European Heart Journal Advance Access originally published online on December 7, 2006
European Heart Journal 2007 28(2):196-203; doi:10.1093/eurheartj/ehl427
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Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study
1 Department of Internal Medicine—Infectious Diseases, K.U. Leuven, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuve Belgium
2 Department of Cardiac Surgery, K.U. Leuven, University Hospital Gasthuisberg, 3000 Leuven Belgium
3 Department of Cardiology, K.U. Leuven, University Hospital Gasthuisberg, 3000 Leuven Belgium
Received 2 January 2006; revised 9 October 2006; accepted 3 November 2006; online publish-ahead-of-print 7 December 2006.
* Corresponding author. Tel: +32 16 344275; fax: +32 16 344230. E-mail address: willy.peetermans{at}uz.kuleuven.ac.be
Aims The aim here is to analyse epidemiology, optimal treatment, and predictors of 6-month mortality in infective endocarditis (IE).
Methods and results A prospective observational cohort study included 193 patients with 203 episodes of definite IE by the modified Duke criteria. Thirty-four percent of episodes involved prosthetic valves. Thirty-three percent of episodes were nosocomial. Forty-three percent included staphylococci, 26% streptococci, and 17% enterococci. At least one complication occurred in 79% of the episodes and 63% had surgical intervention. Six-month mortality was 22%: 33% for staphylococci, 24% for enterococci, and 8% for streptococci. Seventy-four percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 16% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P = 0.03), the causative microorganism (P = 0.04), and treatment group (P < 0.001).
Conclusion Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus and Enterococcus faecalis were predominant microorganisms. Age, staphylococci, and a contraindication to surgery predicted 6-month mortality. Nearly half of deaths had a contraindication to surgery. Six-month mortality did not differ significantly between patients who received surgical treatment as against those who received medical treatment without a contraindication to surgery.
Key Words: Endocarditis • Microbiology • Duke criteria • Cardiac surgery • Outcome
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