Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN

Abstract

Background To determine if there have been contemporary shifts in IE epidemiology in our local population, an analysis of cases from 2007–2013 was conducted. Methods Population-based review of all adults (≥18 years) residing in Olmsted County, Minnesota, with definite or possible IE using the Rochester Epidemiology Project from January 1, 2007 through December 31, 2013. Results We identified 51 cases of IE in Olmsted County, MN between 2007 and 2013. Median age of IE cases was 68.8 years (IQR 55.6–76.5), and 41% were females. Age- and sex-adjusted incidence of IE was 7.4 (95% CI, 5.3–9.4) cases per 100,000 person-years. From a multivariable Poisson regression model, incidence of IE did not change significantly during the study period (p=0.222) but was significantly higher in males and those of older age (p<0.001). The annual incidences (per 100,000 person years) was 2.5 for Staphylococcus aureus, 1.1 for viridans group streptococci, 1.6 for Enterococcus species, and 0.8 for coagulase-negative staphylococci. Only 19.6% (10/51) of Olmsted County patients underwent valve surgery between 2007–2013 as compared to 44.4% (197/444) of non-Olmsted County patients treated at Mayo Clinic Rochester. Conclusion In this population-based study, no significant change in the overall incidence of IE in Olmsted County, MN, between 2007 and 2013 was seen and it was similar to that seen between 1970 and 2006. Male gender and older age were associated with increased IE risk. With a lesser extent of cases attributable to viridans group streptococcal IE compared to previous years, S. aureus was the predominant pathogen in IE cases during 2007–2013. The relatively low valve surgery rate was disparate from that reported from large, tertiary care centers (including our own) with non-population-based cohorts, which are subject to referral bias and can influence the expected characterization of IE.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…11 These findings from referral centers were corroborated by a community-based review of adults in Olmsted County, MN. 14 In this study, age- and sex-adjusted incidence of IE was 7.4 (95% CI, 5.3–9.4) cases per 100 000 person-years. In addition, these guideline changes do not appear to have altered rates of pediatric endocarditis.…”

The Musculoskeletal System Involvement in Patients With Infective Endocarditis

“…According to the literature, musculoskeletal manifestations in patients with IE are part of the complex symptomatology, their presence worsening the clinical course of the disease and increasing the duration of hospitalization. In some instances, these symptoms may arise at onset of the disease in the absence of specific IE clinical signs, causing difficulties in diagnosis establishment and consequently, appropriate treatment initiation [9][10] . However, musculoskeletal changes occur more frequently during the course of the disease and represent manifestations of its complications, more frequently neurological and embolic ones.…”

Streptococcus mutans isolated from a 4‐year‐old girl diagnosed with infective endocarditis

“…A slight but statistically significant increase in the number of IE episodes was observed after 5 years (Dayer et al, 2015). Regarding the U.S. and European countries except the United Kingdom, there are various reports about the increase or decrease in the incidence of IE (Bikdeli et al, 2013;Cahill et al, 2017;DeSimone et al, 2015;Duval et al, 2012;Erichsen, Gislason, & Bruun, 2016;Keller et al, 2017;Mackie, Liu, Savu, Marelli, & Kaul, 2016;Pant, Deshmukh, & Mehta, 2015;Toyoda et al, 2017).…”

“…A slight but statistically significant increase in the number of IE episodes was observed after 5 years (Dayer et al, ). Regarding the U.S. and European countries except the United Kingdom, there are various reports about the increase or decrease in the incidence of IE (Bikdeli et al, ; Cahill et al, ; DeSimone et al, ; Duval et al, ; Erichsen, Gislason, & Bruun, ; Keller et al, ; Mackie, Liu, Savu, Marelli, & Kaul, ; Pant, Deshmukh, & Mehta, ; Toyoda et al, ). Among these reports, the number of IE episodes was reported to have increased due to oral streptococci, suggesting a causal relationship between preventive medication and dental treatment (Pant et al, ).…”