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

Murdoch, David R ; Corey, G Ralph ; Hoen, Bruno ; Miró, José M ; Fowler, Vance G ; Bayer, Arnold S ; Karchmer, Adolf W ; Olaison, Lars ; Pappas, Paul A ; Moreillon, Philippe ; Chambers, Stephen T ; Chu, Vivian H ; Falcó, Vicenç ; Holland, David J ; Jones, Philip ; Klein, John L ; Raymond, Nigel J ; Read, Kerry M ; Tripodi, Marie Francoise ; Utili, Riccardo ; Wang, Andrew ; Woods, Christopher W ; Cabell, Christopher H ; Renseigné, Non

Archives of Internal Medicine, 2009-03, Vol.169 (5), p.463-73

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Título:
Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study
Autor: Murdoch, David R ; Corey, G Ralph ; Hoen, Bruno ; Miró, José M ; Fowler, Vance G ; Bayer, Arnold S ; Karchmer, Adolf W ; Olaison, Lars ; Pappas, Paul A ; Moreillon, Philippe ; Chambers, Stephen T ; Chu, Vivian H ; Falcó, Vicenç ; Holland, David J ; Jones, Philip ; Klein, John L ; Raymond, Nigel J ; Read, Kerry M ; Tripodi, Marie Francoise ; Utili, Riccardo ; Wang, Andrew ; Woods, Christopher W ; Cabell, Christopher H ; Renseigné, Non
Assuntos: Adult ; Aged ; Endocarditis ; Female ; Human health and pathology ; Humans ; Infectious diseases ; Life Sciences ; Male ; Middle Aged ; Prospective Studies ; Staphylococcal Infections ; Staphylococcus aureus
É parte de: Archives of Internal Medicine, 2009-03, Vol.169 (5), p.463-73
Descrição: 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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