Population-Based Surveillance of Infectious Endocarditis in an Italian Region

Abstract

2008, there was wide support for tight glucose control. The impact of these new data on clinical practice has yet to be determined. Studies such as Steno-2 10 that highlight the mortality benefit of aggressive hypertension and cholesterol control, along with our data, should encourage a renewed emphasis of their control among patients with diabetes. Between 1999-2000 and 2005-2006, improvements occurred in the control of hyperglycemia, hypertension, and high cholesterol level among US adults with diabetes. Also, there was increasingly aggressive medication use with substantially more combination therapy in antidiabetes medications and use of newer agents. The data from this study support the perception that control of hyperglycemia frequently takes precedence over control of hypertension and high cholesterol level among adults with diabetes. These observations support the argument for a reprioritization of diabetes treatment goals emphasizing hypertension and cholesterol control before tight glycemic control as part of an evidence-based global CVD risk reduction effort.

Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system

“…IE diagnoses were validated according to the modified Duke criteria [13], demonstrating a positive predictive value and a sensitivity for IE of the selection applied in the present study equal to 91/123 = 81% and 91/98 = 93%, respectively (Pellizzer, personnel communication). To what extent such findings are applicable to the entire region and study period remains uncertain, but disease misclassification does not probably account for such sharp time trends found in our study; moreover, the incidence rate (4.4 per 100000 person-years) is in the range reported in literature and in particular it's similar to incidences estimated by multicenter prospective surveys conducted in other regions of Northern Italy [14,15]. Furthermore, since the period analyzed to exclude prevalent cases increases over time (minimum = 365 days in 2000), possibly not all prevalent cases have been deleted from early study years, leading to a small underestimation of the real increase of IE incidence; this effect was tested using a constant wash-out time of 365 days through the study period.…”

“…However, some studies included only centres with cardiac surgery units, and the percentage of surgical therapy decreased when restricting analysis to patients admitted directly to study sites [1]; moreover they dealt with a younger population (median age under 60). Among population-based studies, the share of patients submitted to surgery ranged from 12.8% to 40% [9,14,15], with the exception of a survey in France where 49% of subjects were surgically treated [27]. Although there are still some areas of debate and individualized factors must be considered, it's been advocated that early surgery could be worth even in patients with high operative risk [27]; in general, in all IE cases, early surgical consultation is recommended [2,26].…”

Profile of infective endocarditis observed from 2003 - 2010 in a single center in Italy

“…The proportion of negative blood cultures ranged from 5 to 10% in recent surveys from multicenter cohorts [3,6,23] that involved selected tertiary care institutions. However, in the Euro Heart Survey, a prospective study involving 92 centers from 25 European countries and in an Italian population-based surveillance, the incidence of negative blood cultures was 14% and 19.3%, respectively [26,28]. We believe that the microbiology diagnosis can be improved by implementing either serological testing or molecular methods in order to detect rare and fastidious bacteria and fungi that are difficult to grow [24,29-31].…”

FatalEnterococcus duransaortic valve endocarditis: a case report and review of the literature

“…They can be differentiated from other species of catalase-negative gram-positive cocci by their ability to produce PYR reaction. Although staphylococci and streptococci are established as the most common causes of bacterial endocarditis, enterococcal species were detected more frequently in a large surveillance study in Italy 3. This was attributed to a high percentage of elderly patients in that study population.…”