Infective endocarditis (IE) is a rare disease associated with high mortality despite advances in medical and surgical treatments. Data are limited on changes in the epidemiology of IE in industrialized countries over the past decades. In this study, we report a patient population diagnosed and treated by an Endocarditis Team at Bordeaux University Hospital.
Between January 2013 and March 2016, we conducted a prospective observational study in the three teaching hospitals of our center (including the cardiac surgery referral unit). Since 2010, members of the multidisciplinary endocarditis team have discussed the weekly management of all IE patients admitted to the center and have extracted detailed demographic, diagnostic, treatment, and follow-up (in-hospital mortality) data from patients’ charts and medical records.
Three hundred and fifty-seven patients were included in this study (mean age: 65 years). One hundred and ninety-four patients (54.3%) had native-valve endocarditis (NVE), and 163 (45.7%) had prosthetic-valve endocarditis (PVE). The prevalence of healthcare-associated IE was 45.7%. Forty patients (11.2%) had implantable heart devices. The aortic (58.3%) and mitral (21.8%) valves were most commonly infected; in 9.2% of patients, both valves were infected. The most common pathogens were Streptococcus (35.0%), Staphylococcus aureus (22.1%), coagulase-negative staphylococci (12.1%), and Enterococcus (15.1%). In 7% of IE patients, the pathogens were not documented. More than half of the patients (52.4%) underwent surgical treatment. The in-hospital mortality rate was 16.2% (NVE = 16.5%; PVE = 15.9%, NS) and increased in the absence of surgical treatment (24.1%, p < 0.001) or in the presence of heart failure (32.1%, p = 0.001) or Staphylococcus (23.8%, p = 0.005).
The epidemiology of IE has changed considerably as illustrated by our study: older patients, more prosthetic valves and increased prevalence of staphylococcal pathogens. Nevertheless, the mortality rate was lower than in other studies. We suggest that the management of IE by a multidisciplinary endocarditis team as advocated in the latest recommendations could improve the prognosis of this disease.
C. Greib, None
G. Wirth, None
O. Peuchant, None
M. Laine, None
L. Barandon, None
F. Camou, None
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