Infective endocarditis, 1984 through 1993: a clinical and microbiological survey

Abstract

Objectives. To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population. Design. A retrospective review. Setting. All episodes hospitalized of infective endocarditis from 1984 to 1993 in Viborg County were reviewed. The county is served by one general and four local hospitals. Subjects. One hundred and nine episodes of suspected infective endocarditis with 62 episodes in 59 patients fulfilling the diagnostic criteria by von Reyn.Results. An overall incidence of 27 episodes per million per year was found. The incidence was 17.4 episodes per million per year in the first part of the decade and 36.5 episodes per million per year in the second part (P Ͻ 0.001). Microscopic haematuria was found in 70.2% of the patients with infective endocarditis, compared to 16.7% of the patients in whom the diagnosis was rejected (P Ͻ 0.01). Staphylococcus aureus was found in 38.9%, non-␤-haemolytic streptococci in 24.1% and Enterococcus faecalis in 16.7%. The overall mortality was 35.5%. The mortality decreased significantly from 50.0% in the first part of the decade to 28.6% in the second part (P Ͻ 0.01). The mortality was 23.1% in patients in whom the diagnosis was established whilst they were alive. This finding was significantly lower than the overall mortality (P Ͻ 0.05). Conclusion. The incidence of infective endocarditis increased during the decade. The frequency of non-␤-haemolytic streptococci was lower than normally reported. Mortality is still high, with the main mortality within the first week in hospital, which stresses the importance of early case detection and treatment.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)

“…Las válvulas protésicas, cardiopatías congénitas, cardiopatías degenerativas esclerocálcicas y marcapasos cardiacos, son las otras patologías cardiacas de base, que van en paralelo a los cambios epidemiológicos ocurridos en los últimos tres a cuatro decenios [4][5][6][7][8] . La ausencia de daño cardiaco estructural en enfermos con EI, se observó en 26,1% de ellos en el examen ecocardiográfico.…”

“…En EI por Pseudomona aeuriginosa, Enterobacteriaceas y hongos, esta mortalidad puede superar el 50% de los casos durante el período intrahospitalario. En una reciente comunicación del grupo del Estudio Colaborativo Internacional de EI (ICE-PCS), la mortalidad durante el episodio agudo fue de 17,7% 5 , a pesar de los avances crecientes en infectología, los altos estándares en aplicación para la técnica de los hemocultivos (automatización), los nuevos y poderosos antibióticos que se emplean en la actualidad en esta enfermedad [6][7][8][9][10] , de la incorporación de nuevas técnicas diagnósticas imagenológicas, entre las que se destaca, especialmente la ecocardiografía [11][12][13][14][15][16][17][18][19] ; los nuevos y estrictos criterios diagnósticos que se han incorporado [20][21][22] y el perfeccionamiento de las técnicas cardioquirúrgicas, incluidos rigurosos controles pre e intraoperatorios, así como de los dispositivos intracardiacos en uso [23][24][25][26][27] , todos ellos factores que se suman para reducir la morbimortalidad de esta patología en las últimas décadas [28][29][30] , esta mortalidad continúa elevada.…”

Streptococcus oralis Neuraminidase Modulates Adherence to Multiple Carbohydrates on Platelets

“…Despite improvements in diagnosis, therapeutics, and surgical treatments, there has been no substantive improvement in the survival rate of IE patients over the last 30 years (1)(2)(3)(4). Vegetative growths on the endocardium that contain bacteria and host factors lead to the clinical effects of IE, including valvular incompetence and congestive heart failure.…”

“…Treatment requires several weeks of antibiotics, and approximately 50% of patients undergo surgery (4). The morbidity and mortality due to IE are high, with an in-hospital death rate of 17.7% and a 1-year mortality approaching 40% (2)(3)(4)(5).…”

The Majority of a Collection of U.S. Endocarditis Enterococcus faecalis Isolates Obtained from 1974 to 2004 Lack Capsular Genes and Belong to Diverse, Non-Hospital-Associated Lineages

“…Endocarditis is a bacterial infection of the valves and/or inner lining of the heart and is uniformly fatal without antibiotic treatment (6). Enterococci cause 5 to 15% of cases of infective endocarditis (IE) (2,7) and are third behind staphylococci and streptococci; however, in the hospital setting, enterococci are second behind staphylococci as a cause of endocarditis (6,8,9). Historically, one species of enterococci, Enterococcus faecalis, causes most cases of enterococcal endocarditis (10)(11)(12)(13).…”