Epidemiology of infective endocarditis in French intensive care units over the 1997–2014 period—from CUB-Réa Network

Abstract

Background Few studies focus only on severe forms of infective endocarditis, for which organ failure requires admission to an intensive care unit (ICU). This study aimed to describe demographical, comorbidities, organ failure, and pathogen-related characteristics in a population of critically ill patients admitted to ICU for infective endocarditis and to identify risk factors of in-ICU mortality. Methods Retrospective observational multicenter ( N = 34) study of the CUB-Rea register, based on ICD-10 coding rules, between 1997 and 2014 in France including ICU patients managed for infective endocarditis. In-ICU mortality associated factors were assessed by multivariate logistic regression including an interrupted time analysis of three periods (1997–2003, 2004–2009, and 2010–2014). Results Four thousand four hundred five patients admitted in ICU for infective endocarditis were included. We observed an increase in endocarditis prevalence, as well as an increase in organ failure severity over the three periods. In addition, valve surgery was more frequently performed (27%, 31%, and 42%, P < 0.0001) while in-ICU mortality significantly decreased (28%, 29%, and 23%, P < 0.001). Since 2010, a significant increase in the trends’ slope of incidence for Streptococcus sp. and Staphylococcus sp. was observed with no change concerning intracellular bacteria, Enterococcus sp. or Candida sp. slope trends. In multivariate analysis, age, SAPS2, organ failure, stroke, and Staphylococcus sp. were associated with ICU mortality. Conversely, surgery, intracardiac devices, male gender, and Streptococcus sp.-related infective endocarditis were associated with a better outcome. Conclusions Our study reveals a shifting landscape of infective endocarditis epidemiology in French ICUs, characterized by reduced in-ICU mortality despite higher severity, more surgery, and substantial changes in microbial epidemiology. Electronic supplementary material The online version of this article (10.1186/s13054-019-2387-8) contains supplementary material, which is available to authorized users.

Infective endocarditis according to type 2 diabetes mellitus status: an observational study in Spain, 2001–2015

“…T2DM was not associated with a higher IHM in our multivariable analysis. In the literature, both opposite and similar results have been published [13, 22–31].…”

“…A previous Spanish investigation based in three tertiary care centers reported that multivariable analysis showed that DM had an independent association with development of septic shock (OR 2.282; 95% CI 1.186–4.393), but it was not a predictor of IHM [23]. In France among 4405 IE patients admitted to ICU, 14% suffering DM, this condition was not a predictor of IHM [31].…”

“…However other studies didn’t identify DM as a risk factor [9, 23, 26, 28–31]. Fedeli et al and Sy et al in population based studies conducted in Veneto Region (North-Eastern Italy) and Australia did not find that DM was a risk factor for mortality [9, 28].…”

“…Further, patients with DM are prone to severe endothelial dysfunction, which is one of the central pathophysiologic steps in the development of IE [14, 15]; (iii) The number of epidemiological population-based studies that have suggested that DM increases the risk of IE is still limited [16–20], and (iv) A recent review to assess the predictors of in-hospital mortality (IHM) in patients with IE concluded that most studies are retrospective, provide data from one or few tertiary center, have long recruitment periods and sample sizes are usually small [21]. Regarding IHM after IE among diabetic patients the number of investigations is limited and results are inconsistent [13, 22–31].…”

National Temporal Trend Analysis of Infective Endocarditis among Patients Infected with HIV in Spain (1997–2014): A Retrospective Study

“…In Spain, Olmos et al found that the IE incidence in the general population increased from 2.72 in 2003 to 3.49 per 100,000 person-years in 2014, in a work published with data from the Minimum Basic Data Set (MBDS) from Spain [3]. Several population-based studies in Europe have also showed an increase in IE incidence in the general population [4,5,6,7] and in intensive care units [8] over time. Regarding the responsible infectious agents, streptococci and staphylococci are the most common cause of IE (approximately 80%) in most developed countries, but the proportion of these two microorganisms varies by region and year.…”