Article Text

Original research
Escalating incidence of infective endocarditis in Europe in the 21st century
  1. Khawaja M Talha1,
  2. Larry M Baddour1,2,
  3. Martin H Thornhill3,
  4. Verda Arshad1,
  5. Wajeeha Tariq1,
  6. Imad M Tleyjeh4,5,
  7. Christopher G Scott6,
  8. Meredith C Hyun6,
  9. Kent R Bailey6,
  10. Nandan S Anavekar2,
  11. Raj Palraj1,
  12. M Rizwan Sohail1,7,
  13. Daniel C DeSimone1,2 and
  14. Mark J Dayer8
  1. 1Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  3. 3School of Clinical Dentistry, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
  4. 4Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
  5. 5Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
  6. 6Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
  8. 8Taunton and Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Dr Khawaja M Talha; talha.kh10{at}


Aim To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe.

Methods A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence.

Results Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%.

Conclusion Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase.

Trial registeration number CRD42020191196.

  • endocarditis
  • systematic reviews as topic
  • epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors We confirm that all authors of this study contributed significantly to the synthesis of the manuscript, meet the authorship criteria and have agreed to report all potential conflicts of interest in the manuscript. The authors also agree to release the copyright should the manuscript be accepted for publication. KMT is the guarantor of the manuscript.

  • Funding The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (LMB), which was paramount in our work to advance the science of cardiovascular infections and has been an ongoing focus of investigation at Mayo Clinic for over 60 years. We also recognise the unique expertise of Danielle J. Gerberi, M.L.S., AHIP for conducting the literature search of the systematic review and Barbara A. Abbott for data retrieval from the Rochester Epidemiology Project (REP).

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests LMB, M.D. reports Boston Scientific, consultant duties; UpToDate, royalty payments (authorship duties); Botanix Pharmaceuticals, consulting duties; Roivant Sciences, consultant duties. MRS, M.D. reports receiving funds from TYRX and Medtronic for prior research unrelated to this study administered according to a sponsored research agreement between Mayo Clinic and study sponsor that prospectively defined the scope of the research effort and corresponding budget; and honoraria/consulting fees from Medtronic, Philips and Aziyo Biologics. Research Grant: Medtronic. MJD, M.B.B.S. reports payments from Biotronik unrelated to this study. IMT, M.D. reports UpToDate, royalty payments (authorship duties). The remaining authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.