Temporal Trends in Infective Endocarditis

Abstract

HE REPRESENTATIVENESS HEUristic of the clinical features of infective endocarditis (IE) as described by Osler has undergone a significant change in developed countries. 1,2 Previously, IE was a disease that commonly affected patients with predisposing valvular abnormalities caused by rheumatic carditis, with viridans group streptococci the most common causative pathogens. 3 This presentation is currently seen in developing countries, where rheumatic heart disease is still prevalent. In developed countries, mitral valve prolapse (MVP) is now thought to be the most common predisposing cardiac condition in patients with IE. 2 Several recent studies from passively reported case series suggest that Staphylococcus aureus is now the most frequently identified causative pathogen. 1 These more recent clinical observations of IE characteristics, however, are based on data that come primarily from large, tertiary care centers 4,5 and may not reflect true changes in the epidemiology of IE but rather temporal changes in referral patterns. Thus, population-based investigations are needed to more accurately characterize IE in the United States. Olmsted County, Minnesota, is a setting uniquely qualified for the conduct of population-based studies of dis-See also pp 3012 and 3061.

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

“…Several important changes were identified in this population, including a significantly increased rate of IE in males and those of older age. Our observation of IE predominately affecting older men is a finding that is consistent with other studies 1, 8, 17 . Furthermore, S. aureus and enterococcal IE have outnumbered viridans group streptococci in many contemporary, large institutional experiences 1, 10, 14, 18 .…”

“…Between 2007 and 2013, the age- and sex-adjusted incidence rates of IE did not change significantly over time and the incidence for this period was similar to that for 1970 thru 2006. Six-month mortality occurred in approximately 29% (15/51) of cases, which is consistent with previous reports in this population 3, 8 and other hospital-based studies 18, 19 . Interestingly, 14 of 15 patients who died within 6-months did not undergo surgery.…”

Twenty-Year Secular Trends in Infective Endocarditis in a Teaching Hospital

“…In our setting, despite a nonsignificant decrease throughout the study period, the main etiology remained VGS with a stable percentage of S. aureus . This is in line with the findings of a population-based study in Olmsted County, Minnesota [ 5 ], and a recent review of IE epidemiology in Europe [ 24 ]. We detected a slight increase in the last 2 periods (without a statistically significant upward trend along the study period) of IE caused by Enterococcus spp.…”

“…The increased mean age could explain the increase in IE among biological prosthetic valves in our series. Unlike other cohorts, however, there was no increase in prosthetic valve, nosocomial, or health care–associated IE in our study [ 5 , 17 , 21 , 22 ]. This may result from our decision to exclude cardiac device–related IE [ 23 ].…”

The Changing ‘Face’ of Endocarditis in Kentucky: An Increase in Tricuspid Cases

“…2 To our knowledge, there is only one study from 1970-2000 that reported Streptococci as the most common causative agent of infective endocarditis. 16 In that study by Tleyjeh et al, intravenous drug use prevalence (3%) was markedly lower than in our study. Studies have shown intravenous drug use is associated with increased rates of S aureus endocarditis.…”