IJCS | Volume 33, Nº1, January / February 2019

17 Table 2 - Microbiological profile of 106 patients with a positive blood culture diagnosed with Infective Endocarditis Microorganism IUD (n = 7) NIUD (n = 7)* ND (n = 92)* Total (n = 106)* p-value Staphylococcus spp 5 (71.4%) 2 (28.6%) 33 (35.9%) 40 (37.7%) 0.133† S. aureus 4 (57.1%)‡ 1 (14.3%) 16 (17.4%)‡ 21 (19.8%) 0.029† Coagulase negative S§ 1 (14.3%) 1 (14.3%) 17 (18.5%) 19 (17.9%) 0.723† Streptococcus spp// - 3 (42.9%) 28 (30.4%) 31 (29.2%) 0.217† Enterococcus - - 14 (15.2%) 14 (13.2%) - Others¶ 1 (14.3%) 1 (14.3%) 8 (8.7%) 10 (9.4%) 0.535† Not specified# 1 (14.3%) 2 (28.6%) 11 (12%) 14 (13.2%) 0.519† ND: non diabetics; NIUD: non-insulin-user diabetics; IUD: insulin-user diabetics. * Some patients had more than one microorganism growing in the blood culture; † Association evaluated via multinomial logistic model; ‡ Indicates pairs with significant difference (p < 0.05); §S. epidermidis, S. warneri, S. haemoliticus, S. lugdunensis, S. capitis; //S. pneumoniae, S. pyogenes, S. sanguinis, S. mitis; ¶ Haemophillus spp, Candida spp, Proteus mirabilis, Proteus penneri, E. coli, Enterobacter sp, Klebsiella sp,, Achromobacter xylosoxidans, Morganella morganii, Stenotrophomonas maltophilia, Facklamia hominis; # Blood culture was positive, but the microorganism was not specified. Lott Bezerra et al. Insulin use and infective endocarditis Int J Cardiovasc Sci. 2020;33(1):14-21 Original Article cultures, our results showed a higher prevalence of the Staphylococcaceae genus (37.7%), almost equally distributed as 19.8% S. aureus and 17.9% of coagulase- negative Staphylococcus . We emphasize that the prevalence of S. aureus was similar when we evaluated the two cities separately, with 18.6% in Ipatinga and 20.6% in Belo Horizonte. Streptococcus spp represented the second most prevalent genus, estimated at 29.2%, followed by Enterococcus spp with 13.2% and other microorganisms in 9.4%of the time. The blood culture was shown to be positive in themedical records, but without specifying the microorganism in 13.2% of the patients. The location of the IE is shown in Table 3. The native valves were the most affected site in the general sample, representing 149 (70.6%) patients, most of them in the mitral valve (41.7%), followed by the aortic valve (26.5%), tricuspid (10%) and pulmonary (1.4%) valve. The valvular prostheses were infected in 51 (24.2%) patients, pacemaker cable in 9 (4.3%) and 6 (2.8%) were infected in other places such as the right atrium, pulmonary arteries, superior vena cava ostium or interventricular septal defect. There were 194 non-diabetic and 17 diabetic patients, of which 9 (52.9%) were insulin users and 8 (47.1%) used only oral hypoglycemic drugs. The data showed 35.29% of mortality in diabetics and 21.1% in non-diabetic patients, with no statistical difference (p = 0.221). When considering diabetics who used or did not use insulin, the observed mortality was 33.3% and 37.5%, respectively, and the statistical tests did not show a significant difference in relation to this variable (p = 0.229). Themicrobiological comparisonbetween the subgroups showed a higher proportion of S. aureus in insulin users than in the non-diabetic group, with a statistical significance (p = 0.029), whereas Streptococcus spp was the most common microorganism in the diabetic patients receiving oral medication and in non-diabetic patients. The native mitral valve was the most often affected in patients who did not use insulin, non-diabetic or diabetic patients, with 42.8%and 25%, respectively. In the diabetic patients who used insulin, we observed that the mitral valve showed the same prevalence as the tricuspid valve, calculated as 33.3%. We emphasize there was a statistical significance between tricuspid valve involvement (p = 0.034). The aortic valve was the secondmost affected in the total sample, in 26.5% of the patients, which was also observed in non-diabetic patients, with 27.8%. There was a higher prevalence of individuals with unidentified sites among diabetics whowere non-insulin- users and non-diabetic patients (p = 0.031). Table 04 shows several characteristics of the diabetic patients in our sample that could influence prognostic, microbiological and valvular aspects in the groups of insulin users or non-users. The statistical analysis showed homogeneity between the two groups, which improves the internal validity of the comparison. However, it