defibrillators 1 , 2 . Despite advances in diagnostic and therapeutic approaches, IE continues to be associated with high mortality and morbidity rates 2 . The annual incidence of IE ranges from 3 to 10 cases per 100,000 individuals 3 . Mortality rates in hospitalized patients can reach up to 30% 3–5 . Rapid identification of high-risk patients can lead to adjustments in management, such as urgent surgery, and improve prognosis 6 – 8 . The epidemiology of IE has changed due to factors such as a decline in rheumatic heart disease, an aging population, increased comorbidities, more frequent healthcare exposures, widespread use of prosthetic valves and intracardiac devices, intravenous drug use, and the growing prevalence of hemodialysis 3 , 9 . These changes have led to a shift toward healthcare-associated infective endocarditis (HAIE). Historically, Streptococcus viridans was the most common causative agent; however, Staphylococcus aureus has become more prevalent in recent years 3 , 9 . Previously, rheumatic heart disease and congenital heart disease were primary risk factors for IE, but their prevalence has decreased over time. Currently, degenerative valvular disease has emerged as the most significant predisposing factor for IE 3 , 6 , 9 . IE is classified based on the site of infection acquisition into community-acquired IE (CAIE) and healthcare-associated IE (HAIE). HAIE was further classified into nosocomial and non-nosocomial HAIE 10 . This classification highlights the importance of identifying the source of infection to guide diagnosis and treatment. The rise in invasive diagnostic and therapeutic procedures has increased the incidence of HAIE, with studies reporting that HAIE cases account for up to 51% of all IE cases 11 . Notably, there has been a decline in nosocomial HAIE and an increase in non-nosocomial HAIE 11 . Given the higher mortality and morbidity rates associated with HAIE, the site of infection acquisition should be carefully considered when initiating empirical therapy 7 . The primary aim of this study is to evaluate the demographic characteristics, clinical, laboratory, and imaging findings, identified causative microorganisms, and antibiotic susceptibilities in patients with HAIE and CAIE. Additionally, the secondary aim is to identify risk factors associated with 28-day mortality. The findings are intended to provide updated guidance for the treatment of both HAIE and CAIE. Methods Study Population and Design This retrospective cohort study evaluated 131 patients diagnosed with infective endocarditis (IE) at Kocaeli University Hospital between December 2016 and December 2022. Patients over 18 years with possible or definite IE, as defined by the European Society of Cardiology (ESC) diagnostic criteria were included. Patients not managed by the Department of Infectious Diseases and Clinical Microbiology were excluded. Data Collection We collected patient data from hospital records, including demographics, infection acquisition site (CAIE or HAIE) predisposing factors, comorbidities, symptoms, laboratory values, microbiological results, complications, treatment modalities, and clinical outcomes. Definitions Patients were divided into two groups based on the site of infection acquisition: community-acquired IE (CAIE) and healthcare-associated IE (HAIE). CAIE was defined as IE with symptoms and signs appearing at the time of hospital admission or within 48 hours of admission. HAIE was further classified into nosocomial and non-nosocomial HAIE. Nosocomial HAIE was defined as IE occurring in a patient whose symptoms and signs compatible with IE started at least 48 hours after hospital admission. Non-nosocomial HAIE was defined as IE diagnosed in a patient within 48 hours of hospital admission or before admission, who had received one of the following healthcare services:1)Intravenous therapy, wound care, specialized nursing care, hemodialysis, or intravenous chemotherapy within the 30 days prior to the onset of IE, 2)Hospitalization for two or more days within the 90 days prior to the onset of IE, 3)Residence in a nursing home or long-term care facility before hospital admission 10 . Infective endocarditis (IE) occurring within six months after the index episode with the same microorganism is defined as relapse, while IE caused by a different microorganism is defined as reinfection. Ethical Approval The study protocol was approved bythe Kocaeli University Faculty of Medicine Clinical Research Ethics Committee with the number GOKAEK-2023/02. Statistical Analysis Statistical analyses were conducted using IBM SPSS 20.0. Normality was assessed via Kolmogorov-Smirnov and Shapiro-Wilk tests. Normally distributed variables were expressed as mean ± standard deviation; non-normal variables as median (25th-75th percentile). Categorical variables were presented as frequencies (percentages). Group comparisons utilized independent sample t-tests for normal distributions and Mann-Whitney U tests for non-normal distributions. Correlations were examined using Pearson or Spearman analyses. Associations between categorical variables were determined via Chi-square analysis. A p-value < 0.05 was considered statistically significant. Results This study included 131 patients diagnosed with IE, where 89 (67.9%) met the criteria for definite IE and 42 (32.1%) for possible IE. Among the patients, 68 (51.9%) were classified as CAIE and 63 (48.1%) as HAIE. Within the HAIE group, 53 (84.1%) cases were categorized as non-nosocomial HAIE. The mean age of patients was 60.48 ± 14.97 years, with 69 (52.7%) being male. No statistically significant differences were observed between CAIE and HAIE groups regarding mean age or gender distribution. Predisposing factors for IE were identified in 112 patients (85.5%), with degenerative heart valve disease (30.9%), prior invasive cardiac procedures (29.4%) being most common in CAIE cases. Hemodialysis was the predominant predisposing factor in HAIE patients (60.3%, p < 0.001), with 84% of hemodialysis patients using venous catheters for vascular access. Among comorbitidies, CKD was significantly more prevalent in HAIE patients compared to CAIE (p = 0.001). While no differences were observed in symptoms between the two groups, the CCI score was significantly higher in HAIE patients(p = 0,001). The demographic and baseline clinical characteristics of the patients are summarized in Table 1. Among patients with CAIE, 58.8% had native valve endocarditis, 26.5% prosthetic valve endocarditis, 4.4% mural endocarditis, and 10.3% cardiac implantable electronic device (CIED)-related endocarditis. In HAIE patients, native valve endocarditis was observed in 46%, prosthetic valve endocarditis in 15.9%, mural endocarditis in 3.2%, CIED-related endocarditis in 6.4%, and hemodialysis catheter-related endocarditis in 28.6% of cases. No statistically significant differences were observed between the two groups regarding the prevalence of native valve, prosthetic valve, mural, or CIED-related endocarditis. Mitral valve involvement was the most common across all IE patients (38.9%), followed by aortic valve (22.9%) and tricuspid valve (5.3%). Multiple valve involvement was observed in 11 patients (8.4%), most commonly affecting the aortic and mitral valves (6.1%). Additionally, only CIED lead tip involvement was detected in nine (6.9%) of the patients and only mural endocardium involvement was detected in five (6.9%) patients. Mitral valve involvement was more frequent in CAIE (47.1%) compared to HAIE (30.2%, p = 0.047), as was aortic valve involvement (30.9% in CAIE vs. 14.3% in HAIE, p = 0.039). Tricuspid valve and mural endocardium involvement showed no significant differences between the groups. Multiple valve involvement was detected in five of the CAIE patients (7.3%) and six of the SBIE patients (9.5%), and multiple valve involvement was found at a similar rate in both groups (p = 0.66) ( Table 2 ) The rate of oscillating vegetation was 74% in CAIE patients and 73% in HAIE patients. The median (interquartile range) vegetation size in CAIE cases was 12 mm (8–17 mm), and in HAIE cases, it was 13 mm (9.7–19.2 mm). No statistical difference was found between the two groups (p = 0.095). The median (interquartile range) value of the estimated embolism risk calculated with the "Embolic Risk (ER) French calculater" for both CAIE and HAIE patients was found to be 1% (1%-2%). No statistical difference was detected between the median estimated embolism risk values ​​of 58 patients who developed embolism and 73 patients who did not develop embolism (p = 0.786). The laboratory findings, including white blood cell(WBC), C-reactive protein(CRP), eritrosit sedimentation rate(ESR) and procalcitonin(PCT) are detailed in Table 3 . At the sixth week, WBC levels were higher in CAIE compared to HAIE patients (p = 0.01). CRP levels were higher in HAIE patients at baseline, first, and sixth weeks (p = 0.006, p = 0.001, p = 0.0013, respectively), while both groups showed a reduction over time. PCT and ESR levels were higher in HAIE patients than CAIE patients at multiple time points, but ESR follow-up values did not show significant differences within groups. At admission, the median troponin level was 14.5 ng/L (range: 0–40) in CAIE patients and 20.5 ng/L (range: 0–115) in HAIE patients, with no significant difference (p > 0.05). The median N-terminal pro B-type natriuretic peptide (NT-proBNP) level was 2970 ng/L (range: 764–8485) in CAIE patients and 13500 ng/L (range: 3938–21562) in HAIE patients, with significantly higher values in HAIE patients at admission and the sixth week (p = 0.001 and p = 0.04, respectively). No significant differences were observed at other time points. Follow-up analyses of troponin and NT-proBNP levels were limited due to insufficient data. Positive blood cultures were identified in 55.2% of CAIE and 75% of HAIE patients, with a significantly higher pathogen detection rate in HAIE cases (p = 0.03). No statistically significant difference was found between the two groups in terms of causative microorganisms ( Table 4 ). Polymicrobial positive blood cultures were similar between groups (p = 0.22). Relapse was observed in five SBIE patients (7.9%), while it was not seen in any CAIE patients. Reinfection occurred in two CAIE patients and one HAIE patient. A total of 35 Coagulase- negative Staphylococci (CoNS) isolates were identified, with methicillin resistance observed in 91.4% of cases. All CoNS isolates were susceptible to vancomycin and linezolid, but teicoplanin resistance was only detected in 4.2% of HAIE cases. Among 17 Staphylococcus aureus isolates, methicillin resistance was slightly higher in HAIE patients (16.7%) compared to CAIE patients (11.1%). No resistance was observed in either group for vancomycin, teicoplanin, linezolid, rifampicin, trimethoprim-sulfamethoxazole, or gentamicin. Resistance to penicillin and ceftriaxone was 28.6%, and resistance to ampicillin was 14.3% in streptococcus species. No resistance to vancomycin or teicoplanin was found, with no significant differences between groups. Eleven enterococcal isolates included one Enterococcus faecium isolate from an HAIE patient, which was resistant to ampicillin and gentamicin but susceptible to vancomycin. Among E. faecalis isolates, 20% from HAIE patients exhibited gentamicin resistance, whereas no resistance was detected in CAIE patients. Both groups showed susceptibility to penicillin, ampicillin, and vancomycin. Gram-negative bacterial isolates were more prevalent in HAIE patients, comprising 72.7% of total isolates. Resistance rates in HAIE isolates were higher for amikacin (33%), extended-spectrum beta-lactamase (ESBL) production (80%), carbapenems (50%), and colistin (16.7%). No gram-negative resistance was reported in CAIE patients. No antifungal resistance was observed in candida species isolated from either group. The most common complications included valvular insufficiency (64.1%), neurological complications (33.6%), and heart failure (27.5%). No significant differences were observed in the overall complication rates between CAIE and HAIE groups ( Table 5 ). Relapse was observed in five HAIE patients (7.9%), while it was not seen in any CAIE patients. Of the patients who experienced relapse, four were undergoing hemodialysis, and it was noted that catheter exchange was not performed during treatment. Reinfection occurred in two CAIE patients and one HAIE patient. Among CAIE patients, 60.3% received only antibiotic therapy, while 39.7% underwent both antibiotic therapy and surgical intervention. In SBIE patients, 57% received only antibiotic therapy, 27% underwent both antibiotic therapy and surgical intervention, and 16% required antibiotic therapy with dialysis catheter exchange or removal. There was no statistically significant difference in the rate of surgical intervention between the two groups (p = 0.17). The 28-day mortality rate was 11.5%, with no significant difference between CAIE (8.8%) and HAIE (14.3%, p = 0.48). Predictors of 28-day mortality in all IE patients included elevated CRP (p = 0.02), PCT (p = 0.009), NT-proBNP (p = 0.001), and sepsis at admission (p = 0.006). Valve insufficiency (p = 0.02) and neurological complications (p = 0.04) were also associated with higher mortality. The characteristics of all patients with and without 28-day short-term mortality are summarized in Table 6. Discussion In recent years, the epidemiology of IE has shifted, with an increasing proportion of HAIE cases, driven by aging populations and the rising use of invasive procedures, highlighting the need for further investigation of this specific patient group 6 , 9 . This study represents the first comparison of HAIE and CAIE patients in our country. We aimed to identify demographic, clinical, and microbiological differences between these two groups. Additionally, we evaluated risk factors associated with short-term mortality, specifically 28-day mortality, among all IE patients. Our study found a high proportion of HAIE cases (48.1%), with 40.5% being non-nosocomial HAIE. This highlights the growing importance of non-nosocomial HAIE in clinical practice. Similarly, Toyoda et al. reported 51% HAIE cases, with a rise in non-nosocomial HAIE from 32.1–35.9% over 15 years, while nosocomial HAIE declined slightly. 11 . Habib et al. found a lower HAIE rate (32.96%), with nosocomial HAIE comprising 20% of cases 8 . All studies emphasize the increasing role of non-nosocomial HAIE, driven by invasive procedures and chronic conditions, highlighting the need for improved prevention strategies. The average age of IE patients in our cohort was higher than in previous studies conducted in our country, likely due to the increasing elderly population and the prevalence of degenerative valve disease 5 , 7 , 12 – 14 . Studies conducted in developed countries have shown that the average age of IE patients has been increasing over time 8 , 11 , 15 , 16 . When analyzed separately, the average age was similar in CAIE and HAIE groups, compatible with findings from China 17 , while a study in Spain reported HAIE patients to be older than CAIE patients 18 . In our study, the high prevalence of degenerative heart disease, a known predisposing factor for infective endocarditis, was notable in both CAIE (30.9%) and HAIE (46%) groups. Additionally, the most striking finding was the significantly higher proportion of patients undergoing hemodialysis(HD) in the HAIE group (60.3%). Historically, rheumatic heart disease (RHD) was the main cause of IE, but recent studies show that degenerative valve disease is now the leading risk factor 19 , 20 . In our study, similarly, rheumatic heart disease (RHD) was observed in only 4.6% of all patients, reflecting trends in developed countries. Although RHD was rare in both groups, it was relatively more frequent in CAIE patients. Conversely, studies from China have reported a higher prevalence of RHD among HAIE patients 17 . HD increases the risk of IE due to factors such as bacteremia, valve calcification, and immunosuppression 7 , 21 . Previous studies have shown that HD patients face a more than 70-fold increased risk of IE compared to the general population 22 . In our cohort, all HD patients were classified under HAIE, with 84% utilizing central venous catheters for vascular access. This finding aligns with evidence that central venous catheters carry a higher IE risk than arteriovenous fistulas 22 .The prominence of dialysis as a predisposing factor in our study is likely influenced by the tertiary care hospital, which treats a high volume of dialysis patients. These findings highlight the importance of optimizing vascular access strategies and infection prevention measures in dialysis patients to mitigate the risk of IE. Comorbidity rates were higher in HAIE patients than in CAIE patients, though not statistically significant, likely due to the tertiary care nature of our hospital. Our study highlights that CKD is an important risk factor for IE, particularly in HAIE cases. CKD was particularly notable in HAIE patients(65.1%), reflecting the high proportion of dialysis patients. Previous studies have shown CKD is present in 29.4% of IE patients, with 18.4% undergoing hemodialysis 11 . Other comorbidities showed similar distributions between the groups in our study. Similarly, studies from China and Spain comparing SBIE and CAIE patients found comparable rates of DM and malignancy in both groups 17 , 18 . However, a study conducted in Japan demonstrated a higher prevalence of malignancy in SBIE patients, while DM rates were similar between the two groups 23 . The CCI, a measure of long-term mortality risk 24 , was higher in HAIE patients compared to CAIE patients in our study (6 vs. 4, respectively). This aligns with previous research which reported higher CCI scores in HAIE patients 17 , 18 , 25 . The elevated CCI scores in our cohort reflect the high proportion of HAIE cases and the prevalence of comorbidities, as nearly all patients had at least one underlying condition. These findings highlight the greater burden of comorbidities in HAIE patients, emphasizing the need for tailored management strategies in this high-risk group. In our study, the blood culture positivity rate was 64.6%, which is lower, likely due to the high rate of prior antibiotic use. However, the pathogen detection rate was higher in HAIE patients compared to CAIE patients. Although there was no statistically significant difference between HAIE and CAIE patients in terms of the identified microorganisms, CoNS was found to be relatively higher in HAIE patients (38%) compared to CAIE patients (19%). CoNS were identified as a causative agent at a higher rate that was found to be higher compared to reported data in the literatüre 8 , 12 , 15 , 26 , 27 . In the study by Habib et al., the blood culture positivity rate in IE patients was 79%, with the most common pathogens being S. aureus (31.4%), Enterococcus spp. (15.8%), and CoNS (12.7%) 8 . Similarly, in our study streptococcal species were relatively more common in CAIE (10%) than in HAIE (1.5%), though these differences were not statistically significant. In the study by Fernandez-Hidalgo et al., culture negativity rates were similar between patients with HAIE and CAIE. However, S. aureus , Enterococcus , and CoNS species were more frequent in HAIE, while streptococcal species were more common in CAIE 18 . The study by Kiriyama et al. reported comparable culture negativity rates between HAIE and CAIE patients. While S. aureus and CoNS species were higher in HAIE compared to CAIE, enterococcal species were found to be similar between the two groups 23 . In the study by Habib et al., methicillin resistance was found in 48% of CoNS strains and 22.9% of S. aureus strains in IE patients 8 , 12 . In the study by Şimşek et al., methicillin resistance was 63% in CoNS strains and 9.2% in S. aureus strains 12 . Fernandez-Hidalgo et al. reported higher methicillin resistance in S. aureus strains from HAIE patients (28.6%) compared to CAIE patients (7%) 18 . In the study by Kiriyama et al., the methicillin resistance rate in S. aureus strains was reported to be significantly higher in HAIE patients (47%) compared to CAIE patients (0.09%) 23 .In our study, methicillin resistance in CoNS strains was over 90% in both HAIE and CAIE patients, while methicillin resistance in S. aureus (MRSA) was 11.1% in CAIE patients and 16.7% in HAIE patients. Globally, the prevalence of MRSA-related IE is increasing 6 . In our country, antibiotic usage is higher compared to European countries 28 . Additionally, in our study, the rate of antibiotic use before the diagnosis of IE was also notably high. Our study supports the rising trend of MRSA-related IE in our country as well. Moreover, resistance rates can vary across different regions. These trends and regional differences should be considered when determining empirical treatment for IE patients. The high resistance rate in CAIE patients highlights the importance of considering methicillin resistance when selecting empirical therapy. Another noteworthy finding in our study is catheter-related IE in hemodialysis patients, with no involvement of other heart valves. Hemodialysis-associated endocarditis was only found in HAIE patients (%28.6), with no significant difference in native, prosthetic valve, mural, or CIED-associated endocarditis between the groups. With the increase in hemodialysis treatment practices today, there is a growing trend in hemodialysis-associated endocarditis cases. A review of the literature reveals that cases of catheter-associated endocarditis without valve involvement have been reported 29 . It is thought that catheter-related endocarditis without valve involvement requires separate evaluation, and there is a gap in the literature on this topic. In our study, both mitral and aortic valve involvement was higher in CAIE patients compared to HAIE, likely due to the higher proportion of hemodialysis catheter-associated endocarditis in HAIE patients. Fernandez-Hidalgo et al. reported higher aortic valve involvement in CAIE compared to HAIE, while mitral valve involvement was more common in HAIE 18 . Kiriyama et al. found higher mitral valve involvement in CAIE, with similar aortic valve involvement in both groups 23 . Yang et al. also reported higher aortic valve involvement in CAIE, with similar mitral valve involvement in both groups 17 . In our study, no significant differences were observed in complication rates between CAIE and HAIE patients, consistent with previous studies 17 , 18 , 23 . However, notably, relapse occurred exclusively in HAIE patients, 80% of whom were on hemodialysis, and 75% had not undergone catheter or fistula exchange. This underscores the importance of dialysis catheter management in reducing relapse risk. Previous studies have reported relapse and reinfection rates of up to 5.9% in IE patients 26 . The 28-day, in-hospital, and 6-month mortality rates for infective endocarditis (IE) were 12%, 25%, and 34%, respectively, consistent with previous findings 6 , 8 , 16 , 26 . In Turkey, studies indicate that in-hospital mortality rates range between 15% and 33% 4,5,13,14,30 In our study, while HAIE patients showed higher in-hospital mortality compared to CAIE patients, the difference was not statistically significant, likely due to the small sample size. Studies have reported varying trends, with some indicating higher mortality in HAIE patients 18 , while others found no significant differences between HAIE and CAIE 17 . Few studies in the literature have focused on mortality within the first four weeks of IE diagnosis. Previous studies on 30-day mortality in IE patients, such as those by Ahtela et al. and Baddour et al., found mortality rates ranging from 11.4–16.3% 26,31 . Ahtela et al., showed that 30-day mortality increased with age and the Charlson Comorbidity Index (CCI), although no gender-related differences in mortality risk were found 31 . Key factors associated with 28-day mortality in our study included elevated biomarkers such as CRP, PCT, troponin, and NT-proBNP, as well as the presence of sepsis at admission and complications like valve insufficiency, arrhythmias, and cerebral embolism. In our study, WBC levels decreased over time in both CAIE and HAIE patients. CRP levels were higher in HAIE patients before treatment but decreased significantly in both groups after the first week. ESR levels were higher in HAIE patients initially and during the first two weeks, with minimal decline afterward. This likely due to the longer half-life of fibrinogen 32 . A Finnish study demonstrated that patients with uncomplicated recovery had a more rapid decline in WBC and CRP levels compared to those with complications or mortality, with persistent CRP elevations indicating potential treatment failure 33 . Elevated CRP and PCT levels at admission were significantly associated with 28-day mortality in our cohort, corroborating studies identifying PCT as a robust predictor of clinical deterioration, with levels exceeding 0.5 ng/mL indicating poor outcomes 34 . Cardiac biomarkers also proved valuable in risk stratification. In our study, baseline and post-treatment NT-proBNP levels were higher in HAIE patients. Elevated NT-proBNP and troponin levels at admission were strongly associated with mortality, consistent with prior studies linking these markers to poor prognosis in IE 35 . These findings underscore the importance of CRP, PCT, NT-proBNP, and troponin as prognostic tools in IE management. Further research is warranted to establish standardized thresholds and improve predictive accuracy for diverse patient populations, aiding in early identification of high-risk individuals and optimizing therapeutic strategies. In our study, no significant differences were observed in causative microorganisms between survivors and non-survivors. However, it is noteworthy that no mortality was observed in patients with enterococcal IE. Previous studies have found S. aureus to be associated with higher mortality, whereas Streptococcus species have been linked to lower mortality rates 8 , 12 . A Spanish study further reported that S. aureus , Enterococcus spp., Gram-negative bacteria, and fungal pathogens were more prevalent in patients with in-hospital mortality, whereas Streptococcus species were more common in survivors 36 . In our study, complications such as valve insufficiency, neurological complications, and cerebral embolism were more frequent among patients who experienced 28-day mortality, consistent with previous research highlighting the role of cerebral embolism, paravalvular abscess, and heart failure in in-hospital mortality 8 , 12 . Notably, heart failure was not identified as a significant risk factor for 28-day mortality in our cohort, possibly due to the lack of distinction between congestive and non-congestive forms. Less common complications, including arrhythmia and myocardial infarction, were also associated with higher mortality in our study 17 , 37 . These findings underscore the importance of recognizing and managing complications to improve outcomes in IE patients. Our study found no statistically significant difference in 28-day mortality between patients who underwent surgical treatment and those who did not, although mortality was relatively higher in non-surgical patients. Studies have shown that surgical treatment is a protective factor against mortality in IE patients 12 , 27 , 38 . The lack of statistical significance in our study may be attributed to the small sample size. Conclusion As life expectancy increases, along with the rise in invasive diagnostic and therapeutic procedures, the epidemiology and microbiological characteristics of IE are undergoing significant changes. The growing prevalence of non-nosocomial HAIE underscores the need for more targeted and individualized empirical treatment strategies for this patient group. Despite advances in medical care, the persistently high mortality and morbidity associated with IE remain a challenge. This underscores the urgent need for comprehensive, large-scale prospective studies to elucidate the changing dynamics of IE. Such studies should focus on identifying emerging risk factors and developing targeted prevention and management protocols to improve patient outcomes effectively. Declarations Acknowledgments I would like to express my sincere gratitude to my thesis advisor, Birsen Mutlu, for her invaluable guidance and support throughout my academic journey. I am especially grateful to Emel Azak, who stood by me at every stage of my thesis preparation. Her knowledge, experience, and endless patience have been a true source of guidance. Her unwavering support, dedication, and encouragement were the greatest inspiration in completing this work. 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Int J Infect Dis 30:106–114. 10.1016/j.ijid.2014.11.007 Gursul NC, Vardar I, Demirdal T, Gursul E, Ural S, Yesil M (2016) Clinical and microbiological findings of infective endocarditis. J Infect Developing Ctries 10(05):478–487. 10.3855/jidc.7516 Acibuca A, Yilmaz M, Okar S et al (2021) An epidemiological study to define the recent clinical characteristics and outcomes of infective endocarditis in southern Turkey. Cardiovasc J Afr 32(4):188–192. 10.5830/CVJA-2021-009 Murdoch DR, Corey GR, Hoen B et al (2009) Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis–Prospective Cohort Study. Arch Intern Med 169(5):463–473. 10.1001/archinternmed.2008.603 Jensen AD, Østergaard L, Petersen JK et al (2023) Temporal trends of mortality in patients with infective endocarditis: a nationwide study. 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PLoS ONE 11(11):e0166764. 10.1371/journal.pone.0166764 Khan MZ, Zahid S, Ullah W, Khan MU (2021) Trends in Infective Endocarditis in End-stage Renal Disease Patients (From National Inpatient Sample [2006–2017]). Am J Cardiol 147:149–150. 10.1016/j.amjcard.2021.02.029 Chaudry MS, Carlson N, Gislason GH et al (2017) Risk of Infective Endocarditis in Patients with End Stage Renal Disease. Clin J Am Soc Nephrol 12(11):1814. 10.2215/CJN.02320317 Kiriyama H, Daimon M, Nakanishi K et al (2020) Comparison Between Healthcare-Associated and Community-Acquired Infective Endocarditis at Tertiary Care Hospitals in Japan. Circ J 84(4):670–676. 10.1253/circj.CJ-19-0887 Roffman CE, Buchanan J, Allison GT (2016) Charlson Comorbidities Index. J Physiotherapy 62(3):171. 10.1016/j.jphys.2016.05.008 Wu KS, Lee SSJ, Tsai HC et al (2011) Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome. BMC Infect Dis 11(1):221. 10.1186/1471-2334-11-221 Baddour LM, Shafiyi A, Lahr BD et al (2021) A Contemporary Population-Based Profile of Infective Endocarditis Using the Expanded Rochester Epidemiology Project. Mayo Clinic Proceedings . ;96(6):1438–1445. 10.1016/j.mayocp.2020.08.044 Vahabi A, Gül F, Garakhanova S, Sipahi H, Sipahi OR (2019) Pooled analysis of 1270 infective endocarditis cases in Turkey. J Infect Developing Ctries 13(02):93–100. 10.3855/jidc.10056 Kılıç E, Yenilmez F (2019) Türkiye ve AB Ülkelerinde Antibiyotik Kullanımı, Antibiyotik Direnci ve Dış Ticaret Dengesi Üzerine Bir Değerlendirme / An Evaluation on Antibiotic Use, Antibiotic Resistance and Trade Balance in Turkey and EU Countries. Eskişehir Türk Dünyası Uygulama ve Araştırma . Merkezi Halk Sağlığı Dergisi 4:45–54. 10.35232/estudamhsd.503456 Sousa M, Martins J, Barreto S et al (2020) A rare complication of a hemodialysis tunneled catheter: Case report of a superior vena cava and right atrium candida endocarditis. IDCases 20:e00768. 10.1016/j.idcr.2020.e00768 Zencirkiran Agus H, Kahraman S, Arslan C et al (2019) Characterization, epidemiological profile and risk factors for clinical outcome of infective endocarditis from a tertiary care centre in Turkey. Infect Dis 51(10):738–744. 10.1080/23744235.2019.1646431 Ahtela E, Oksi J, Porela P, Ekström T, Rautava P, Kytö V (2019) Trends in occurrence and 30-day mortality of infective endocarditis in adults: population-based registry study in Finland. BMJ Open 9(4):e026811. 10.1136/bmjopen-2018-026811 Litao MKS, Kamat D (2014) Erythrocyte Sedimentation Rate and C-Reactive Protein: How Best to Use Them in Clinical Practice. Pediatr Ann 43(10):417–420. 10.3928/00904481-20140924-10 Heiro M, Helenius H, Sundell J et al (2005) Utility of serum C-reactive protein in assessing the outcome of infective endocarditis. Eur Heart J 26(18):1873–1881. 10.1093/eurheartj/ehi277 Cornelissen CG, Frechen DA, Schreiner K, Marx N, Krüger S (2013) Inflammatory parameters and prediction of prognosis in infective endocarditis. BMC Infect Dis 13(1):272. 10.1186/1471-2334-13-272 Postigo A, Vernooij RWM, Fernández-Avilés F, Martínez- Sellés M (2021) Cardiac troponin and infective endocarditis prognosis: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 10(3):356–366. 10.1093/ehjacc/zuab008 Muñoz P, Kestler M, De Alarcon A et al (2015) Current Epidemiology and Outcome of Infective Endocarditis: A Multicenter, Prospective, Cohort Study. Medicine 94(43):e1816. 10.1097/MD.0000000000001816 Roux V, Salaun E, Tribouilloy C et al (2017) Coronary events complicating infective endocarditis. Heart 103(23):1906–1910. 10.1136/heartjnl-2017-311624 Wei Xbiao, Liu Y, hui, He P, cheng et al (2017) Prognostic value of N-terminal prohormone brain natriuretic peptide for in-hospital and long-term outcomes in patients with infective endocarditis. Eur J Prev Cardiol 24(7):676–684. 10.1177/2047487316686436 Tables Table 1. Clinical Characteristics of Patients CAIE (n=68) HAIE (n=63) Total (n=131) p Age, year (mean ± SD) 61,24±14,58 59,67±15,46 60,48±14,97 0,551 Women, n (%) 28(41,2) 34 (54) 62 (47,3) 0,16 Predisposing factors, n (%) 55 (80,9) 57 (90,5) 112 (85,5) 0,19 Degenerative heart valve 21 (30,9) 29 (46) 50 (38,2) 0,08 History of invasive cardiac procedure 20 (29,4) 22 (34,9) 42 (32,1) 0,62 Hemodialysis 0 (0) 38 (60,3) 38 (29) 0,001 Valve surgery history 18 (26,5) 12 (19) 30 (22,9) 0,42 CIED 9 (13,2) 7 (11,1) 16 (12,2) 0,91 MVP 11 (16,2) 5 (7,9) 16 (12,2) 0,24 BAV 7 (10,3) 2 (3,2) 9 (6,9) - History of IE 2 (2,9) 6 (9,5) 8 (6,1) - Rheumatic heart valve 5 (7,4) 1 (1,6) 6 (4,6) - Intermittent blood transfusion 0 (0) 4 (6,3) 4 (3,5) - IVDU 1 (100) 0 (0) 1 (0,8) - Comorbities, n (%) 60 (88,2) 62 (98,4) 122 (93,1) 0,051 Hypertansion 46 (67,6) 41 (65,1) 87 (66,4) 0,9 Coronary heart disease 21 (30,9) 26 (41,3) 47 (35,9) 0,29 Chronic kidney disease 6 (8,8) 41 (65,1) 47 (35,9) 0,001 Hyperlipidemia 21 (31,3) 24 (38,1) 45 (34,6) 0,53 Diabetes mellitus 21 (30,9) 23 (36,5) 44 (33,6) 0,62 Cerebrovascular disease 16 (23,5) 12 (19) 28 (21,4) 0,68 Heart failure 8 (11,8) 13 (21) 21 (16,2) 0,23 Malignancy 6 (8,8) 12 (19) 18 (13,7) 0,14 COPD 9 (13,2) 6 (9,5) 15 (11,5) 0,69 Asthma 4 (6) 2 (3,2) 6 (4,6) - Symptoms, n (%) Fatigue 59 (89,4) 62 (98,4) 121 (93,8) 0,79 Chills-rigors 41(62,1) 45 (71,4) 86 (66,7) 0,35 Fever 43 (65,2) 41 (65,1) 84 (65,1) 1,00 Charlson comorbidity index, median(IQR) 4(2-5) 6(4-8) 4,7(2-6) 0,001 Abbreviations: CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, MVP: mitral valve proplapse, IVDU: intravenous drug user, BAV: bicuspid aortic valve, CIED: cardiac impantable device, COPD: chronic obstructive pulmonary disease Table 2. Heart Valve Involvement in Infective Endocarditis Patients CAIE (n=68) HAIE (n=63) Total (n=131) p Involved valve, n (%) Mitral 32 (47,1) 19 (30,2) 51 (38,8) 0,047 Aort 21 (30,9) 9 (14,3) 30 (22,9) 0,039 Aort and Mitral 4 (5,9) 4 (6,3) 8 (6,1) 1,000 Tricuspid 2 (2,9) 5 (7,9) 7 (5,3) 0,260 Mitral and Tricuspid 1 (1,5) 2 (3,2) 3 (2,3) 0,608 Abbreviations: IE: infektif endokarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis Table 3. The laboratory results of the Infective Endocarditis Laboratory Parameters Time CAIE Median (Interquartile Range) HAIE Median(Interquartile Range) p WBC (/µl) Baseline 9230 (7276.5-12041) 8915 (6344-12065.25) 0.44 Week 1 8352.5 (6359.5-11032.75) 7872.5 (5979.25-9808.25) 0.31 Week 2 7863 (6035.25-11046.25) 7346 (5384-9700) 0.11 Week 4 7319 (5040-10710) 6600 (5292-8830) 0.54 Week 6 7700 (3588-20300) 6085 (4790-8090) 0.01 CRP (mg/l) Baseline 67 (15-116) 89.5 (38-184.7) 0.006 Week 1 28 (10-55.7) 63.5 (18-109.5) 0.001 Week 2 32.5 (13-62) 48 (14-131) 0.137 Week 4 41.5 (13.5-61.25) 39 (9.5-86) 0.73 Week 6 18 (6-52) 36 (11-92) 0.013 PCT (ng/ml) Baseline 0.17 (0.05-1.4) 1.2 (0.2-7.7) 0.016 Week 1 0.23 (0.09-0.88) 1.03 (0.2-6.1) 0.016 Week 2 0.18 (0.13-0.37) 0.42 (0.15-1.36) 0.024 Week 4 0.16 (0.06-0.68) 0.43 (0.15-0.8) 0.08 Week 6 0.15 (0.02-0.3) 0.6 (0.14-1.3) 0.005 ESR (mm/h) Baseline 38 (21.5-54) 64 (35-81) 0.001 Week 1 35 (19-52) 63 (33-81) 0.001 Week 2 42 (28.5-58.5) 60 (40-84) 0.001 Week 4 41 (26.5-62) 48 (33-73.5) 0.18 Week 6 40.5 (20.75-61.5) 49 (22.5-81.25) 0.14 Abbreviations: IE: infektif endokarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, WBC: white blood cell, , ESR: eritrosit sedimentation rate, PCT: procalcitonin Table 4. Pathogenic Microorganisms in Infective Endocarditis Patients CAIE (n=68) HAIE (n=63) Total (n=131) Positive Blood Culture, n(%) 37 (55,2) 45 (75) 82 (64,6) Pathogenic Microorganism, n(%) CoNS 13 (19) 24 (38) 37 (28) Staphylococcus aureus 10 (14,7) 7 (11) 17 (13) Streptococcus species 7 (10) 1 (1,5) 8 (6,2) Enterococcus species 5 (7,3) 6 (9,5) 11 (8,4) Gram-negative bacteria 3 (4,4) 8 (12,6) 11 (8,4) Fungal pathogens 1 (1,4) 3 (4,7) 4 (3) Corynebacterium striatum 0 (0) 1 (1,5) 1 (0,8) Unidentified 30 (44,8) 15 (25) 45 (35,4) Abbreviations: CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, CoNS: coagulase-negative staphylococci Table 5. Complications and Mortality in Infective Endocarditis Patients CAIE (n=68) HAIE (n=63) Tota (n=131) p Complication, n(%) 60 (88,2) 50 (79,4) 110 (84) 0,25 Valve failure 44 (64,7) 40 (63,5) 84 (64,1) 1,00 Neurological complication 23 (33,8) 21 (33,3) 44 (33,6) 1,00 Heart failure 18 (26,5) 18 (28,6) 36 (27,5) 0,94 Brain embolism 18 (26,5) 12 (19) 30 (22,9) 0,42 Left ventricular dysfunction 20 (29,4) 12 (19) 32 (24,4) 0,24 Peripheral vascular complications 12 (17,6) 16 (25,4) 28 (21,4) 0,38 Arrhythmia 8 (11,8) 3 (4,8) 11 (8,4) 0,25 Pulmonary embolism 4 (5,9) 5 (7,9) 9 (6,9) - Paravalvular abscess 2 (2,9) 3 (4,8) 5 (3,8) - Chord rupture 2 (2,9) 3 (4,8) 5 (3,8) - Myocardial infarction 1 (1,5) 2 (3,2) 3 (2,3) - Mortality Duration, n(%) 28 days 6 (8,8) 9 (14,3) 15 (11,5) 0,48 6 months 18 (26,5) 27 (42,9) 45 (34,4) 0,074 In-hospital mortality 15(22,1) 18 (28,6) 33 (25,2) 0,5 Abbreviations; İE: Infective Endocarditis, CIAE: Community-Acquired Infective Endocarditis, HAIE: Healthcare-Associated Infective Endocarditis Tablo 6. Characteristics of Patients with and without Short-Term (28-day) Mortality Characteristic No Mortality (n=116) Mortality Present (n=15) p Age (years), mean (±SD) 60,54±14,8 60±16,7 0,89 >65 years, n (%) 46 (39,7) 8 (46,7) 0,8 Male gender, n (%) 61 (52,6) 8 (53,3) 1 HAIE, n (%) 54 (46,6) 9 (60) 0,2 Predisposing factors 98 (84,5) 14 (93,3) 0,69 Comorbidities 108 (93,1) 14 (93,3) 1 Charlson Comorbity İndex 4 (2-6) 4(2-8) 0,73 Laboratory values on hospital admission WBC(/µl) 9.070 (7.000-11.330) 11.997 (6.178-13.444) 0,23 CRP (mg/dl) 71 (23-120) 149 (70-22) 0,02 PCT (ng/ml) 0,29 (0,08-1,9) 7,8 (7-16) 0,009 ESR (mm/h) 49,3±33,5 51,2±25,1 0,83 Troponin (ng/l) 13 (0-33,7) 125 (9,5-655) 0,008 NT-proBNP (ng/l) 4430 (1130-10700) 16100 (12580-20700) 0,001 D-dimer 1,8 (1,3-6,6) 3,3 (1,9-11) 0,08 Sepsis at admission, n (%) 4 (3,4) 4 (26,7) 0,006 Endocarditis Type Native valve, n (%) 62 (53,4) 7 (46,7) 0,621 Prosthetic valve, n (%) 23 (19,8) 5 (33,3) 0,312 CIED, n (%) 11 (9,5) 0 (0) - Mural, n (%) 4 (3,4) 1 (6,7) 0,461 HD related 16 (13,8) 2 (13,3) 1,00 Valve involvement Aortic, n (%) 25 (23,1) 5 (38,5) Mitral, n (%) 46 (42,6) 5 (38,5) 0,51 Aortic and Mitral, n (%) 8 (7,4) 0 (0) Only lead tip, n (%) 9 (8,3) 0 (0) Multiple valve involvement, n (%) 12 (10,3) 2 (13,3) 0,66 Vegetation size (mm) 12 (9-18,7) 15 (8-20) 0,57 Mobile vegetation, n (%) 85 (98,8) 10 (100) - ER French Calculater, (%) 1 (1-2) 2 (1-3) - Complications 95 (81,9) 15 (100) 0,12 Heart failure, n (%) 30 (25,9) 6 (40) 0,35 Valve insufficiency, n (%) 70 (60,3) 14 (93,3) 0,02 Arrhythmia, n (%) 7 (6) 4 (26,7) 0,02 Neurological complication, n (%) 35 (30,2) 9 (60) 0,04 Brain embolism, n (%) 22 (19) 8 (53,3) 0,006 Pulmonary embolism, n (%) 8 (6,9) 1 (6,7) 1 Peripheral vascular complications, n (%) 26 (22,4) 2 (13,3) 0,54 Paravalvular abscess, n (%) 4 (3,4) 1 (6,7) - Myocardial infarction, n (%) 0 (0) 3 (20) - Paravalvular abscess 4 (3,4) 1 (6,7) - Chord rupture 5 (4,3) 0 (0) - Definite IE, n (%) 75 (64,7) 14 (93,3) 0,036 Positive blood culture, n (%) 70 (61,9) 12 (85,7) 0,13 Polymicrobial growth, n (%) 10 (90,9) 1 (9,1) 1 Microorganisms S.aureus , n (%) 12 (10,4) 5 (35,7) CoNS, n (%) 36 (31) 4 (28,6) Streptococcus spp., n (%) 7 (6,1) 1 (7,1) 0,051 Enterococcus spp., n (%) 12 (10,3) 0 (0) Gram-negative, n (%) 6 (5,1) 3 (20) Surgical procedure, n (%) 42 (36,2) 2 (13,3) 0,14 Abbreviations: IE: infective endocarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, WBC: white blood cell, ESR: eritrosit sedimentation rate, PCT: Procalcitonin, NT-proBNP: N-terminal pro B-type natriuretic peptide, CIED : cardiac impantable device HD: Hemodialysis, ER French Calculater: embolic risk French calculater, CoNS: coagulase-negative staphylococci Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6135558","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":422715184,"identity":"3c992256-48d9-4a57-95dc-926b63e16980","order_by":0,"name":"sonay arslan","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-8443-9026","institution":"bulanık devlet hastanesi","correspondingAuthor":true,"prefix":"","firstName":"sonay","middleName":"","lastName":"arslan","suffix":""},{"id":422715185,"identity":"e443479b-6b3c-4c00-b8d1-016ca9ebf71e","order_by":1,"name":"birsen mutlu","email":"","orcid":"https://orcid.org/0000-0001-6273-9802","institution":"kocaeli üniversitesi","correspondingAuthor":false,"prefix":"","firstName":"birsen","middleName":"","lastName":"mutlu","suffix":""},{"id":422715186,"identity":"f6719779-238f-4b7a-b762-92a8fca293ec","order_by":2,"name":"müge toygar deniz","email":"","orcid":"https://orcid.org/0000-0002-6946-2727","institution":"kocaeli üniversitesi","correspondingAuthor":false,"prefix":"","firstName":"müge","middleName":"toygar","lastName":"deniz","suffix":""}],"badges":[],"createdAt":"2025-03-01 15:39:29","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6135558/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6135558/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77658395,"identity":"308ee008-1919-4dce-a369-478a9e799e3e","added_by":"auto","created_at":"2025-03-04 04:06:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1375768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6135558/v1/6810a6fc-04a8-4afa-8690-40dd6dc6c5a7.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEpidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eInfective endocarditis (IE) refers to the infection of the endocardial surface of the heart\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. It most commonly affects the heart valves (either native or prosthetic) but can also involve the mural endocardium and intracardiac devices such as permanent pacemakers and defibrillators\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Despite advances in diagnostic and therapeutic approaches, IE continues to be associated with high mortality and morbidity rates\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The annual incidence of IE ranges from 3 to 10 cases per 100,000 individuals\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Mortality rates in hospitalized patients can reach up to 30% \u003csup\u003e3\u0026ndash;5\u003c/sup\u003e. Rapid identification of high-risk patients can lead to adjustments in management, such as urgent surgery, and improve prognosis\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe epidemiology of IE has changed due to factors such as a decline in rheumatic heart disease, an aging population, increased comorbidities, more frequent healthcare exposures, widespread use of prosthetic valves and intracardiac devices, intravenous drug use, and the growing prevalence of hemodialysis\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. These changes have led to a shift toward healthcare-associated infective endocarditis (HAIE). Historically, \u003cem\u003eStreptococcus viridans\u003c/em\u003e was the most common causative agent; however, \u003cem\u003eStaphylococcus aureus\u003c/em\u003e has become more prevalent in recent years\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Previously, rheumatic heart disease and congenital heart disease were primary risk factors for IE, but their prevalence has decreased over time. Currently, degenerative valvular disease has emerged as the most significant predisposing factor for IE\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIE is classified based on the site of infection acquisition into community-acquired IE (CAIE) and healthcare-associated IE (HAIE). HAIE was further classified into nosocomial and non-nosocomial HAIE\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. This classification highlights the importance of identifying the source of infection to guide diagnosis and treatment. The rise in invasive diagnostic and therapeutic procedures has increased the incidence of HAIE, with studies reporting that HAIE cases account for up to 51% of all IE cases\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Notably, there has been a decline in nosocomial HAIE and an increase in non-nosocomial HAIE \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Given the higher mortality and morbidity rates associated with HAIE, the site of infection acquisition should be carefully considered when initiating empirical therapy\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The primary aim of this study is to evaluate the demographic characteristics, clinical, laboratory, and imaging findings, identified causative microorganisms, and antibiotic susceptibilities in patients with HAIE and CAIE. Additionally, the secondary aim is to identify risk factors associated with 28-day mortality. The findings are intended to provide updated guidance for the treatment of both HAIE and CAIE.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population and Design\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study evaluated 131 patients diagnosed with infective endocarditis (IE) at Kocaeli University Hospital between December 2016 and December 2022. Patients over 18 years with possible or definite IE, as defined by the European Society of Cardiology (ESC) diagnostic criteria were included. Patients not managed by the Department of Infectious Diseases and Clinical Microbiology were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eWe collected patient data from hospital records, including demographics, infection acquisition site (CAIE or HAIE) predisposing factors, comorbidities, symptoms, laboratory values, microbiological results, complications, treatment modalities, and clinical outcomes.\u003c/p\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003ePatients were divided into two groups based on the site of infection acquisition: community-acquired IE (CAIE) and healthcare-associated IE (HAIE). CAIE was defined as IE with symptoms and signs appearing at the time of hospital admission or within 48 hours of admission. HAIE was further classified into nosocomial and non-nosocomial HAIE. Nosocomial HAIE was defined as IE occurring in a patient whose symptoms and signs compatible with IE started at least 48 hours after hospital admission. Non-nosocomial HAIE was defined as IE diagnosed in a patient within 48 hours of hospital admission or before admission, who had received one of the following healthcare services:1)Intravenous therapy, wound care, specialized nursing care, hemodialysis, or intravenous chemotherapy within the 30 days prior to the onset of IE, 2)Hospitalization for two or more days within the 90 days prior to the onset of IE, 3)Residence in a nursing home or long-term care facility before hospital admission \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInfective endocarditis (IE) occurring within six months after the index episode with the same microorganism is defined as relapse, while IE caused by a different microorganism is defined as reinfection.\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e The study protocol was approved bythe Kocaeli University Faculty of Medicine Clinical Research Ethics Committee with the number GOKAEK-2023/02.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using IBM SPSS 20.0. Normality was assessed via Kolmogorov-Smirnov and Shapiro-Wilk tests. Normally distributed variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; non-normal variables as median (25th-75th percentile). Categorical variables were presented as frequencies (percentages). Group comparisons utilized independent sample t-tests for normal distributions and Mann-Whitney U tests for non-normal distributions. Correlations were examined using Pearson or Spearman analyses. Associations between categorical variables were determined via Chi-square analysis. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 131 patients diagnosed with IE, where 89 (67.9%) met the criteria for definite IE and 42 (32.1%) for possible IE. Among the patients, 68 (51.9%) were classified as CAIE and 63 (48.1%) as HAIE. Within the HAIE group, 53 (84.1%) cases were categorized as non-nosocomial HAIE. The mean age of patients was 60.48\u0026thinsp;\u0026plusmn;\u0026thinsp;14.97 years, with 69 (52.7%) being male. No statistically significant differences were observed between CAIE and HAIE groups regarding mean age or gender distribution.\u003c/p\u003e \u003cp\u003ePredisposing factors for IE were identified in 112 patients (85.5%), with degenerative heart valve disease (30.9%), prior invasive cardiac procedures (29.4%) being most common in CAIE cases. Hemodialysis was the predominant predisposing factor in HAIE patients (60.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 84% of hemodialysis patients using venous catheters for vascular access. Among comorbitidies, CKD was significantly more prevalent in HAIE patients compared to CAIE (p\u0026thinsp;=\u0026thinsp;0.001). While no differences were observed in symptoms between the two groups, the CCI score was significantly higher in HAIE patients(p\u0026thinsp;=\u0026thinsp;0,001). The demographic and baseline clinical characteristics of the patients are summarized in \u003cb\u003eTable\u0026nbsp;1.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmong patients with CAIE, 58.8% had native valve endocarditis, 26.5% prosthetic valve endocarditis, 4.4% mural endocarditis, and 10.3% cardiac implantable electronic device (CIED)-related endocarditis. In HAIE patients, native valve endocarditis was observed in 46%, prosthetic valve endocarditis in 15.9%, mural endocarditis in 3.2%, CIED-related endocarditis in 6.4%, and hemodialysis catheter-related endocarditis in 28.6% of cases. No statistically significant differences were observed between the two groups regarding the prevalence of native valve, prosthetic valve, mural, or CIED-related endocarditis.\u003c/p\u003e \u003cp\u003eMitral valve involvement was the most common across all IE patients (38.9%), followed by aortic valve (22.9%) and tricuspid valve (5.3%). Multiple valve involvement was observed in 11 patients (8.4%), most commonly affecting the aortic and mitral valves (6.1%). Additionally, only CIED lead tip involvement was detected in nine (6.9%) of the patients and only mural endocardium involvement was detected in five (6.9%) patients. Mitral valve involvement was more frequent in CAIE (47.1%) compared to HAIE (30.2%, p\u0026thinsp;=\u0026thinsp;0.047), as was aortic valve involvement (30.9% in CAIE vs. 14.3% in HAIE, p\u0026thinsp;=\u0026thinsp;0.039). Tricuspid valve and mural endocardium involvement showed no significant differences between the groups. Multiple valve involvement was detected in five of the CAIE patients (7.3%) and six of the SBIE patients (9.5%), and multiple valve involvement was found at a similar rate in both groups (p\u0026thinsp;=\u0026thinsp;0.66) (\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e)\u003c/p\u003e \u003cp\u003eThe rate of oscillating vegetation was 74% in CAIE patients and 73% in HAIE patients. The median (interquartile range) vegetation size in CAIE cases was 12 mm (8\u0026ndash;17 mm), and in HAIE cases, it was 13 mm (9.7\u0026ndash;19.2 mm). No statistical difference was found between the two groups (p\u0026thinsp;=\u0026thinsp;0.095). The median (interquartile range) value of the estimated embolism risk calculated with the \"Embolic Risk (ER) French calculater\" for both CAIE and HAIE patients was found to be 1% (1%-2%). No statistical difference was detected between the median estimated embolism risk values ​​of 58 patients who developed embolism and 73 patients who did not develop embolism (p\u0026thinsp;=\u0026thinsp;0.786).\u003c/p\u003e \u003cp\u003eThe laboratory findings, including white blood cell(WBC), C-reactive protein(CRP), eritrosit sedimentation rate(ESR) and procalcitonin(PCT) are detailed in \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e. At the sixth week, WBC levels were higher in CAIE compared to HAIE patients (p\u0026thinsp;=\u0026thinsp;0.01). CRP levels were higher in HAIE patients at baseline, first, and sixth weeks (p\u0026thinsp;=\u0026thinsp;0.006, p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.0013, respectively), while both groups showed a reduction over time. PCT and ESR levels were higher in HAIE patients than CAIE patients at multiple time points, but ESR follow-up values did not show significant differences within groups. At admission, the median troponin level was 14.5 ng/L (range: 0\u0026ndash;40) in CAIE patients and 20.5 ng/L (range: 0\u0026ndash;115) in HAIE patients, with no significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median N-terminal pro B-type natriuretic peptide (NT-proBNP) level was 2970 ng/L (range: 764\u0026ndash;8485) in CAIE patients and 13500 ng/L (range: 3938\u0026ndash;21562) in HAIE patients, with significantly higher values in HAIE patients at admission and the sixth week (p\u0026thinsp;=\u0026thinsp;0.001 and p\u0026thinsp;=\u0026thinsp;0.04, respectively). No significant differences were observed at other time points. Follow-up analyses of troponin and NT-proBNP levels were limited due to insufficient data.\u003c/p\u003e \u003cp\u003ePositive blood cultures were identified in 55.2% of CAIE and 75% of HAIE patients, with a significantly higher pathogen detection rate in HAIE cases (p\u0026thinsp;=\u0026thinsp;0.03). No statistically significant difference was found between the two groups in terms of causative microorganisms (\u003cb\u003eTable\u0026nbsp;4\u003c/b\u003e). Polymicrobial positive blood cultures were similar between groups (p\u0026thinsp;=\u0026thinsp;0.22). Relapse was observed in five SBIE patients (7.9%), while it was not seen in any CAIE patients. Reinfection occurred in two CAIE patients and one HAIE patient.\u003c/p\u003e \u003cp\u003eA total of 35 \u003cem\u003eCoagulase- negative Staphylococci\u003c/em\u003e (CoNS) isolates were identified, with methicillin resistance observed in 91.4% of cases. All CoNS isolates were susceptible to vancomycin and linezolid, but teicoplanin resistance was only detected in 4.2% of HAIE cases. Among 17 \u003cem\u003eStaphylococcus aureus\u003c/em\u003e isolates, methicillin resistance was slightly higher in HAIE patients (16.7%) compared to CAIE patients (11.1%). No resistance was observed in either group for vancomycin, teicoplanin, linezolid, rifampicin, trimethoprim-sulfamethoxazole, or gentamicin. Resistance to penicillin and ceftriaxone was 28.6%, and resistance to ampicillin was 14.3% in streptococcus species. No resistance to vancomycin or teicoplanin was found, with no significant differences between groups. Eleven enterococcal isolates included one \u003cem\u003eEnterococcus faecium\u003c/em\u003e isolate from an HAIE patient, which was resistant to ampicillin and gentamicin but susceptible to vancomycin. Among \u003cem\u003eE. faecalis\u003c/em\u003e isolates, 20% from HAIE patients exhibited gentamicin resistance, whereas no resistance was detected in CAIE patients. Both groups showed susceptibility to penicillin, ampicillin, and vancomycin. Gram-negative bacterial isolates were more prevalent in HAIE patients, comprising 72.7% of total isolates. Resistance rates in HAIE isolates were higher for amikacin (33%), extended-spectrum beta-lactamase (ESBL) production (80%), carbapenems (50%), and colistin (16.7%). No gram-negative resistance was reported in CAIE patients. No antifungal resistance was observed in candida species isolated from either group.\u003c/p\u003e \u003cp\u003eThe most common complications included valvular insufficiency (64.1%), neurological complications (33.6%), and heart failure (27.5%). No significant differences were observed in the overall complication rates between CAIE and HAIE groups (\u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e). Relapse was observed in five HAIE patients (7.9%), while it was not seen in any CAIE patients. Of the patients who experienced relapse, four were undergoing hemodialysis, and it was noted that catheter exchange was not performed during treatment. Reinfection occurred in two CAIE patients and one HAIE patient.\u003c/p\u003e \u003cp\u003eAmong CAIE patients, 60.3% received only antibiotic therapy, while 39.7% underwent both antibiotic therapy and surgical intervention. In SBIE patients, 57% received only antibiotic therapy, 27% underwent both antibiotic therapy and surgical intervention, and 16% required antibiotic therapy with dialysis catheter exchange or removal. There was no statistically significant difference in the rate of surgical intervention between the two groups (p\u0026thinsp;=\u0026thinsp;0.17).\u003c/p\u003e \u003cp\u003eThe 28-day mortality rate was 11.5%, with no significant difference between CAIE (8.8%) and HAIE (14.3%, p\u0026thinsp;=\u0026thinsp;0.48). Predictors of 28-day mortality in all IE patients included elevated CRP (p\u0026thinsp;=\u0026thinsp;0.02), PCT (p\u0026thinsp;=\u0026thinsp;0.009), NT-proBNP (p\u0026thinsp;=\u0026thinsp;0.001), and sepsis at admission (p\u0026thinsp;=\u0026thinsp;0.006). Valve insufficiency (p\u0026thinsp;=\u0026thinsp;0.02) and neurological complications (p\u0026thinsp;=\u0026thinsp;0.04) were also associated with higher mortality. The characteristics of all patients with and without 28-day short-term mortality are summarized in \u003cb\u003eTable\u0026nbsp;6.\u003c/b\u003e\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eIn recent years, the epidemiology of IE has shifted, with an increasing proportion of HAIE cases, driven by aging populations and the rising use of invasive procedures, highlighting the need for further investigation of this specific patient group\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. This study represents the first comparison of HAIE and CAIE patients in our country. We aimed to identify demographic, clinical, and microbiological differences between these two groups. Additionally, we evaluated risk factors associated with short-term mortality, specifically 28-day mortality, among all IE patients.\u003c/p\u003e \u003cp\u003eOur study found a high proportion of HAIE cases (48.1%), with 40.5% being non-nosocomial HAIE. This highlights the growing importance of non-nosocomial HAIE in clinical practice. Similarly, Toyoda et al. reported 51% HAIE cases, with a rise in non-nosocomial HAIE from 32.1\u0026ndash;35.9% over 15 years, while nosocomial HAIE declined slightly.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Habib et al. found a lower HAIE rate (32.96%), with nosocomial HAIE comprising 20% of cases\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. All studies emphasize the increasing role of non-nosocomial HAIE, driven by invasive procedures and chronic conditions, highlighting the need for improved prevention strategies.\u003c/p\u003e \u003cp\u003eThe average age of IE patients in our cohort was higher than in previous studies conducted in our country, likely due to the increasing elderly population and the prevalence of degenerative valve disease\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Studies conducted in developed countries have shown that the average age of IE patients has been increasing over time\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. When analyzed separately, the average age was similar in CAIE and HAIE groups, compatible with findings from China\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, while a study in Spain reported HAIE patients to be older than CAIE patients\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, the high prevalence of degenerative heart disease, a known predisposing factor for infective endocarditis, was notable in both CAIE (30.9%) and HAIE (46%) groups. Additionally, the most striking finding was the significantly higher proportion of patients undergoing hemodialysis(HD) in the HAIE group (60.3%). Historically, rheumatic heart disease (RHD) was the main cause of IE, but recent studies show that degenerative valve disease is now the leading risk factor\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In our study, similarly, rheumatic heart disease (RHD) was observed in only 4.6% of all patients, reflecting trends in developed countries. Although RHD was rare in both groups, it was relatively more frequent in CAIE patients. Conversely, studies from China have reported a higher prevalence of RHD among HAIE patients\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. HD increases the risk of IE due to factors such as bacteremia, valve calcification, and immunosuppression\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Previous studies have shown that HD patients face a more than 70-fold increased risk of IE compared to the general population \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. In our cohort, all HD patients were classified under HAIE, with 84% utilizing central venous catheters for vascular access. This finding aligns with evidence that central venous catheters carry a higher IE risk than arteriovenous fistulas\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.The prominence of dialysis as a predisposing factor in our study is likely influenced by the tertiary care hospital, which treats a high volume of dialysis patients. These findings highlight the importance of optimizing vascular access strategies and infection prevention measures in dialysis patients to mitigate the risk of IE.\u003c/p\u003e \u003cp\u003eComorbidity rates were higher in HAIE patients than in CAIE patients, though not statistically significant, likely due to the tertiary care nature of our hospital. Our study highlights that CKD is an important risk factor for IE, particularly in HAIE cases. CKD was particularly notable in HAIE patients(65.1%), reflecting the high proportion of dialysis patients. Previous studies have shown CKD is present in 29.4% of IE patients, with 18.4% undergoing hemodialysis\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Other comorbidities showed similar distributions between the groups in our study. Similarly, studies from China and Spain comparing SBIE and CAIE patients found comparable rates of DM and malignancy in both groups\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. However, a study conducted in Japan demonstrated a higher prevalence of malignancy in SBIE patients, while DM rates were similar between the two groups\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. The CCI, a measure of long-term mortality risk\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, was higher in HAIE patients compared to CAIE patients in our study (6 vs. 4, respectively). This aligns with previous research which reported higher CCI scores in HAIE patients\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. The elevated CCI scores in our cohort reflect the high proportion of HAIE cases and the prevalence of comorbidities, as nearly all patients had at least one underlying condition. These findings highlight the greater burden of comorbidities in HAIE patients, emphasizing the need for tailored management strategies in this high-risk group.\u003c/p\u003e \u003cp\u003eIn our study, the blood culture positivity rate was 64.6%, which is lower, likely due to the high rate of prior antibiotic use. However, the pathogen detection rate was higher in HAIE patients compared to CAIE patients. Although there was no statistically significant difference between HAIE and CAIE patients in terms of the identified microorganisms, CoNS was found to be relatively higher in HAIE patients (38%) compared to CAIE patients (19%). CoNS were identified as a causative agent at a higher rate that was found to be higher compared to reported data in the literat\u0026uuml;re\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In the study by Habib et al., the blood culture positivity rate in IE patients was 79%, with the most common pathogens being \u003cem\u003eS. aureus\u003c/em\u003e (31.4%), Enterococcus spp. (15.8%), and CoNS (12.7%)\u003csup\u003e8\u003c/sup\u003e. Similarly, in our study streptococcal species were relatively more common in CAIE (10%) than in HAIE (1.5%), though these differences were not statistically significant. In the study by Fernandez-Hidalgo et al., culture negativity rates were similar between patients with HAIE and CAIE. However, \u003cem\u003eS. aureus\u003c/em\u003e, \u003cem\u003eEnterococcus\u003c/em\u003e, and CoNS species were more frequent in HAIE, while streptococcal species were more common in CAIE\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. The study by Kiriyama et al. reported comparable culture negativity rates between HAIE and CAIE patients. While \u003cem\u003eS. aureus\u003c/em\u003e and CoNS species were higher in HAIE compared to CAIE, enterococcal species were found to be similar between the two groups\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In the study by Habib et al., methicillin resistance was found in 48% of CoNS strains and 22.9% of \u003cem\u003eS. aureus\u003c/em\u003e strains in IE patients\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In the study by Şimşek et al., methicillin resistance was 63% in CoNS strains and 9.2% in \u003cem\u003eS. aureus\u003c/em\u003e strains\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Fernandez-Hidalgo et al. reported higher methicillin resistance in \u003cem\u003eS. aureus\u003c/em\u003e strains from HAIE patients (28.6%) compared to CAIE patients (7%)\u003csup\u003e18\u003c/sup\u003e. In the study by Kiriyama et al., the methicillin resistance rate in \u003cem\u003eS. aureus\u003c/em\u003e strains was reported to be significantly higher in HAIE patients (47%) compared to CAIE patients (0.09%)\u003csup\u003e23\u003c/sup\u003e.In our study, methicillin resistance in CoNS strains was over 90% in both HAIE and CAIE patients, while methicillin resistance in \u003cem\u003eS. aureus\u003c/em\u003e (MRSA) was 11.1% in CAIE patients and 16.7% in HAIE patients. Globally, the prevalence of MRSA-related IE is increasing\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In our country, antibiotic usage is higher compared to European countries\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Additionally, in our study, the rate of antibiotic use before the diagnosis of IE was also notably high. Our study supports the rising trend of MRSA-related IE in our country as well. Moreover, resistance rates can vary across different regions. These trends and regional differences should be considered when determining empirical treatment for IE patients. The high resistance rate in CAIE patients highlights the importance of considering methicillin resistance when selecting empirical therapy.\u003c/p\u003e \u003cp\u003eAnother noteworthy finding in our study is catheter-related IE in hemodialysis patients, with no involvement of other heart valves. Hemodialysis-associated endocarditis was only found in HAIE patients (%28.6), with no significant difference in native, prosthetic valve, mural, or CIED-associated endocarditis between the groups. With the increase in hemodialysis treatment practices today, there is a growing trend in hemodialysis-associated endocarditis cases. A review of the literature reveals that cases of catheter-associated endocarditis without valve involvement have been reported\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. It is thought that catheter-related endocarditis without valve involvement requires separate evaluation, and there is a gap in the literature on this topic. In our study, both mitral and aortic valve involvement was higher in CAIE patients compared to HAIE, likely due to the higher proportion of hemodialysis catheter-associated endocarditis in HAIE patients. Fernandez-Hidalgo et al. reported higher aortic valve involvement in CAIE compared to HAIE, while mitral valve involvement was more common in HAIE\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Kiriyama et al. found higher mitral valve involvement in CAIE, with similar aortic valve involvement in both groups\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Yang et al. also reported higher aortic valve involvement in CAIE, with similar mitral valve involvement in both groups\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, no significant differences were observed in complication rates between CAIE and HAIE patients, consistent with previous studies\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, notably, relapse occurred exclusively in HAIE patients, 80% of whom were on hemodialysis, and 75% had not undergone catheter or fistula exchange. This underscores the importance of dialysis catheter management in reducing relapse risk. Previous studies have reported relapse and reinfection rates of up to 5.9% in IE patients\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe 28-day, in-hospital, and 6-month mortality rates for infective endocarditis (IE) were 12%, 25%, and 34%, respectively, consistent with previous findings \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. In Turkey, studies indicate that in-hospital mortality rates range between 15% and 33%\u003csup\u003e4,5,13,14,30\u003c/sup\u003e In our study, while HAIE patients showed higher in-hospital mortality compared to CAIE patients, the difference was not statistically significant, likely due to the small sample size. Studies have reported varying trends, with some indicating higher mortality in HAIE patients\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, while others found no significant differences between HAIE and CAIE\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Few studies in the literature have focused on mortality within the first four weeks of IE diagnosis. Previous studies on 30-day mortality in IE patients, such as those by Ahtela et al. and Baddour et al., found mortality rates ranging from 11.4\u0026ndash;16.3%\u003csup\u003e26,31\u003c/sup\u003e. Ahtela et al., showed that 30-day mortality increased with age and the Charlson Comorbidity Index (CCI), although no gender-related differences in mortality risk were found\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eKey factors associated with 28-day mortality in our study included elevated biomarkers such as CRP, PCT, troponin, and NT-proBNP, as well as the presence of sepsis at admission and complications like valve insufficiency, arrhythmias, and cerebral embolism. In our study, WBC levels decreased over time in both CAIE and HAIE patients. CRP levels were higher in HAIE patients before treatment but decreased significantly in both groups after the first week. ESR levels were higher in HAIE patients initially and during the first two weeks, with minimal decline afterward. This likely due to the longer half-life of fibrinogen\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. A Finnish study demonstrated that patients with uncomplicated recovery had a more rapid decline in WBC and CRP levels compared to those with complications or mortality, with persistent CRP elevations indicating potential treatment failure\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Elevated CRP and PCT levels at admission were significantly associated with 28-day mortality in our cohort, corroborating studies identifying PCT as a robust predictor of clinical deterioration, with levels exceeding 0.5 ng/mL indicating poor outcomes\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Cardiac biomarkers also proved valuable in risk stratification. In our study, baseline and post-treatment NT-proBNP levels were higher in HAIE patients. Elevated NT-proBNP and troponin levels at admission were strongly associated with mortality, consistent with prior studies linking these markers to poor prognosis in IE\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. These findings underscore the importance of CRP, PCT, NT-proBNP, and troponin as prognostic tools in IE management. Further research is warranted to establish standardized thresholds and improve predictive accuracy for diverse patient populations, aiding in early identification of high-risk individuals and optimizing therapeutic strategies. In our study, no significant differences were observed in causative microorganisms between survivors and non-survivors. However, it is noteworthy that no mortality was observed in patients with enterococcal IE. Previous studies have found \u003cem\u003eS. aureus\u003c/em\u003e to be associated with higher mortality, whereas Streptococcus species have been linked to lower mortality rates\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. A Spanish study further reported that \u003cem\u003eS. aureus\u003c/em\u003e, Enterococcus spp., Gram-negative bacteria, and fungal pathogens were more prevalent in patients with in-hospital mortality, whereas Streptococcus species were more common in survivors \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, complications such as valve insufficiency, neurological complications, and cerebral embolism were more frequent among patients who experienced 28-day mortality, consistent with previous research highlighting the role of cerebral embolism, paravalvular abscess, and heart failure in in-hospital mortality\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Notably, heart failure was not identified as a significant risk factor for 28-day mortality in our cohort, possibly due to the lack of distinction between congestive and non-congestive forms. Less common complications, including arrhythmia and myocardial infarction, were also associated with higher mortality in our study\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. These findings underscore the importance of recognizing and managing complications to improve outcomes in IE patients. Our study found no statistically significant difference in 28-day mortality between patients who underwent surgical treatment and those who did not, although mortality was relatively higher in non-surgical patients. Studies have shown that surgical treatment is a protective factor against mortality in IE patients\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. The lack of statistical significance in our study may be attributed to the small sample size.\u003c/p\u003e \u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eAs life expectancy increases, along with the rise in invasive diagnostic and therapeutic procedures, the epidemiology and microbiological characteristics of IE are undergoing significant changes. The growing prevalence of non-nosocomial HAIE underscores the need for more targeted and individualized empirical treatment strategies for this patient group.\u003c/p\u003e \u003cp\u003eDespite advances in medical care, the persistently high mortality and morbidity associated with IE remain a challenge. This underscores the urgent need for comprehensive, large-scale prospective studies to elucidate the changing dynamics of IE. Such studies should focus on identifying emerging risk factors and developing targeted prevention and management protocols to improve patient outcomes effectively.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my sincere gratitude to my thesis advisor, Birsen Mutlu, for her invaluable guidance and support throughout my academic journey. I am especially grateful to Emel Azak, who stood by me at every stage of my thesis preparation. Her knowledge, experience, and endless patience have been a true source of guidance. Her unwavering support, dedication, and encouragement were the greatest inspiration in completing this work. Additionally, I extend my heartfelt appreciation to M\u0026uuml;ge Toygar Deniz for her valuable assistance during the article preparation process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBennett JE, Dolin R, Blaser MJ (eds) (2020) \u003cem\u003eMandell\u003c/em\u003e, Douglas, and Bennett\u0026rsquo;s Principles and Practice of Infectious Diseases. Ninth edition. 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Heart 103(23):1906\u0026ndash;1910. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/heartjnl-2017-311624\u003c/span\u003e\u003cspan address=\"10.1136/heartjnl-2017-311624\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei Xbiao, Liu Y, hui, He P, cheng et al (2017) Prognostic value of N-terminal prohormone brain natriuretic peptide for in-hospital and long-term outcomes in patients with infective endocarditis. Eur J Prev Cardiol 24(7):676\u0026ndash;684. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2047487316686436\u003c/span\u003e\u003cspan address=\"10.1177/2047487316686436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eTable 1. Clinical Characteristics of Patients\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"0%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eCAIE\u003c/p\u003e\n \u003cp\u003e(n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eHAIE\u003c/p\u003e\n \u003cp\u003e(n=63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, year (mean\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e61,24\u0026plusmn;14,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e59,67\u0026plusmn;15,46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e60,48\u0026plusmn;14,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e28(41,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e34 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e62 (47,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredisposing factors, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55 (80,9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57 (90,5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e112 (85,5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eDegenerative heart valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21 (30,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e29 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e50 (38,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHistory of invasive cardiac procedure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e20 (29,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e22 (34,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e42 (32,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e38 (60,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e38 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eValve surgery history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e18 (26,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e30 (22,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCIED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9 (13,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7 (11,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16 (12,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eMVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e11 (16,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5 (7,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16 (12,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eBAV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7 (10,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2 (3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9 (6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHistory of IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 (9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8 (6,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eRheumatic heart valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5 (7,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1 (1,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 (4,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eIntermittent blood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4 (6,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4 (3,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eIVDU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1 (0,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbities,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60 (88,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e62 (98,4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e122 (93,1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,051\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHypertansion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e46 (67,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e41 (65,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e87 (66,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21 (30,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e26 (41,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e47 (35,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 \u0026nbsp; (8,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e41 (65,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e47 (35,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21 (31,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e24 (38,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e45 (34,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21 (30,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e23 (36,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e44 (33,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCerebrovascular disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16 (23,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e28 (21,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8 \u0026nbsp; (11,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e13 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21 (16,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eMalignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 \u0026nbsp; (8,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e18 (13,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9 \u0026nbsp; (13,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 \u0026nbsp;(9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e15 (11,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0,69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4 \u0026nbsp; \u0026nbsp;(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2 \u0026nbsp;(3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6 (4,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms, n (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e59 (89,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e62 (98,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e121 (93,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eChills-rigors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e41(62,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e45 (71,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e86 (66,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e43 (65,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e41 (65,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e84 (65,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson comorbidity index, median(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4(2-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6(4-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4,7(2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, MVP: mitral valve proplapse, IVDU: intravenous drug user, BAV: bicuspid aortic valve, CIED: cardiac impantable device, COPD: chronic obstructive pulmonary disease\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHeart Valve Involvement in Infective Endocarditis Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eCAIE\u003c/p\u003e\n \u003cp\u003e(n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eHAIE\u003c/p\u003e\n \u003cp\u003e(n=63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=131)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvolved valve, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMitral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e32 (47,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e19 (30,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e51 (38,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e21 (30,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9 (14,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e30 (22,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAort and Mitral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (5,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (6,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e8 (6,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e1,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eTricuspid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (7,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e7 (5,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0,260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMitral and Tricuspid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3 (2,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0,608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e IE: infektif endokarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;The laboratory results of the Infective Endocarditis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAIE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (Interquartile Range)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAIE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian(Interquartile Range)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBC (/\u0026micro;l)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e9230 (7276.5-12041)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e8915 (6344-12065.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e8352.5 (6359.5-11032.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7872.5 (5979.25-9808.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7863 (6035.25-11046.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7346 (5384-9700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7319 (5040-10710)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e6600 (5292-8830)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7700 (3588-20300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e6085 (4790-8090)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP (mg/l)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e67 (15-116)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e89.5 (38-184.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e28 (10-55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e63.5 (18-109.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e32.5 (13-62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e48 (14-131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e41.5 (13.5-61.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e39 (9.5-86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e18 (6-52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e36 (11-92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCT (ng/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.17 (0.05-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1.2 (0.2-7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.23 (0.09-0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1.03 (0.2-6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.18 (0.13-0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.42 (0.15-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.16 (0.06-0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.43 (0.15-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.15 (0.02-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.6 (0.14-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eESR \u0026nbsp;(mm/h)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e38 (21.5-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e64 (35-81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e35 (19-52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e63 (33-81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e42 (28.5-58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e60 (40-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e41 (26.5-62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e48 (33-73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eWeek 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e40.5 (20.75-61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e49 (22.5-81.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e IE: infektif endokarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, WBC: white blood cell, , ESR: eritrosit sedimentation rate, PCT: procalcitonin\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 562px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePathogenic Microorganisms in Infective Endocarditis Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eCAIE\u003c/p\u003e\n \u003cp\u003e(n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eHAIE\u003c/p\u003e\n \u003cp\u003e(n=63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=131)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Blood Culture, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e37 (55,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45 (75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e82 (64,6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathogenic Microorganism, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCoNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e13 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e37 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e10 (14,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eStreptococcus species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e7 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (6,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEnterococcus species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5 (7,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6 (9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (8,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGram-negative bacteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (4,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (12,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (8,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eFungal pathogens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1 (1,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (4,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eCorynebacterium striatum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUnidentified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e30 (44,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e45 (35,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 562px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, CoNS:\u003cem\u003ecoagulase-negative staphylococci\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5. Complications and Mortality in Infective Endocarditis Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eCAIE\u003c/p\u003e\n \u003cp\u003e(n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eHAIE\u003c/p\u003e\n \u003cp\u003e(n=63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTota\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=131)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60 (88,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50 (79,4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e110 (84)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eValve failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e44 (64,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e40 (63,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e84 (64,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eNeurological complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e23 (33,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e21 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e44 (33,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18 (26,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e18 (28,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e36 (27,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eBrain embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18 (26,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e30 (22,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eLeft ventricular dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e20 (29,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e32 (24,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003ePeripheral vascular complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e12 (17,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e16 (25,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e28 (21,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eArrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e8 (11,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3 (4,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e11 (8,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003ePulmonary embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e4 (5,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e5 (7,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e9 (6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eParavalvular abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3 (4,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e5 (3,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eChord rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3 (4,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e5 (3,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eMyocardial infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2 (3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3 (2,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality Duration, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e28 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e6 (8,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e9 (14,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e15 (11,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18 (26,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e27 (42,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e45 (34,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,074\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e15(22,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e18 (28,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e33 (25,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eAbbreviations; İE: Infective Endocarditis, CIAE: Community-Acquired Infective Endocarditis, HAIE: Healthcare-Associated Infective Endocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTablo 6. Characteristics of Patients with and without Short-Term (28-day) Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Mortality (n=116)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality Present (n=15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eAge (years), mean (\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e60,54\u0026plusmn;14,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e60\u0026plusmn;16,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026gt;65 years, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e46 (39,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e8 (46,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMale gender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e61 (52,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e8 (53,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eHAIE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e54 (46,6)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e9 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePredisposing factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e98 (84,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14 (93,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e108 (93,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14 (93,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eCharlson Comorbity İndex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e4(2-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eLaboratory values on hospital admission\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eWBC(/\u0026micro;l)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e9.070 (7.000-11.330)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e11.997 (6.178-13.444)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eCRP (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e71 (23-120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e149 (70-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePCT (ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0,29 (0,08-1,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7,8 (7-16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eESR (mm/h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e49,3\u0026plusmn;33,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e51,2\u0026plusmn;25,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eTroponin (ng/l)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e13 (0-33,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e125 (9,5-655)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNT-proBNP (ng/l)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4430 (1130-10700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e16100 (12580-20700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1,8 (1,3-6,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3,3 (1,9-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eSepsis at admission, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (3,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e4 (26,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eEndocarditis Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNative valve, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e62 (53,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7 (46,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eProsthetic valve, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e23 (19,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eCIED, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11 (9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMural, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (3,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 (6,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eHD related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e16 (13,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2 (13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eValve involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eAortic, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e25 (23,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5 (38,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMitral, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e46 (42,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5 (38,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eAortic and Mitral, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e8 (7,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eOnly lead tip, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e9 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMultiple valve involvement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (10,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2 (13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eVegetation size (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (9-18,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e15 (8-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMobile vegetation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;85 (98,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e10 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eER French Calculater, (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (1-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e95 (81,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e15 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eHeart failure, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e30 (25,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e6 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eValve insufficiency, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e70 (60,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14 (93,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eArrhythmia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e4 (26,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNeurological complication, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e35 (30,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e9 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eBrain embolism, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e22 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e8 (53,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePulmonary embolism, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e8 (6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 (6,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePeripheral vascular complications, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e26 (22,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2 (13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eParavalvular abscess, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (3,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 (6,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMyocardial infarction, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eParavalvular abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (3,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 (6,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eChord rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e5 (4,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eDefinite IE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e75 (64,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14 (93,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePositive blood culture, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e70 (61,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e12 (85,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePolymicrobial growth, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (90,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 (9,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMicroorganisms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cem\u003eS.aureus\u003c/em\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (10,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5 (35,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eCoNS, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e36 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e4 (28,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eStreptococcus spp., n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7 (6,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 (7,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eEnterococcus spp., n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (10,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eGram-negative, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e6 (5,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eSurgical procedure, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e42 (36,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2 (13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0,14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e IE: infective endocarditis, CAIE: community-acquired infective endocarditis, HAIE: healthcare-associated infective endocarditis, WBC: white blood cell, ESR: eritrosit sedimentation rate, PCT: Procalcitonin, NT-proBNP: N-terminal pro B-type natriuretic peptide, CIED\u003cem\u003e:\u003c/em\u003e cardiac impantable device HD: Hemodialysis, ER French Calculater: embolic risk French calculater, CoNS: \u003cem\u003ecoagulase-negative staphylococci\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kocaeli Üniversitesi Araştırma ve Uygulama Hastanesi","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"endocarditis, healthcare-associated, community-acquired infections, complications, mortality","lastPublishedDoi":"10.21203/rs.3.rs-6135558/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6135558/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAs the epidemiology of infective endocarditis (IE) changes, updated antimicrobial management assessments are needed. This study aimed to evaluate patients with healthcare-associated (HAIE) and community-acquired infective endocarditis (CAIE), as well as identify risk factors for 28-day mortality. The findings are intended to guide the treatment of both HAIE and CAIE.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of 131 IE patients treated at Kocaeli University Hospital from December 2016 to December 2022. Data were extracted from hospital records, and patients were categorized into HAIE and CAIE groups. Comparative analyses were performed between the groups, and risk factors for 28-day mortality in IE patients were determined.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 131 patients, 51.9% had CAIE and 48.1% had HAIE. Predisposing factors were present in 85.5% of cases, with degenerative heart valves most common in CAIE (30.9%) and hemodialysis in HAIE (60%). Chronic kidney disease was more common in HAIE than in CAIE (65.1%)(p\u0026thinsp;=\u0026thinsp;0.001). Elevated levels of C-reactive protein, prokalsitonin, troponin, and N-terminus pro-B-type natriuretic peptide at admission correlated with increased 28-day mortality. Blood culture positivity was greater in HAIE (75%), with coagulase-negative staphylococci as the leading pathogen (38%). Aortic and mitral valve involvement higher in CAIE compared to HAIE (p\u0026thinsp;=\u0026thinsp;0.047 and p\u0026thinsp;=\u0026thinsp;0.039,respectively). Complications such as valve insufficiency (64.1%), neurological events (33.6%), heart failure (27.5%), brain embolism (22.9%), and arrhythmia (8.4%) were associated with 28-day mortality.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCases of HAIE, particularly non-nosocomial are rising with hemodialysis being a significant risk factor. This trend requires specific planning for empirical treatment in affected patients.\u003c/p\u003e","manuscriptTitle":"Epidemiology Of Community Acquired And Health Care Associated Infective Endocarditis And 28 Day Mortality Risk Factors: A University Hospital Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 03:58:37","doi":"10.21203/rs.3.rs-6135558/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ac44a17-86bc-4a5b-851a-b61dabfa3d1c","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45150752,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2025-03-04T03:58:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-04 03:58:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6135558","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6135558","identity":"rs-6135558","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}