Contemporary Clinical Spectrum and Factors Associated with Mortality in Infective Endocarditis: A Multicenter Cohort Study (COSMO-IE)
Journal of Clinical Medicine, cilt.15, sa.19, ss.1-23, 2026 (Hakemli Dergi)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 15 Sayı: 19
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcm15197760
- Dergi Adı: Journal of Clinical Medicine
- Sayfa Sayıları: ss.1-23
- İnönü Üniversitesi Adresli: Evet
Özet
Background: Despite continuous advancements in diagnostic imaging and targeted antimicrobial protocols for infective endocarditis (IE), global epidemiological data show that both
disease burden and incidence continue to rise. This study aimed to evaluate real-world
diagnostic and treatment approaches in accordance with the 2023 European Society of
Cardiology (ESC) IE Guidelines and to identify independent predictors of mortality in
a contemporary patient cohort. Methods: This multicenter, retrospective cohort study
analyzed data from 470 consecutive adult patients diagnosed with IE across 27 academic
reference centers between 1 September 2023 and 1 June 2025. Patients were managed and
adjudicated according to the 2023 ESC diagnostic criteria. Demographic data, clinical characteristics, microbiological profiles, imaging findings, empirical antibiotic therapy patterns,
and clinical outcomes were analyzed. Independent predictors of mortality were determined
using multivariable Cox proportional hazards regression models. Results: The mean age
of the overall study population was 58.08 ± 16.81 years, with a male predominance (60.6%,
n = 285). Staphylococcus aureus was the most frequently isolated pathogen (27.9%), with
a high proportion of methicillin resistance (38.9%). Hospital-acquired IE was identified
in 41.1% of cases. Surgical treatment was performed in 40.6% (n = 191) of the cohort. The
28-day mortality rate was 11.9%, and the overall mortality during follow-up reached 26.4%.
Multivariable Cox regression analysis identified hospital-acquired IE (HR = 2.247; 95% CI:
1.216–4.167; p = 0.010) and the presence of major clinical complications (HR = 4.207; 95% CI:
1.556–11.378; p = 0.005) as the strongest independent predictors of mortality. Conclusions:
Contemporary infective endocarditis is a highly complex and fatal disease characterized
by a prominent healthcare-associated burden and a predominant staphylococcal etiology.
The occurrence of major clinical complications and hospital-acquired infections were the
primary independent predictors of mortality.
Keywords: infective endocarditis; hospital-acquired infection; Staphylococcus aureus; clinical complications