Changes in Clinical and Demographic Features of Infective Endocarditis Over Three Decades: A Tertiary Center Experience

Abstract

Background:
Infective endocarditis (IE) continues to present significant diagnostic and therapeutic challenges, despite advances in healthcare. The epidemiology of IE has shifted globally, but regional data, especially from Türkiye, remains limited.

Objective:
This study aims to examine the clinical and demographic changes in IE over three decades at a tertiary referral center in Türkiye.

Methods:
We conducted a retrospective analysis of 56 patients diagnosed with definite or probable IE between 2001 and 2010, comparing these with previous cohorts from 1978–1992 (n = 88) and 1992–2001 (n = 66). Diagnosis was based on the modified Duke criteria. Clinical, microbiological, echocardiographic, and treatment outcomes were compared, and logistic regression analysis was used to identify predictors of in-hospital mortality.

Results:
The mean age of patients increased significantly over time, from 32.3 years in 1978–1992 to 51.7 years in 2001–2010 (p<0.001). The incidence of rheumatic heart disease declined, while prosthetic valve endocarditis and degenerative valve disease increased. Culture-negative cases decreased, while infections with enterococci and coagulase-negative staphylococci rose. Surgery was required in 46.4% of recent cases. Female gender, presence of S3 or rales on auscultation, and mobile vegetations were significant predictors of higher mortality. Early surgical intervention was associated with improved survival.

Conclusion:
Over the last three decades, IE in Türkiye has shifted from being predominantly associated with rheumatic heart disease to being more related to prosthetic valves and device-associated infections, aligning with trends observed in developed countries. While diagnostic and surgical advances have improved management, mortality remains high, underscoring the importance of early intervention and standardized treatment protocols.