{ "abstract": "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.", "abstract_shown": true, "affiliations": [ "Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Türkiye", "Department of Cardiology, University of Bakırçay, Izmir 35665, Türkiye", "Department of Cardiology, Başakşehir Çam and Sakura City Hospital, Istanbul 34480, Türkiye", "Department of Cardiology, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Istanbul 34785, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli 41380, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir 35110, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Kayseri City Hospital, Kayseri 38080, Türkiye", "Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, Istanbul 34865, Türkiye", "Department of Cardiology, Izmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir 35360, Türkiye", "Department of Cardiology, Ankara Training and Research Hospital, Ankara 06230, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya 07100, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Istanbul Kartal Dr. Lütfi Kırdar City Hospital, Istanbul 34865, Türkiye", "Department of Cardiology, Tepecik Training and Research Hospital, Izmir 35020, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, İnönü University, Malatya 44280, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atatürk University, Erzurum 25240, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya 54187, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır 21070, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul 34214, Türkiye", "Department of Cardiology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır 21070, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize 53100, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas 58140, Türkiye", "Department of Cardiology, Batman Training and Research Hospital, Batman 72070, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University, Konya 42090, Türkiye", "Department of Cardiology, Van Training and Research Hospital, Van 65170, Türkiye", "Department of Cardiology, Faculty of Medicine, Hitit University, Çorum 19040, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Şanlıurfa 63300, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ 59030, Türkiye", "Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Türkiye" ], "article_type": "research article", "arxiv": null, "author_total": 37, "authors": [ { "affs": [ 0 ], "name": "Mehmet Kış", "orcid": "0000-0003-0775-8992" }, { "affs": [ 1 ], "name": "Oktay Şenöz" }, { "affs": [ 2 ], "name": "Duygu İnan", "orcid": "0000-0003-3921-6469" }, { "affs": [ 3 ], "name": "Onur Akhan", "orcid": "0000-0003-4440-9599" }, { "affs": [ 4 ], "name": "Esra Canbolat Ünlü" }, { "affs": [ 5 ], "name": "Özlem Güler", "orcid": "0000-0002-7018-7224" }, { "affs": [ 6 ], "name": "Tuba Tatlı Kış" }, { "affs": [ 4 ], "name": "Şemsi Nur Karabela" }, { "affs": [ 7 ], "name": "Duygu Çerçioğlu Özdemir", "orcid": "0000-0003-1792-515X" }, { "affs": [ 8 ], "name": "Süleyman Çağan Efe" }, { "affs": [ 9 ], "name": "Pınar Şen" }, { "affs": [ 10 ], "name": "Hatice Özdamar", "orcid": "0000-0002-0269-0872" }, { "affs": [ 11 ], "name": "Derya Seyman" }, { "affs": [ 12 ], "name": "Ayşe Batırel" }, { "affs": [ 13 ], "name": "Utku Zeybey" }, { "affs": [ 0 ], "name": "Çisem Oktay", "orcid": "0009-0003-7671-9740" }, { "affs": [ 12 ], "name": "Pelin Geyik Pekin" }, { "affs": [ 9 ], "name": "Selin Özdemir" }, { "affs": [ 14 ], "name": "Adem Köse", "orcid": "0000-0002-1853-1243" }, { "affs": [ 15 ], "name": "Kemalettin Özden" }, { "affs": [ 16 ], "name": "Oğuz Karabay", "orcid": "0000-0003-1514-1685" }, { "affs": [ 17 ], "name": "Şafak Kaya Kavak", "orcid": "0000-0001-9912-7340" }, { "affs": [ 18 ], "name": "Ali Mert", "orcid": "0000-0001-8945-2385" }, { "affs": [ 14 ], "name": "Sena Kaçan" }, { "affs": [ 19 ], "name": "Tuncay Güzel" }, { "affs": [ 18 ], "name": "Selda Aydın" }, { "affs": [ 20 ], "name": "Uğur Kostakoğlu", "orcid": "0000-0002-4589-0962" }, { "affs": [ 21 ], "name": "Seyit Ali Büyüktuna", "orcid": "0000-0001-6518-7361" }, { "affs": [ 22 ], "name": "Mesut Gitmez", "orcid": "0000-0003-1078-9095" }, { "affs": [ 23 ], "name": "Esma Kepenek Kurt", "orcid": "0000-0002-0295-1745" }, { "affs": [ 20 ], "name": "Fatma Zühre Alparslan Tanyeri" }, { "affs": [ 24 ], "name": "Veysi Can", "orcid": "0000-0002-4731-4061" }, { "affs": [ 25 ], "name": "Lütfü Bekar", "orcid": "0000-0002-3920-1382" }, { "affs": [ 26 ], "name": "Mehmet Çelik", "orcid": "0000-0002-0583-929X" }, { "affs": [ 27 ], "name": "Nazan Tuna" }, { "affs": [ 28 ], "name": "Şükran Köse" }, { "affs": [ 0 ], "name": "Mehmet Birhan Yılmaz" } ], "bibtex": "https://research.draconitic.com/paper/9pmtg9fkcy63q.bib", "cited_by": 0, "doi": "10.3390/jcm15197760", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666091/?tool=EBI", "id": "9pmtg9fkcy63q", "issns": [ "2077-0383" ], "landing_url": "https://europepmc.org/article/PMC/PMC13666091", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2713|Infective Endocarditis Diagnosis and Management" ] ], "openalex": "W7221070196", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666091/pdf/?tool=EBI", "pmcid": "PMC13666091", "pmid": null, "published": "2026-10-01", "publisher": "MDPI AG", "ris": "https://research.draconitic.com/paper/9pmtg9fkcy63q.ris", "sources": [ { "first_seen": "2026-10-30T12:17:31Z", "native_id": "PMC:PMC13666091", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13666091" }, { "first_seen": "2026-10-30T12:20:00Z", "native_id": "10.3390/jcm15197760", "source": "crossref", "url": "https://www.mdpi.com/2077-0383/15/19/7760" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Infective Endocarditis Diagnosis and Management", "subfield": "epidemiology-public-health" } ], "title": "Contemporary Clinical Spectrum and Factors Associated with Mortality in Infective Endocarditis: A Multicenter Cohort Study (COSMO-IE)", "title_text": "Contemporary Clinical Spectrum and Factors Associated with Mortality in Infective Endocarditis: A Multicenter Cohort Study (COSMO-IE)", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:00Z", "url": "https://research.draconitic.com/paper/9pmtg9fkcy63q", "venue": "Journal of clinical medicine", "versions": [] }