Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Round 1

Reviewer 1 Report

The paper “Prognostic outcomes in Infective Endocarditis" by Ucciferri et al. is a retrospective study with the aim of evaluating how prognostic outcome is influenced by several patient’s characteristics.

The article is quite well written. The study has a good design. The article is logically divided into sections and subsections. The references cited are relevant and adequate. The sample size is quite small. The work has an average degree of novelty and of good interest to the readers.

Comments:

• Keywords: I suggest the authors should add “Infective endocarditis”
• The authors should provide a table with general characteristics of the study population
• Diabetes was not found to be associated with poorer outcome, which is strange also according to previous report and may be due to the small sample size. I suggest the authors should also analyse, if available, weather a strict glycaemic control was performed in this subset of patients, as in other disease such as acute coronary syndrome it has been proven an outcome amelioration (10.1016/j.diabres.2021.108959).

Author Response

Dear Editor,

We thank the reviewers for the comments on the work .

We appreciated the comments and suggestions that we believe have improved the quality of the paper.

Keywords: I suggest the authors should add “Infective endocarditis”

we have added the keyword as correctly suggested

The authors should provide a table with general characteristics of the study population

we have added the table on general patient characteristics, as correctly suggested

Diabetes was not found to be associated with poorer outcome, which is strange also according to previous report and may be due to the small sample size. I suggest the authors should also analyse, if available, weather a strict glycaemic control was performed in this subset of patients, as in other disease such as acute coronary syndrome it has been proven an outcome amelioration (10.1016/j.diabres.2021.108959).

we agree with the reviewer that the sample size may not have allowed us to highlight diabetes as an poorer outcame

in our series 33.8% had diabetes in history, all were subjected  made a strict glycaemic control.

Reviewer 2 Report

Interesting study on prognostic indicators for IE. Authors describe age and procalcitonin levels to be predictors of mortality. 

1. Do you have subspecies for Enterococcus?
2. Were all patient treated with beta lactam plus aminoglycoside? 
3. Recent reports suggest that in case of E. durans double beta lactam treatment can be curative which helps avoid nephrotoxicity associated with aminoglycoside therapy and this might be clinically relevant https://www.mdpi.com/1648-9144/58/2/307

Author Response

Dear Editor,

We thank the reviewers for the comments on the work .

We appreciated the comments and suggestions that we believe have improved the quality of the paper.

Do you have subspecies for Enterococcus?

In our population enterococcus represent 22% of isolates, they are almost all Enterococcus faecalis (1 faecium). no other species of enteroccoccus.

Were all patient treated with beta lactam plus aminoglycoside? Recent reports suggest that in case of E. durans double beta lactam treatment can be curative which helps avoid nephrotoxicity associated with aminoglycoside therapy and this might be clinically relevant https://www.mdpi.com/1648-9144/58/2/307

All patients with enterococcus endocarditis  were treated with association therapy, as per guideline suggest.