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
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Endorsed by the European Society of Clinical Micro, Authors/Task Force Members, G. Habib, B. Hoen, P. Tornos, F. Thuny, B. Prendergast, I. Vilacosta, P. Moreillon, M. de Jesus Antunes, et al. 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) Eur. Heart J., October 1, 2009; 30(19): 2369 - 2413. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Benito, J. M. Miro, E. de Lazzari, C. H. Cabell, A. del Rio, J. Altclas, P. Commerford, F. Delahaye, S. Dragulescu, H. Giamarellou, et al. Health Care-Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition Ann Intern Med, May 5, 2009; 150(9): 586 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rehm, M. Campion, D. E. Katz, R. Russo, and H. W. Boucher Community-based outpatient parenteral antimicrobial therapy (CoPAT) for Staphylococcus aureus bacteraemia with or without infective endocarditis: analysis of the randomized trial comparing daptomycin with standard therapy J. Antimicrob. Chemother., May 1, 2009; 63(5): 1034 - 1042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Winearls, S. McGloughlin, and J. F Fraser Splenic rupture as a presenting feature of endocarditis Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 737 - 739. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V H Chu, J M Miro, B Hoen, C H Cabell, P A Pappas, P Jones, M E Stryjewski, I Anguera, S Braun, P Munoz, et al. Coagulase-negative staphylococcal prosthetic valve endocarditis--a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study Heart, April 1, 2009; 95(7): 570 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Sy, C. Chawantanpipat, D. R. Richmond, and L. Kritharides Development and validation of a time-dependent risk model for predicting mortality in infective endocarditis Eur. Heart J., March 28, 2009; (2009) ehp085v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. G. Daniel and F. A. Flachskampf CHAPTER 22 Infective Endocarditis ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. Hill, M.-C. Herregods, S. Vanderschueren, P. Claus, W. E. Peetermans, and P. Herijgers Outcome of Patients Requiring Valve Surgery During Active Infective Endocarditis Ann. Thorac. Surg., May 1, 2008; 85(5): 1564 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Rahimtoola The Year in Valvular Heart Disease. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]
|
|
|
|
 |
|
 A. KIM and T. KEYS Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy Cleveland Clinic Journal of Medicine, February 1, 2008; 75(2): 89 - 92. [Full Text] [PDF]
|
|
|
|
|
|
C. Acar Early surgery in mitral valve endocarditis: it is sometimes too early Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 947 - 947. [Full Text] [PDF]
|
|
|
|
|
|
L. de Kerchove, A. Poncelet, and G. El Khoury Reply to Acar Early surgery in active valve endocarditis Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 948 - 948. [Full Text] [PDF]
|
|