The Infectious Tricuspid Endocarditis in ICU: Clinical Features, Management and Outcome

Objectives: Infectious tricuspid endocarditis is known to simply require antibiotherapy and to have good prognosis in most cases. Few studies focused on severe episodes managed in ICU. We aimed to describe clinical and microbiological features, and final outcome of infectious tricuspid endocarditis managed in ICU. Methods: From 1 January 2009 to 31 August 2017, all patients hospitalized in intensive care unit with infectious tricuspid endocarditis were enrolled. Key findings: We collected 15 episodes of infectious tricuspid endocarditis. Median age was of 39 years. Risk factors were: intravenous drug users (n = 10), pace maker (n = 1), vascular device (n = 2), none (n = 2). Median SAPS II, APACHE II and SOFA on admission were 21, 10 and 2 respectively. Organ failures on admission were: acute respiratory failure (n = 10), sepsis (n = 7), coma (n = 1) and acute kidney injury (n = 8). The most frequent causative pathogen was Staphylococcus Aureus. Antibiotherapy failure happened in 10 patients from whom 8 underwent cardiac surgery (53.3%). Most frequent complications were acute kidney injury (n = 14) and withdrawal syndrom. Infectious tricuspid endocarditis relapse on bioprosthesis occurred within 2 intravenous drug users after hospital discharge. Overall in-hospital mortality was 40%. Conclusions: Infectious tricuspid endocarditis in ICU is fitted with poor prognosis and high need to cardiac surgery. Special care should be provided to intravenous drug users to prevent relapse.