Abstract
Background
The characteristics of patients with infective endocarditis (IE) vary significantly by region of the world. The aim of this study was to evaluate the contemporary epidemiology, characteristics, and outcome of IE in a large, nationwide cohort of Italian patients.
Methods
We conducted a prospective, observational study at 24 medical centers in Italy, including all the consecutive patients with a definite or possible diagnosis of IE (modified Duke criteria) admitted from January 2004 through December 2009. A number of clinical variables were collected through an electronic case report form and analyzed to comprehensively delineate the features of IE. We report the data on patients with definite IE.
Results
A total of 1,082 patients with definite IE were included. Of these, 753 (69.6 %) patients had infection on a native valve, 277 (25.6 %) on a prosthetic valve, and 52 (4.8 %) on an implantable electronic device. Overall, community-acquired (69.2 %) was more common than nosocomial (6.2 %) or non-nosocomial (24.6 %) health care-associated IE. Staphylococcus aureus was the most common pathogen (22.0 %). In-hospital mortality was 15.1 %. From the multivariate analysis, congestive heart failure (CHF), stroke, prosthetic valve infection, S. aureus, and health care-associated acquisition were independently associated with increased in-hospital mortality, while surgery was associated with decreased mortality.
Conclusions
The current mortality of IE remains high, and is mainly due to its complications, such as CHF and stroke.
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References
Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345:1318–30.
Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363:139–49.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169:463–73.
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.
Wilson WR, Jaumin PM, Danielson GK, Giuliani ER, Washington JA II, Geraci JE. Prosthetic valve endocarditis. Ann Intern Med. 1975;82:751–6.
Klug D, Balde M, Pavin D, Hidden-Lucet F, Clementy J, Sadoul N, Rey JL, Lande G, Lazarus A, Victor J, Barnay C, Grandbastien B, Kacet S; PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation. 2007;116:1349–55.
Chirillo F, Bacchion F, Pedrocco A, Scotton P, De Leo A, Rocco F, Valfrè C, Olivari Z. Infective endocarditis in patients with diabetes mellitus. J Heart Valve Dis. 2010;19:312–20.
Bishara J, Peled N, Samra Z, Sagie A, Leibovici L, Pitlik S. Infective endocarditis in diabetic and non-diabetic patients. Scand J Infect Dis. 2004;36:795–8.
Moreno R, Zamorano J, Almería C, Villate A, Rodrigo JL, Herrera D, Alvarez L, Morán J, Aubele A, Mataix L, De Marco E, Sánchez-Harguindey L. Influence of diabetes mellitus on short- and long-term outcome in patients with active infective endocarditis. J Heart Valve Dis. 2002;11:651–9.
Tripodi MF, Adinolfi LE, Ragone E, Durante Mangoni E, Fortunato R, Iarussi D, Ruggiero G, Utili R. Streptococcus bovis endocarditis and its association with chronic liver disease: an underestimated risk factor. Clin Infect Dis. 2004;38:1394–400.
Fernández Guerrero ML, González López J, Górgolas M. Infectious endocarditis in patients with cirrhosis of the liver: a model of infection in the frail patient. Eur J Clin Microbiol Infect Dis. 2010;29:1271–5.
Cesaro C, Tiso A, Del Prete A, Cariello R, Tuccillo C, Cotticelli G, Del Vecchio Blanco C, Loguercio C. Gut microbiota and probiotics in chronic liver diseases. Dig Liver Dis. 2011;43:431–8.
Netzer RO, Zollinger E, Seiler C, Cerny A. Native valve infective endocarditis in elderly and younger adult patients: comparison of clinical features and outcomes with use of the Duke criteria. Clin Infect Dis. 1999;28:933–5.
Dhawan VK. Infective endocarditis in elderly patients. Clin Infect Dis. 2002;34:806–12.
Anderson HJ, Staffurth JS. Subacute bacterial endocarditis in the elderly. Lancet. 1955;269:1055–8.
Durante-Mangoni E, Bradley S, Selton-Suty C, Tripodi MF, Barsic B, Bouza E, Cabell CH, Ramos AI, Fowler V Jr, Hoen B, Koneçny P, Moreno A, Murdoch D, Pappas P, Sexton DJ, Spelman D, Tattevin P, Miró JM, van der Meer JT, Utili R; International Collaboration on Endocarditis Prospective Cohort Study Group. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med. 2008;168:2095–103.
Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005;293:3012–21.
Benito N, Miró JM, de Lazzari E, Cabell CH, del Río A, Altclas J, Commerford P, Delahaye F, Dragulescu S, Giamarellou H, Habib G, Kamarulzaman A, Kumar AS, Nacinovich FM, Suter F, Tribouilloy C, Venugopal K, Moreno A, Fowler VG Jr; ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators. Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med. 2009;150:586–94.
Scudeller L, Badano L, Crapis M, Pagotto A, Viale P. Population-based surveillance of infectious endocarditis in an Italian region. Arch Intern Med. 2009;169:1720–3.
Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA. 2003;289:1933–40.
San Román JA, López J, Vilacosta I, Luaces M, Sarriá C, Revilla A, Ronderos R, Stoermann W, Gómez I, Fernández-Avilés F. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med. 2007;120:369.e1–7.
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL; ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30:2369–413.
Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111:e394–434.
Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Cardiol Clin. 2003;21:273–82.
Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. JAMA. 2003;290:3207–14.
Tleyjeh IM, Abdel-Latif A, Rahbi H, Scott CG, Bailey KR, Steckelberg JM, Wilson WR, Baddour LM. A systematic review of population-based studies of infective endocarditis. Chest. 2007;132:1025–35.
Tleyjeh IM, Ghomrawi HM, Steckelberg JM, Montori VM, Hoskin TL, Enders F, Huskins WC, Mookadam F, Wilson WR, Zimmerman V, Baddour LM. Propensity score analysis with a time-dependent intervention is an acceptable although not an optimal analytical approach when treatment selection bias and survivor bias coexist. J Clin Epidemiol. 2010;63:139–40.
Austin PC, Platt RW. Survivor treatment bias, treatment selection bias, and propensity scores in observational research. J Clin Epidemiol. 2010;63:136–8.
Tleyjeh IM, Ghomrawi HM, Steckelberg JM, Montori VM, Hoskin TL, Enders F, Huskins WC, Mookadam F, Wilson WR, Zimmerman V, Baddour LM. Conclusion about the association between valve surgery and mortality in an infective endocarditis cohort changed after adjusting for survivor bias. J Clin Epidemiol. 2010;63:130–5.
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The authors declare that they have no competing interests.
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For the Italian Study on Endocarditis.
Appendix
Appendix
Italian Study on Endocarditis (SEI) investigators Fredy Suter, Marco Rizzi, Veronica Ravasio, Sebastiano Leone (Bergamo), Alberto Biglino, Paolo Crivelli (Asti), Giampiero Carosi, Roberto Stellini, Silvia Magri (Brescia), Peter Mian, Greta Spoladore (Bolzano), Domenico Di Caprio (Caserta), Nicoletta Barzaghi (Cuneo), Angelo Pan (Cremona), Marco Libanore, Mario Pantaleoni (Ferrara), Claudio Viscoli, Valerio Del Bono (Genova), Maria Riccarda Villa (Milano), Gianni Gattuso, Alfredo Scalzini (Mantova), Riccardo Utili, Emanuele Durante-Mangoni, Marie-Françoise Tripodi, Enrico Ragone, Irene Mattucci, Susanna Cuccurullo, Mariano Bernardo, Giovanni Dialetto (Napoli), Elke Erne, Francesco Barbaro (Padova), Laura Stoppini, Benedetta Canovari (Pesaro), Lorenzo Minoli (Pavia), Maria Bruna Pasticci, Laura Martinelli (Perugia), Nicola Petrosillo, Pierangelo Chinello, Mario Venditti, Marco Falcone (Roma), Palma Delle Foglie (Trento), Alberto Vaglia, Pier Giorgio Scotton, Mario Giobbia, Walter Inoiosa (Treviso), Pierluigi Viale, Massimo Crapis (Udine), Paolo Grossi, Daniela Dalla Gasperina, Alessandro Tebini (Varese), Gian Pietro Pellizzer, Roberto Nicolin (Vicenza), Ercole Concia, Paola Del Bravo, Andrea Tedesco (Verona).
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Leone, S., Ravasio, V., Durante-Mangoni, E. et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection 40, 527–535 (2012). https://doi.org/10.1007/s15010-012-0285-y
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DOI: https://doi.org/10.1007/s15010-012-0285-y