First and Already Sobering Results of the Brandenburg Endocarditis Registry (BER)

Objectives: Endocarditis is continuously increasing. However, an endocarditis registry allowing for further insights into epidemiological data are still absent in Germany. We thus initiated an endocarditis registry on a statewide basis.

Methods: Brandenburg Endocarditis Registry (BER) started in March 2020 after approval from the Ministry of Health and the Ethics Committee. Within 7 months, a total of 47 patients diagnosed with endocarditis were included (70.21% male, mean age: 68 years, BMI: 27, log EuroSCORE (logES): 33.9%).

Result: 36.2% of patients had an implanted heart valve, 36.2% other implants (ICD, PM, event recorder, etc.) and 6.4% dialysis catheters. Within the last 12 months, 65.9% had a relevant infection, 25.5% surgery, 8.5% profound dental treatment, 8.5% recurrent endocarditis, 17% early endocarditis, and 27.7% redo surgery. 29.8% were immunosuppressed, 23.4% were diabetic (DM), and 14.9% alcohol/drug addicted. 57.4% were predisposed to endocarditis. In 63.8% of patients no endocarditis prophylaxis was indicated according to current guidelines, in 4.2% it was indicated and performed, in 19.1% it was indicated but not performed and in 8.5% indicated and not performed sufficiently. Aortic valve 72.3% followed by mitral valve 34% was mostly affected. The most common pathogens were S. aureus 25.5% and E. faecalis 21.3%. Preoperatively, 36.2% suffered from septic embolism, 25.5% acute renal failure, and 51.1% sepsis. Time from symptom onset to diagnosis was 71.6 days and from diagnosis to transfer to cardiac surgery 7 days. Delirium occurred in 14.9%. Early mortality (EM) was 42.5%. Odds ratios (OR) for EM increased significantly in female (OR = 4.15, p = 0.04), immunocompromised patients (OR = 5.94, p = 0.05), preoperative sepsis (OR = 16.47, p < 0.001), and logES (p < 0.001). EM increased nonsignificantly in dialysis patients (OR = 6.89), DM (OR = 2.21), advanced intraoperative spreading (OR = 2.12 perforation/OR = 6.89 shunt/fistula), implanted foreign body (OR = 1.69).

Conclusion: First statewide data already demonstrate a lack of proper endocarditis prophylaxis in almost one third of the patients. The data also show the severity of the disease with an early mortality of over 40%. An average of almost 72 days from diagnosis to treatment in a heart center is highly suspicious of an inadequate response in terms of timely treatment at least in some cases. These first data demonstrate that preventive measures as well as timely treatment in a specialized interdisciplinary setting are of utmost importance to tackle this devastating disease.

Publication History

Article published online:
19 February 2021