Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data

Abstract

The epidemiology, and clinical and microbiological spectrum, of infective endocarditis (IE) in Greece was analysed in a prospective 4-year study in a tertiary hospital and a heart surgery centre in Athens. In total, 101 cases of IE (71 men, 30 women, aged 54.4 +/- 17.1 years) were studied, with a follow-up period of 3 months. Seventy-seven cases were definite and 24 possible; 59 involved native valves (native valve endocarditis; NVE), 31 prosthetic valves (prosthetic valve endocarditis; PVE), of which nine were early and 22 late, and 11 permanent pacemakers (pacemaker endocarditis; PME). There was a predominant involvement of aortic (48/101) and mitral (40/101) valves. Seven patients had rheumatic valvular disease, two had mitral valve prolapse, and eight had a previous history of IE. Thirteen and six patients had undergone dental and endoscopic procedures, respectively. In 13 patients, intravenous catheters were used within the 3 months before diagnosis of IE. There were three intravenous drug users among the patients. Staphylococcus aureus was the most important pathogen, isolated in 22% of cases, followed by viridans streptococci (19%) and coagulase-negative staphylococci (16%). Enterococcus spp. were responsible for 3%, HACEK group for 2%, and fungi for 6% of cases. Viridans streptococci were the leading cause of NVE (29%), Staphylococcus epidermidis of PVE (16%), and S. aureus of PME (54.5%). Six of 22 S. aureus and ten of 16 S. epidermidis isolates were methicillin-resistant. Surgical intervention, including total pacemaker removal, was performed in 51.5% of patients. Overall mortality was 16%, but was 29% with PVE, and was significantly higher with medical than with combined surgical and medical therapy (24.5% vs. 8%). Compared with previous studies, there were changing trends in the epidemiology, microbiology, treatment and prognosis of IE in Greece.

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

“…Although IE patients included in the present study manifested with a wide range of signs and symptoms, in consistent with the previous studies, [7,8,[11][12][13][14][15][16][17][18] the most common symptom was fever (86.7%), while the most common physical examination finding was murmur (88.1%). The patients who received the diagnosis of IE within the first 30 days following symptom onset accounted only for 53.8% of the study population.…”

“…[2] According to data collected in the Euro Heart Survey study, the mean age of patients at IE onset was 56±17 years in Europe, while a study performed in Greece, one of Turkey's neighbor countries, reported a mean age of 54±17 years. [11,12] The mean age of patients at IE onset is as low as 32 years in countries such as Tunisia and India. [13,14] Studies performed in Turkey in different time points reported the mean age at disease onset varying between 45 and 47 years.…”

“…[2,4,21,22] In contrast, RHD is still a frequent entity in underdeveloped and developing countries and, therefore, IE manifests itself at younger ages and Streptococci remain to be the most frequently isolated IE agent. [2,7,12,21] The most frequently isolated microorganism in the previous studies performed in Turkey was Staphylococcus aureus; however, its incidence considerably varied between studies. [15,17,20] In a multi-central IE study performed by Elbey et al, [16] the rate of Staphylococcus infection was reported as 29%.…”

Detection of Identical Isolates of <i>Enterococcus faecalis</i> from the Blood and Oral Mucosa in a Patient with Infective Endocarditis

“…In the majority of retrospective studies published during the 1990's, the oral cavity was identified to be the portal of entry of the causative microbial agent in 14-20% of cases of bacterial endocarditis (1)(2)(3), with the prevalence of bacterial endocarditis of possible oral origin in recently published series being similar to that reported in these older series (4)(5)(6).…”

Periodontitis, Bacteremia and Infective Endocarditis: A Review Study

“…In all, VGS are now the most frequent etiological agents in IE (54)(55)(56)(57)(58)(59)(60)(61). Moreover, in nonintravenous users, where aortic or mitral IE dominates, VGS are the major etiological agents (25,62).…”