Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

Abstract

BACKGROUND:

We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.

METHODS:

Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005.

RESULTS:

The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk.

CONCLUSIONS:

In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

• Authors: David R Murdoch, G Ralph Corey, Bruno Hoen, José M Miró, Vance G Fowler Jr, Arnold S Bayer, Adolf W Karchmer, Lars Olaison, Paul A Pappas, Philippe Moreillon, Stephen T Chambers, Vivian H Chu, Vicenç Falcó, David J Holland, Philip Jones, John L Klein, Nigel J Raymond, Kerry M Read, Marie Francoise Tripodi, Riccardo Utili, Andrew Wang, Christopher W Woods, Christopher H Cabell, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators
• Journal: Archives of internal medicine (Arch Intern Med) Vol. 169 Issue 5 Pg. 463-73 (Mar 09 2009) ISSN: 1538-3679 [Electronic] United States
• PMID: 19273776 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Endocarditis (microbiology, mortality, therapy)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Staphylococcal Infections (microbiology)
• Staphylococcus aureus (isolation & purification)