Infective endocarditis and litigation for compensation on healthcare-associated infections: An Italian sample analysis

Background: Litigation related to Healthcare-Associated Infections (HAIs) in Italy represent a growing field of interest in establishing the medico-legal link between infection and the healthcare environment and practices for compensation; it is little explored in the cardiovascular surgery regarding infective endocarditis (IE). Methods: We retrospectively analysed the civil judgements on infective endocarditis in the Italian region Emilia-Romagna from 2016 to July 2024 using Ministry of Justice national official database. The search was conducted on the online database on July 31, 2024, using the free word "endocarditis”. Two authors independently analysed the full-text judgements:, those IE without relevance in the reason for the claim were excluded. Main items were the timeline and outcome, with complaint motivation and liability ascertainment. In-court confirmation of healthcare causal link was reported. Results: Twenty-five judgments were retrieved. After screening for inclusion, nineteen judgements (11 of first instance and 8 of appeal) were included, for overall 15 cases of infective endocarditis. Of the fifteen cases, median age 60.5 years, 73 % males, median time for claim 6 years, for judgement 10 years and, if appealed, 16.5 years. Annual distribution of the claims was linear over time. Eleven (67 %) infective endocarditis were confirmed as healthcare-associated in trial. The prevalent reason for liability was improper or delayed diagnosis and/or treatment of the IE. Valvular surgery resulted in 40 %, while the more frequent pathogens were Staphylococcus aureus (40 %) and epidermidis (30 %). Of fifteen cases, 73 % was decided in favour of the patient-claimant, with an average cost of €289.872, plus an additional €55.296 in case of appeal. Only in 25 % the appeal's judge changed decision. In all cases, technical advisors were appointed. Conclusions: This sample provides an initial insight into litigation for compensation related to infective endocarditis, highlighting specific characteristics compared to HAIs management in court. Medico-legal reasoning should be integrated into infection prevention and control policies and overall clinical risk management strategies.