Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study

Hill, Evelyn; Herijgers, Paul; Claus, Piet; Vanderschueren, Steven; Herregods, Marie‐Christine; Peetermans, Willy

doi:10.1093/eurheartj/ehl427

Cited by 332 publications

(213 citation statements)

References 26 publications

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“…[14][15][16]19] On the other hand, the most common predisposing condition observed in the developed western societies is degenerative valvular diseases, which is in line with the aging population. [5,8] In the present study, although the most common predisposing risk factor was RHD, the rate of RHD was found to be lower than the rates previously reported by other Turkish studies. [15,16] History of prosthetic (mechanical or biological) valve operation or surgical valve repair and dental interventions were found to be the other significant predisposing risk factors.…”

Section: Discussioncontrasting

confidence: 79%

“…This rate is considerably higher than the rates reported in the Western patient series. The ratio of negative blood culture growth was reported as 11% in the study of Hill et al, [5] 10.8% in EIRA-2 study, and 10% in ICE-PCS study. [7,8] This rate varied between 35 and 43% in previous Turkish studies, reaching up to 59% in studies performed in underdeveloped societies.…”

Section: Discussionmentioning

confidence: 90%

“…As shown in Table 3, left-sided IE was more common than right-sided IE in our patient population, a finding which is in consistent with the EIRA-2 study showing right-sided endocarditis in 11% of the cases. [7] On the contrary, in their prospective study performed in Europe, Hill et al [5] reported right-sided endocarditis in 18% of their cases. The lower rate of right-sided endocarditis in our series, compared to the previously reported rates in THE European populations, can be due to less frequent implementation of invasive healthcare procedures, such as hemodialysis and pacemaking, relatively small sample size in the study population who underwent tricuspid valve surgery, and absence of intravenousdrug dependent patients.…”

Section: Discussionmentioning

confidence: 91%

“…[2] As shown in clinical trials, IE incidence has been growing in the recent years, and epidemiological features of the disease have considerably changed. [5] The mean age of IE patients at disease onset significantly varies between studies, ranges from 36 to 69 years. [4] This difference mainly originates from the Western populations, where IE is a disease of the elderly.…”

Section: Discussionmentioning

confidence: 99%

“…[3] In the industrialized countries, IE predominantly affects the individuals without a known valvular disease or elderly with a prosthetic valve. [4,5] As interventional therapeutic procedures become available with the improvements in healthcare, Staphylococci stand out as the most common cause of IE. [3] However, acute rheumatic fever and subsequent rheumatic heart disease (RHD) still remain to be the most significant risk factors in the developing countries, where affected patients are mostly the young individuals and Streptococci are the most commonly isolated infectious microorganisms.…”

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confidence: 99%

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Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

Kocabaş¹,

Kaya²,

Çakan³

2017

Turk Gogus Kalp Dama

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ÖZ ABSTRACT Background:This study aims to evaluate the clinical, echocardiographic, and microbiological profile and in-hospital complication and mortality rates of infective endocarditis cases in the tertiary setting. Methods: A total of 210 consecutive cases (138 males, 72 females; mean age 48.8±17.9 years; range, 18 to 89 years) who were diagnosed with definite infective endocarditis based on the modified Duke criteria and treated between September 2000 and September 2015 were retrospectively analyzed. Results:The rate of prosthetic valve infective endocarditis was 12.3%. Rheumatic heart disease was the most common predisposing factor (20.5%). Transthoracic and/or transesophageal echocardiography showed a vegetation in 174 cases (82.9%). Causative microorganisms were identified in 119 cases (56.7%) as Staphylococci (30.5%), Streptococci (15.2%), and Enterococci (7.6%). Cultures were negative in 91 cases (43.3%). Surgical therapy was necessary in 111 cases (53%). Twenty-four percent of cases had a total recovery with appropriate antibiotheraphy without needing any surgical procedures. The most common complications were septic embolism (25.2%) and congestive heart failure (13.4%). In-hospital mortality occurred in 41 cases (19.5%). Conclusion: Our study results show that infective endocarditis is still associated with high in-hospital mortality and morbidity rates.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

Kocabaş¹,

Kaya²,

Çakan³

2017

Turk Gogus Kalp Dama

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Clinical Characteristics and Factors Associated With Mortality in First-Episode Infective Endocarditis Among Persons Who Inject Drugs

et al. 2018

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Key Points Question In first-episode infective endocarditis in persons who inject drugs, what are the clinical differences between patients who receive surgery vs those who are medically treated, and which factors are associated with mortality? Findings In this case series of 370 first-episode cases of infective endocarditis, the main significant differences between persons who inject drugs who received surgery and those who did not were the site of infection and cardiac complications. Decreased mortality was associated with surgery and referral to addiction treatment services, while higher mortality was associated with left-sided and bilateral infections. Meaning In selected persons who inject drugs with first-episode endocarditis, surgical management and referral to addiction treatment were associated with reduced mortality.

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Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

et al. 2022

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IMPORTANCEEmerging evidence supports the use of outpatient parenteral antimicrobial therapy (OPAT) and, in many cases, partial oral antibiotic therapy for the treatment of injection drug use-associated infective endocarditis (IDU-IE); however, long-term outcomes and cost-effectiveness remain unknown. OBJECTIVE To compare the added value of inpatient addiction care services and the costeffectiveness and clinical outcomes of alternative antibiotic treatment strategies for patients with IDU-IE. DESIGN, SETTING, AND PARTICIPANTS This decision analytical modeling study used a validated microsimulation model to compare antibiotic treatment strategies for patients with IDU-IE. Model inputs were derived from clinical trials and observational cohort studies. The model included all patients with injection opioid drug use (N = 5 million) in the US who were eligible to receive OPAT either in the home or at a postacute care facility. Costs were annually discounted at 3%. Costeffectiveness was evaluated from a health care sector perspective over a lifetime starting in 2020. Probabilistic sensitivity, scenario, and threshold analyses were performed to address uncertainty. INTERVENTIONS The model simulated 4 treatment strategies: (1) 4 to 6 weeks of inpatient intravenous (IV) antibiotic therapy along with opioid detoxification (usual care strategy), (2) 4 to 6 weeks of inpatient IV antibiotic therapy along with inpatient addiction care services that offered medication for opioid use disorder (usual care/addiction care strategy), (3) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by OPAT (OPAT strategy), and (4) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by partial oral antibiotic therapy (partial oral antibiotic strategy). MAIN OUTCOMES AND MEASURES Mean percentage of patients completing treatment for IDU-IE, deaths associated with IDU-IE, life expectancy (measured in life-years [LYs]), mean cost per person, and incremental cost-effectiveness ratios (ICERs). RESULTSAll modeled scenarios were initialized with 5 million individuals (mean age, 42 years; range, 18-64 years; 70% male) who had a history of injection opioid drug use. The usual care strategy resulted in 18.63 LYs at a cost of $416 570 per person, with 77.6% of hospitalized patients completing treatment. Life expectancy was extended by each alternative strategy. The partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the OPAT strategy (78.8%) and the usual care/addiction care strategy (77.6%). The OPAT strategy was the least expensive at $412 150 per person. Compared with the OPAT strategy, the partial oral antibiotic (continued) Key Points Question What is the most clinically beneficial and cost-effective antibiotic treatment strategy for injection drug use-associated infective endocarditis (IDU-IE)? Findings In this decision analytical modeling study simulating 4 treatment strategies among 5 million individuals with IDU-IE in the US, a va...

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Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study

Cited by 332 publications

References 26 publications

Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

Clinical Characteristics and Factors Associated With Mortality in First-Episode Infective Endocarditis Among Persons Who Inject Drugs

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

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