Background Fever is common in infective endocarditis (IE), yet little is known about fever duration in such patients. We aim to identify predictors of persistent fever in patients with suspected IE. Methods This study was conducted at the Lausanne University Hospital, Switzerland, from January 2014 to June 2023. All patients with suspected IE being febrile upon presentation were included. Fever (>38°C) was considered persistent if it continued for at least 96 hours from antimicrobial treatment initiation. A case was classified as IE by the Endocarditis Team. Results Among 1399 episodes with suspected IE, persistent fever was observed in 260 (19%) episodes. IE was diagnosed in 536 (41%) episodes, of which 82 (15%) had persistent fever. Among episodes with suspected IE, persistent bacteremia/candidemia for 96 hours (P < .001), spondylodiscitis (P = .039), intrabdominal infection (P = .001) were associated with persistent fever. Conversely, bacteremia by streptococci (P = .049), or enterococci (P = .001), source control performed withing 96 hours (P = .015) and appropriate antimicrobial treatment within 48 hours (P = .018) were associated with early defervescence. No association between persistent fever and infective endocarditis was found (P = .207). Among 536 IE episodes, persistent bacteremia/candidemia for 96 hours (P < .001), and native bone and joint infection (P = .020) were associated with persistent fever. Conversely, bacteremia by streptococci or enterococci (P = .001; adjusted odds ratio [aOR] 0.25, 95% confidence interval [CI] .11–.58) were associated with early defervescence. Conclusions In episodes with suspected IE, persistent fever was associated with spondylodiscitis, inappropriate antimicrobial treatment and absence of source control interventions. Among IE patients, persistent fever was associated with native bone and joint infections.

中文翻译：

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疑似感染性心内膜炎患者持续发热的预测因素：跳出框框思考


背景 发热在感染性心内膜炎 （IE） 中很常见，但对此类患者的发热持续时间知之甚少。我们旨在确定疑似 IE 患者持续发热的预测因素。方法 本研究于 2014 年 1 月至 2023 年 6 月在瑞士洛桑大学医院进行。所有疑似 IE 就诊时发热的患者均被纳入。如果发烧 （>38°C） 在抗菌治疗开始后持续至少 96 小时，则认为发热持续存在。一例被心内膜炎团队归类为 IE。结果 在 1399 例疑似 IE 发作中，260 例 （19%） 发作持续发热。IE 在 536 例 （41%） 发作中被诊断出来，其中 82 例 （15%） 持续发热。在疑似 IE 的发作中，持续 96 小时菌血症/念珠菌血症 （P < .001） 、椎间盘炎 （P = .039） 、腹腔感染 （P = .001） 与持续发热相关。相反，链球菌 （P = .049） 或肠球菌 （P = .001） 引起的菌血症、96 小时内进行的源控制 （P = .015） 和 48 小时内的适当抗菌治疗 （P = .018） 与早期退热相关。未发现持续发热与感染性心内膜炎之间存在关联 （P = .207）。在 536 例 IE 发作中，持续 96 小时菌血症/念珠菌血症 （P < .001） 和自体骨和关节感染 （P = .020） 与持续发热相关。相反，链球菌或肠球菌引起的菌血症 （P = .001;校正比值比 [aOR] 0.25,95% 置信区间 [CI] .11–.58）与早期退热相关。结论 在疑似 IE 的发作中，持续发热与椎间盘炎、不适当的抗菌治疗和缺乏源控制干预措施有关。 在 IE 患者中，持续发热与自体骨和关节感染有关。