To investigate the clinical and etiological characteristics of patients with multivalvular infected endocarditis (IE), retrospectively, and to provide a basis for clinical diagnosis and treatment.

The clinical data of 57 patients with multivalve IE hospitalized from January 2011 to December 2018 in Peking Union Medical College Hospital were analyzed, retrospectively and compared with patients with single valve IE for the clinical manifestations, underlying cardiac disease, pathogenic microorganisms, treatment and outcome.

Total of 57 patients with multivalve IE were enrolled, representing 13.4% of total IE cases. Among them, 49 patients were male and 8 patients were female, with an average age of (46 ± 15) years old. The median period from onset of disease to diagnosis was 14 weeks; Fever [100% (57/57)] was the most common clinical presentation, followed by cardiac murmur [91.2% (52/57)]; the main complications were heart failure [66.7% (38/57)] and organ embolism [33.3% (19/57)]. There were 35 patients (61.4%) predisposing cardiac diseases with congenital heart diseases as the leading cause [65.7% (23/35)]. Most patients [66.7% (38/57)] with multivalve IE had mitral valve and aortic valve involvement, and 56 redundant patients (98.2%) were found. Total of 44 patients (77.2%) were positive for blood culture and (or) valve vegetation culture. Most of the isolated pathogens of the enrolled patients were Streptococcus viridians [61.4% (27/44)]. All 57 patients were treated with anti-infection therapy, 52 patients (91.2%) underwent combined surgery, and 3 patients (5.3%) died during hospitalization. Compared with single valve IE, patients with multivalvular IE was associated with more males (86.0% vs. 64.9%: χ² = 9.946, P = 0.002) and more patients with congestive heart failure (66.7% vs. 50.9%: χ² = 4.870, P = 0.027); with higher proportion of valve perforation (35.1% vs. 17.9%: χ² = 8.924, P = 0.003) and perivalvular abscess (17.5% vs. 7.4%: χ² = 6.132, P = 0.013); however, the difference of hospitalization mortality rates between the two groups (5.3% vs. 4.8%) was not significantly different (χ² = 0.000, P = 1.000).

Multivalvular IE is a special entity of patients with IE. The occurrence of valve perforation, pervalvular abscess and congestive heart failure are more common, which usually requires more aggressive and complex surgical intervention, but does not increase the hospital fatality rate, which is presumed to be related to timely surgical treatment.