Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study
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, David Gordon, Uma Devi, Denis Spelman, Jan T M van der Meer, Carol Kauffman, Suzanne Bradley, William Armstrong, Efthymia Giannitsioti, Helen Giamarellou, Stamatios Lerakis, Ana del Rio, Asuncion Moreno, Carlos A Mestres, Carlos A Ninot, Carlos Pare, Cristina Garcia de la Maria, Yolanda Armero, Elisa de Lazzari, Francesc Marco, Jose M Gatell, Manel Almela, Manuel Azqueta, Marta Sitges, Xavier Claramonte, Maria Jesús Jiménez-Expósito, Natividad de Benito, Jose Ramirez, Noel Perez, José M Miro, Benito Almirante, Nuria Fernandez-Hidalgo, Pablo Rodriguez de Vera, Pilar Tornos, Vicenç Falco, Xavier Claramonte, Nisreen Sidani, Souha Kanj-Sharara, Zeina Kanafani, Annibale Raglio, Antonio Goglio, Fabrizio Gnecchi, Fredy Suter, Grazia Valsecchi, Marco Rizzi, Veronica Ravasio, Bruno Hoen, Catherine Chirouze, Efthymia Giannitsioti, Joel Leroy, Patrick Plesiat, Yvette Bernard, Anna Casey, Peter Lambert, Richard Watkin, Tom Elliott, Mukesh Patel, William Dismukes, Angelo Pan, Giampiero Caros, Amel Brahim Mathiron, Christophe Tribouilloy, Thomas Goissen, Armelle Delahaye, Francois Delahaye, Francois Vandenesch, Carla Vizzotti, Francisco M Nacinovich, Marcelo Marin, Marcelo Trivi, Martin Lombardero, Claudia Cortes, José Horacio Casabé, Javier Altclas, Silvia Kogan, Liliana Clara, Marisa Sanchez, Anita Commerford, Cass Hansa, Eduan Deetlefs, Mpiko Ntsekhe, Patrick Commerford, Dannah Wray, Lisa L Steed, Preston Church, Robert Cantey, Arthur Morris, David J Holland, David R Murdoch, Stephen T Chambers, Kerry M Read, Nigel J Raymond, Selwyn Lang, Despina Kotsanas, Tony M Korman, Gail Peterson, Jon Purcell, Paul M Southern Jr, Manisha Shah, Roger Bedimo, Arjun Reddy, Donald Levine, Gaurav Dhar, Alanna Hanlon-Feeney, Margaret Hannan, Sinead Kelly, Andrew Wang, Christopher H Cabell, Christopher W Woods, Daniel J Sexton, Daniel J Benjamin Jr, Jay R McDonald, Jeff Federspiel, John J Engemann, Barth Reller, Laura Drew, L B Caram, Martin Stryjewski, Susan Morpeth, Tahaniyat Lalani, Vance G Fowler Jr, Vivian H Chu, Bahram Mazaheri, Carl Neuerburg, Christoph Naber, Eugene Athan, Margaret Henry, Owen Harris, Eric Alestig, Lars Olaison, Lotta Wikstrom, Ulrika Snygg-Martin, Johnson Francis, K Venugopal, Lathi Nair, Vinod Thomas, Jaruwan Chaiworramukkun, Orathai Pachirat, Ploenchan Chetchotisakd, Tewan Suwanich, Adeeba Kamarulzaman, Syahidah Syed Tamin, Manica Mueller Premru, Mateja Logar, Tatjana Lejko-Zupanc, Christina Orezzi, John L Klein, Emilio Bouz, Marta Rodríguez-Créixems, Mercedes Marín, Miguel Fernández, Patricia Muñoz, Rocío Fernández, Victor Ramallo, Didier Raoult, Franck Thuny, Gilbert Habib, Jean-Paul Casalta, Pierre-Edouard Fournier, Natalia Chipigina, Ozerecky Kirill, Tatiana Vinogradova, Vadim P Kulichenko, O M Butkevich, Christine Lion, Christine Selton-Suty, Hélène Coyard, Thanh Doco-Lecompte, Diana Iarussi, Emanuele Durante-Mangoni, Enrico Ragone, Giovanni Dialetto, Marie Francoise Tripodi, Riccardo Utili, Roberta Casillo, A Sampath Kumar, Gautam Sharma, Stuart A Dickerman, Alan Street, Damon Peter Eisen, Emma Sue McBryde, Leeanne Grigg, Elias Abrutyn, Christian Michelet, Pierre Tattevin, Pierre Yves Donnio, Claudio Querido Fortes, Jameela Edathodu, Mashael Al-Hegelan, Bernat Font, Ignasi Anguera, Joan Raimon Guma, M Cereceda, Miguel J Oyonarte, Rodrigo Montagna Mella, Patricia Garcia, Sandra Braun Jones, Auristela Isabel de Oliveira Ramos, Marcelo Goulart Paiva, Regina Aparecida de Medeiros Tranchesi, Lok Ley Woon, Luh-Nah Lum, Ru-San Tan, David Rees, Pam Kornecny, Richard Lawrence, Robyn Dever, Jeffrey Post, Philip Jones, Suzanne Ryan, John Harkness, Michael Feneley, Ethan Rubinstein, Jacob Strahilewitz, Adina Ionac, Cristian Mornos, Stefan Dragulescu, Davide Forno, Enrico Cecchi, Francesco De Rosa, Massimo Imazio, Rita Trinchero, Franz Wiesbauer, Rainer Gattringer, Ethan Rubinstein, Greg Deans, Arjana Tambic Andrasevic, Bruno Barsic, Igor Klinar, Josip Vincelj, Suzana Bukovski, Vladimir Krajinovic, Christopher H Cabell, Judy Stafford, Khaula Baloch, Paul A Pappas, Thomas Redick, Tina Harding, Adolf W Karchmer, Arnold S Bayer, Bruno Hoen, Christopher H Cabell, Ralph Corey, José M Miro, Philippe Moreillon, Vance G Fowler Jr, Lars Olaison, Daniel J Sexton, David T Durack, Elias Abrutyn, Ethan Rubinstein, Susannah Eykyn, David R Murdoch, Arnold S Bayer, Bruno Hoen, Christopher H Cabell, Vance G Fowler Jr, Vivian H Chu, José M Miro, Ralph Corey, Paul A Pappas, Elias Abrutyn, Eugene Athan, 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, David Gordon, Uma Devi, Denis Spelman, Jan T M van der Meer, Carol Kauffman, Suzanne Bradley, William Armstrong, Efthymia Giannitsioti, Helen Giamarellou, Stamatios Lerakis, Ana del Rio, Asuncion Moreno, Carlos A Mestres, Carlos A Ninot, Carlos Pare, Cristina Garcia de la Maria, Yolanda Armero, Elisa de Lazzari, Francesc Marco, Jose M Gatell, Manel Almela, Manuel Azqueta, Marta Sitges, Xavier Claramonte, Maria Jesús Jiménez-Expósito, Natividad de Benito, Jose Ramirez, Noel Perez, José M Miro, Benito Almirante, Nuria Fernandez-Hidalgo, Pablo Rodriguez de Vera, Pilar Tornos, Vicenç Falco, Xavier Claramonte, Nisreen Sidani, Souha Kanj-Sharara, Zeina Kanafani, Annibale Raglio, Antonio Goglio, Fabrizio Gnecchi, Fredy Suter, Grazia Valsecchi, Marco Rizzi, Veronica Ravasio, Bruno Hoen, Catherine Chirouze, Efthymia Giannitsioti, Joel Leroy, Patrick Plesiat, Yvette Bernard, Anna Casey, Peter Lambert, Richard Watkin, Tom Elliott, Mukesh Patel, William Dismukes, Angelo Pan, Giampiero Caros, Amel Brahim Mathiron, Christophe Tribouilloy, Thomas Goissen, Armelle Delahaye, Francois Delahaye, Francois Vandenesch, Carla Vizzotti, Francisco M Nacinovich, Marcelo Marin, Marcelo Trivi, Martin Lombardero, Claudia Cortes, José Horacio Casabé, Javier Altclas, Silvia Kogan, Liliana Clara, Marisa Sanchez, Anita Commerford, Cass Hansa, Eduan Deetlefs, Mpiko Ntsekhe, Patrick Commerford, Dannah Wray, Lisa L Steed, Preston Church, Robert Cantey, Arthur Morris, David J Holland, David R Murdoch, Stephen T Chambers, Kerry M Read, Nigel J Raymond, Selwyn Lang, Despina Kotsanas, Tony M Korman, Gail Peterson, Jon Purcell, Paul M Southern Jr, Manisha Shah, Roger Bedimo, Arjun Reddy, Donald Levine, Gaurav Dhar, Alanna Hanlon-Feeney, Margaret Hannan, Sinead Kelly, Andrew Wang, Christopher H Cabell, Christopher W Woods, Daniel J Sexton, Daniel J Benjamin Jr, Jay R McDonald, Jeff Federspiel, John J Engemann, Barth Reller, Laura Drew, L B Caram, Martin Stryjewski, Susan Morpeth, Tahaniyat Lalani, Vance G Fowler Jr, Vivian H Chu, Bahram Mazaheri, Carl Neuerburg, Christoph Naber, Eugene Athan, Margaret Henry, Owen Harris, Eric Alestig, Lars Olaison, Lotta Wikstrom, Ulrika Snygg-Martin, Johnson Francis, K Venugopal, Lathi Nair, Vinod Thomas, Jaruwan Chaiworramukkun, Orathai Pachirat, Ploenchan Chetchotisakd, Tewan Suwanich, Adeeba Kamarulzaman, Syahidah Syed Tamin, Manica Mueller Premru, Mateja Logar, Tatjana Lejko-Zupanc, Christina Orezzi, John L Klein, Emilio Bouz, Marta Rodríguez-Créixems, Mercedes Marín, Miguel Fernández, Patricia Muñoz, Rocío Fernández, Victor Ramallo, Didier Raoult, Franck Thuny, Gilbert Habib, Jean-Paul Casalta, Pierre-Edouard Fournier, Natalia Chipigina, Ozerecky Kirill, Tatiana Vinogradova, Vadim P Kulichenko, O M Butkevich, Christine Lion, Christine Selton-Suty, Hélène Coyard, Thanh Doco-Lecompte, Diana Iarussi, Emanuele Durante-Mangoni, Enrico Ragone, Giovanni Dialetto, Marie Francoise Tripodi, Riccardo Utili, Roberta Casillo, A Sampath Kumar, Gautam Sharma, Stuart A Dickerman, Alan Street, Damon Peter Eisen, Emma Sue McBryde, Leeanne Grigg, Elias Abrutyn, Christian Michelet, Pierre Tattevin, Pierre Yves Donnio, Claudio Querido Fortes, Jameela Edathodu, Mashael Al-Hegelan, Bernat Font, Ignasi Anguera, Joan Raimon Guma, M Cereceda, Miguel J Oyonarte, Rodrigo Montagna Mella, Patricia Garcia, Sandra Braun Jones, Auristela Isabel de Oliveira Ramos, Marcelo Goulart Paiva, Regina Aparecida de Medeiros Tranchesi, Lok Ley Woon, Luh-Nah Lum, Ru-San Tan, David Rees, Pam Kornecny, Richard Lawrence, Robyn Dever, Jeffrey Post, Philip Jones, Suzanne Ryan, John Harkness, Michael Feneley, Ethan Rubinstein, Jacob Strahilewitz, Adina Ionac, Cristian Mornos, Stefan Dragulescu, Davide Forno, Enrico Cecchi, Francesco De Rosa, Massimo Imazio, Rita Trinchero, Franz Wiesbauer, Rainer Gattringer, Ethan Rubinstein, Greg Deans, Arjana Tambic Andrasevic, Bruno Barsic, Igor Klinar, Josip Vincelj, Suzana Bukovski, Vladimir Krajinovic, Christopher H Cabell, Judy Stafford, Khaula Baloch, Paul A Pappas, Thomas Redick, Tina Harding, Adolf W Karchmer, Arnold S Bayer, Bruno Hoen, Christopher H Cabell, Ralph Corey, José M Miro, Philippe Moreillon, Vance G Fowler Jr, Lars Olaison, Daniel J Sexton, David T Durack, Elias Abrutyn, Ethan Rubinstein, Susannah Eykyn, David R Murdoch, Arnold S Bayer, Bruno Hoen, Christopher H Cabell, Vance G Fowler Jr, Vivian H Chu, José M Miro, Ralph Corey, Paul A Pappas, Elias Abrutyn, Eugene Athan
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.
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Source: PubMed