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Acute Endocarditis: Clinical Advances in Diagnosis, Treatment, and Management
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Acute Endocarditis: Clinical Advances in Diagnosis, Treatment, and Management

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Cardiology".

Deadline for manuscript submissions: 20 December 2026 | Viewed by 3831

Editor

Dr. Pasquale Totaro

E-Mail Website
Guest Editor
Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Piazzale Golgi, 1, 20123 Pavia, Italy
Interests: heart transplantation; mechanical supports; mitral valve repair; minimal access surgery; beating heart surgery; patient-prosthesis mismatch following valve surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite advances in diagnostics and therapeutics, acute bacterial endocarditis (ABE) remains one of the most serious challenges in contemporary medicine. The annual incidence of infective endocarditis (IE) is estimated at 3–14 cases per 100,000 subjects/year in developed countries, and has been gradually increasing in recent years. In addition, an increase in mortality has recently been reported, especially in younger patients (aged 25–44 years).

Depending on the pathophysiological effects, surgical treatment is indicated when there is an increased risk of systemic embolization or a severe degree of valve dysfunction with relevant hemodynamic impact.

Recent advances in understanding both the pathophysiological mechanisms and the diagnosis and treatment of bacterial endocarditis have recently led to the publication of new guidelines. However, some aspects of this topic still need to be clarified, especially to facilitate routine decision-making in centers with limited experience due to the small number of cases.

The aim of this Special Issue is to collect information and assessments aimed at prompt application to improve the decision-making process for complex cases at medium-exposure centers.

Dr. Pasquale Totaro
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute endocarditis
  • disease natural history
  • surgical treatment
  • postoperative outcome
  • long term follow up

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Published Papers (2 papers)

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Research

16 pages, 568 KB  
Article
Impact of Adherence to Guideline-Recommended Surgical Timing on Outcomes in Infective Endocarditis
by Daniel Pastor-Wulf, Rafael Gonzalez-Manzanares, Jorge Perea-Armijo, Manuel Crespín-Crespín, José López-Aguilera, Manuel Pan, Juan Carlos Castillo and Manuel Anguita
J. Clin. Med. 2026, 15(14), 5421; https://doi.org/10.3390/jcm15145421 - 10 Jul 2026
Viewed by 531
Abstract
Background: Infective endocarditis (IE) frequently requires surgical intervention; however, the prognostic impact of adherence to guideline-recommended surgical timing remains uncertain. We aimed to evaluate the association between adherence to recommended surgical timing and short- and mid-term mortality in patients with IE undergoing [...] Read more.
Background: Infective endocarditis (IE) frequently requires surgical intervention; however, the prognostic impact of adherence to guideline-recommended surgical timing remains uncertain. We aimed to evaluate the association between adherence to recommended surgical timing and short- and mid-term mortality in patients with IE undergoing surgery. Methods: We conducted a retrospective, observational single-center study including consecutive patients diagnosed with IE and an indication for surgery who underwent surgery during the index hospitalization between January 2000 and April 2021. Patients were classified according to whether surgery was performed within or outside the guideline-recommended time frame based on surgical priority. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included in-hospital complications and one-year mortality. Multivariable logistic and Cox regression analyses were performed to evaluate the association between adherence to recommended surgical timing and outcomes. Results: Among 368 patients with IE, 282 (76.6%) had an indication for surgery; 193 surgically treated patients were included in the analysis. Surgery was performed within the recommended time frame in 148 patients (76.7%) and outside the recommended time frame in 45 (23.3%). Thirty-day mortality was 20.2%, with no significant differences between groups (19.6% vs. 22.2%; OR 0.85, 95% CI 0.38–1.92; p = 0.701). In multivariable analysis, no association was observed between adherence to guideline-recommended surgical timing and 30-day mortality (OR 1.97, 95% CI 0.77–5.04; p = 0.159) or one-year mortality (HR 1.19, 95% CI 0.65–2.17; p = 0.578). Society of Thoracic Surgeons (STS) score remained independently associated with both short- and mid-term mortality. Results were consistent in a sensitivity analysis including patients who died before surgery and in a propensity-score overlap weighting analysis. Conclusions: In this cohort of patients with IE and surgical indication who underwent surgery during the index hospitalization, adherence to guideline-recommended surgical timing was not associated with short- and mid-term mortality. Preoperative risk was independently associated with both short- and mid-term mortality, whereas surgical priority was associated with short-term mortality. Future prospective studies are needed to better characterize the role of surgical timing in the prognosis of IE. Full article
(This article belongs to the Special Issue Acute Endocarditis: Clinical Advances in Diagnosis, Treatment, and Management)
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18 pages, 1330 KB  
Article
Insurance Status and Quality of Care in Infective Endocarditis: A National Analysis of Disparities in Length of Stay, Discharge, and Mortality
by Joseph Hozayen, Omar Hozayen, Benjamin J. Behers, Nicolas Riveros, Anas Abu Jad, Bashar Roumia, Christoph A. Stephenson-Moe, Matthew W. Miller and Karen M. Hamad
J. Clin. Med. 2026, 15(12), 4738; https://doi.org/10.3390/jcm15124738 - 18 Jun 2026
Viewed by 421
Abstract
Background: Infective endocarditis (IE) requires 4–6 weeks of intravenous antimicrobial therapy, and timely transition to outpatient parenteral antimicrobial therapy (OPAT) allows clinically stable patients to complete treatment outside the hospital. Because OPAT requires home infusion services or post-acute facility placement that typically [...] Read more.
Background: Infective endocarditis (IE) requires 4–6 weeks of intravenous antimicrobial therapy, and timely transition to outpatient parenteral antimicrobial therapy (OPAT) allows clinically stable patients to complete treatment outside the hospital. Because OPAT requires home infusion services or post-acute facility placement that typically depend on coverage, insurance status may strongly influence length of stay (LOS); national data on this association in IE remain limited. Methods: We performed a retrospective cross-sectional analysis of the 2016–2019 National Inpatient Sample (NIS) using ICD-10-CM codes I33 and I38 to identify adult IE hospitalizations. Patients were classified as insured (Medicare, Medicaid, or private insurance) or uninsured (self-pay or no charge). Outcomes included mean and prolonged LOS (>14 and >28 days), in-hospital mortality, discharge against medical advice (AMA), and hospitalization costs. Comparisons used chi-square and Student’s t-tests with appropriate NIS survey weighting. Multivariable Gamma regression (LOS, cost) and logistic regression (binary outcomes) were performed, adjusting for age, sex, race/ethnicity, income quartile, injection drug use (IDU), Elixhauser Comorbidity Index, and hospital characteristics, with an insurance × IDU interaction term. Results: Of 87,211 weighted IE hospitalizations, 81,667 (93.6%) were insured and 5544 (6.4%) were uninsured. Uninsured patients were younger (mean age 40.1 vs. 59.4 years) with lower comorbidity burden but higher injection drug use (IDU) prevalence (38.7% vs. 15.5%). Mean LOS was longer among the uninsured (15.5 vs. 12.4 days, p < 0.001); LOS > 14 days occurred in 35.8% vs. 26.6%, and LOS > 28 days in 18.5% vs. 9.2% (both p < 0.001). AMA discharge was four-fold higher among the uninsured (22.2% vs. 5.5%, p < 0.001), while unadjusted in-hospital mortality was similar (9.0% vs. 9.4%, p = 0.32). LOS and AMA disparities persisted in both IDU and non-IDU subgroups, with a six-fold AMA disparity among non-IDU patients (15.2% vs. 2.5%). Based on multivariable analysis, uninsured status remained independently associated with prolonged LOS > 28 days (adjusted odds ratio [aOR] 1.46, 95% CI 1.30–1.65), AMA discharge (aOR 3.51, 95% CI 3.10–3.97), and—after accounting for age and comorbidity differences—higher in-hospital mortality (aOR 1.25, 95% CI 1.10–1.43). Conclusions: Uninsured adults hospitalized with IE experienced longer stays, markedly higher AMA rates, and—after adjustment for age and comorbidity—higher in-hospital mortality than insured patients. These findings are consistent with nonclinical barriers to discharge—particularly limited OPAT and post-acute care access—and suggest that the younger, less comorbid profile of uninsured patients masks an underlying outcome disparity. The results identify uninsured IE patients as a population that may benefit from alternative care models and policy reforms expanding safe post-acute antimicrobial therapy. Full article
(This article belongs to the Special Issue Acute Endocarditis: Clinical Advances in Diagnosis, Treatment, and Management)
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