Zapalenie wsierdzia
Epidemiologia
Zapalenie wsierdzia (IE) pozostaje chorobą o rosnącej częstości występowania, szczególnie w krajach rozwiniętych, gdzie częstość wynosi od 2,6 do 15 przypadków na 100 000 mieszkańców rocznie, z tendencją wzrostową w ostatnich dekadach. Mediana wieku pacjentów wzrosła do 58-69 lat, a ponad połowa chorych to osoby powyżej 50 roku życia. Wzrosła także liczba przypadków związanych z opieką zdrowotną, stanowiących obecnie 24-50% wszystkich zachorowań, co wiąże się z rosnącym zastosowaniem urządzeń wewnątrzsercowych i cewników dożylnych. W USA obserwuje się dodatkowo wzrost zapalenia wsierdzia u dożylnych użytkowników narkotyków, z częstością około 2 przypadków na 1000 osób w tej grupie. Dominującym patogenem stał się Staphylococcus aureus, odpowiadający za około 40% przypadków, co jest zmianą w stosunku do ery przedantybiotykowej, gdy dominowały paciorkowce z grupy viridans. Śmiertelność wewnątrzszpitalna wynosi 14-30%, a jednoroczna może sięgać 40%, z czynnikami ryzyka obejmującymi wiek, niewydolność serca, etiologię gronkowcową oraz powikłania wewnątrzsercowe.
- Epidemiologia zapalenia wsierdzia
- Globalna zachorowalność
- Zmieniający się profil demograficzny
- Zmieniające się czynniki ryzyka
- Zapalenie wsierdzia związane z opieką zdrowotną
- Wpływ dożylnego używania narkotyków
- Mikrobiologia i patogeny
- Regionalne różnice w epidemiologii
- Chorobowość i śmiertelność
- Nadzór i zapobieganie
- Przyszłe trendy
- Przegląd danych epidemiologicznych
- Nowe wyzwania w nadzorze epidemiologicznym
Epidemiologia zapalenia wsierdzia
Zapalenie wsierdzia (IE – Infective Endocarditis) pozostaje rzadką, lecz potencjalnie śmiertelną chorobą, charakteryzującą się istotnymi zmianami epidemiologicznymi w ostatnich dziesięcioleciach. Pomimo postępów w diagnostyce i leczeniu, choroba ta nadal wiąże się z wysoką chorobowością i śmiertelnością.12 Zrozumienie zmieniającej się epidemiologii zapalenia wsierdzia jest kluczowe dla skutecznej profilaktyki i leczenia tej choroby.
Globalna zachorowalność
Częstość występowania zapalenia wsierdzia w krajach rozwiniętych wynosi od 2,6 do 9 przypadków na 100 000 mieszkańców rocznie.12 W ostatnich dziesięcioleciach obserwuje się tendencję wzrostową zachorowalności. W Stanach Zjednoczonych częstość przypadków zwiększyła się z 11 na 100 000 mieszkańców w 2000 roku do 15 na 100 000 mieszkańców w 2011 roku.1 Niektóre badania wskazują na jeszcze wyższe wartości – do 12,7 przypadków na 100 000 osób rocznie.1
We Francji roczna zachorowalność na zapalenie wsierdzia została oszacowana na 33,8 przypadków na milion mieszkańców.1 Z kolei badanie obserwacyjne w Hiszpanii wykazało wzrost częstości występowania z 2,72 do 3,49 na 100 000 osobolat między 2003 a 2014 rokiem.2 Według Europejskiego Towarzystwa Kardiologicznego (ESC) szacowana globalna częstość występowania wynosi około 13,8 przypadków na 100 000 osób rocznie.1
Zmieniający się profil demograficzny
Jedną z najważniejszych zmian epidemiologicznych jest wzrost średniego wieku pacjentów z zapaleniem wsierdzia. Obecnie mediana wieku wynosi od 58 do 69 lat, przy czym ponad 50% pacjentów ma ponad 50 lat.12 Badanie Mendiratty i współpracowników wykazało 26% wzrost hospitalizacji z powodu zapalenia wsierdzia wśród pacjentów w wieku 65 lat i starszych, z 3,19 do 3,95 na 10 000 osób w tej grupie wiekowej.1
Zapalenie wsierdzia jest trzykrotnie częstsze u mężczyzn niż u kobiet, z szacunkowym stosunkiem płci 1,7:1.12 Jednak w badaniu przeprowadzonym w hrabstwie Minnesota między 1970 a 2006 rokiem, podczas gdy częstość występowania u mężczyzn pozostała stabilna (8,6 do 12,7 przypadków/100 000 osobolat), u kobiet wzrosła znacząco (z 1,4 do 6,7 przypadków/100 000 osobolat).1
Zmieniające się czynniki ryzyka
W krajach rozwiniętych nastąpiły istotne zmiany w epidemiologii zapalenia wsierdzia, z pojawieniem się nowych czynników ryzyka, takich jak obecność urządzeń wewnątrzsercowych (głównie defibrylatorów i stymulatorów) oraz zwyrodnieniowe choroby zastawek, co przyczyniło się do przesunięcia częstości występowania zapalenia wsierdzia w kierunku starszej populacji (≥65 lat).1
Współczesne czynniki ryzyka obejmują:12
- Wiek powyżej 60 lat 1
- Płeć męska 1
- Dożylne używanie narkotyków 12
- Wcześniejsze zapalenie wsierdzia 1
- Zły stan uzębienia lub zabiegi stomatologiczne 1
- Obecność zastawki sztucznej lub urządzenia wewnątrzsercowego 12
- Choroby zastawkowe (choroba reumatyczna serca, wypadanie zastawki mitralnej, choroba zastawki aortalnej, niedomykalność mitralna) 1
- Wrodzone wady serca (zwężenie aorty, dwupłatkowa zastawka aortalna, zwężenie tętnicy płucnej, ubytek przegrody międzykomorowej, przetrwały przewód tętniczy, koarktacja aorty i tetralogia Fallota) 1
- Cewniki dożylne 1
- Immunosupresja 1
- Hemodializa 12
- Cukrzyca 1
Zapalenie wsierdzia związane z opieką zdrowotną
Jedną z najbardziej zauważalnych zmian w epidemiologii zapalenia wsierdzia jest wzrost przypadków związanych z opieką zdrowotną. Zapalenie wsierdzia związane z opieką zdrowotną obejmuje przypadki szpitalne, a także przypadki występujące w społeczności po niedawnej hospitalizacji lub jako konsekwencja długotrwałego stosowania urządzeń medycznych.1
Zapalenie wsierdzia związane z opieką zdrowotną stanowi od 24% do 34% przypadków niezwiązanych z aktualną operacją kardiochirurgiczną i obejmuje jeszcze większy odsetek przypadków w Stanach Zjednoczonych.1 W badaniu przeprowadzonym we Francji w 2008 roku zapalenie wsierdzia związane z opieką zdrowotną stanowiło 27% przypadków.1
Obecnie zapalenie wsierdzia związane z opieką zdrowotną stanowi już około połowy wszystkich przypadków i oczekuje się, że w najbliższej przyszłości będzie nadal wzrastać.1 Szczególnie niepokojące jest to, że ryzyko zapalenia wsierdzia może wynosić nawet 10% w przypadkach bakteriemii wywołanej przez S. aureus związanej z cewnikiem.1
Wpływ dożylnego używania narkotyków
Ostatnia epidemia opioidowa znacząco wpłynęła na obecną epidemiologię zapalenia wsierdzia w krajach rozwiniętych, szczególnie w USA, gdzie obserwuje się zwiększoną częstość występowania zapalenia wsierdzia zastawki trójdzielnej z powodu dożylnego używania narkotyków, dotykającego głównie kobiety i młode osoby.1
Częstość występowania zapalenia wsierdzia u osób używających narkotyków dożylnie jest znacznie wyższa niż w populacji ogólnej i wynosi około 2 przypadki na 1000 osób w tej grupie pacjentów.1 Badanie przeprowadzone w wiejskich regionach stanu Nowy Jork wykazało zwiększoną częstość występowania dożylnego używania narkotyków wśród przypadków zapalenia wsierdzia w latach 2015-2016 w porównaniu z latami poprzednimi.1
Mikrobiologia i patogeny
W krajach o wysokim dochodzie profil mikrobiologiczny zapalenia wsierdzia uległ znaczącym zmianom w ciągu ostatnich dziesięcioleci. Przed erą antybiotyków i do lat 60-70. XX wieku paciorkowce z grupy viridans odpowiadały za większość przypadków zapalenia wsierdzia.1
Obecnie gatunki gronkowców wyprzedziły paciorkowce z grupy viridans, stanowiąc do 40% przypadków, przy czym S. aureus jest dominującym organizmem.1 Ta zmiana wiąże się z rosnącą populacją osób z obniżoną odpornością, takich jak pacjenci długotrwale przyjmujący sterydy i inne leki immunosupresyjne, oraz osoby po przeszczepach narządów stałych lub szpiku kostnego.2
Zmiana ta jest również związana ze wzrostem stosowania długotrwale utrzymywanych cewników, zwiększeniem liczby zabiegów inwazyjnych, takich jak przezcewnikowa implantacja zastawki aortalnej (TAVR), oraz wszechobecnością urządzeń protetycznych, w tym sztucznych zastawek i urządzeń wszczepialnych do elektroterapii serca.3
Regionalne różnice w epidemiologii
Istnieją znaczące różnice regionalne w epidemiologii zapalenia wsierdzia na świecie. W krajach o niskim dochodzie zapalenie wsierdzia wciąż pozostaje chorobą podostrą lub przewlekłą, występującą głównie u młodszych pacjentów z reumatycznymi nieprawidłowościami zastawek, przy dominacji paciorkowców jako czynników etiologicznych.1
W przeciwieństwie do tego, w krajach rozwiniętych, takich jak USA i Europa, zapalenie wsierdzia szybko się zmienia, prezentując niewiele klasycznych objawów klinicznych tradycyjnie kojarzonych z tą chorobą.1 W tych krajach dominują przypadki związane z opieką zdrowotną, u starszych pacjentów z wieloma chorobami współistniejącymi.1
Badanie epidemiologiczne w Hiszpanii wykazało znaczne różnice między różnymi regionami autonomicznymi pod względem częstości występowania, predysponujących warunków i profilu mikrobiologicznego zapalenia wsierdzia.1 Podobnie, badanie z zachodnich Indii podkreśliło różnice w epidemiologii, profilu klinicznym i spektrum mikrobiologicznym zapalenia wsierdzia w porównaniu ze światem zachodnim.1
Chorobowość i śmiertelność
Pomimo postępu w diagnostyce i leczeniu, zapalenie wsierdzia pozostaje chorobą o wysokiej śmiertelności. Śmiertelność wewnątrzszpitalna wynosi od 14% do 30%, a śmiertelność jednoroczna może sięgać nawet 40%.12
Czynniki ryzyka związane ze zwiększoną śmiertelnością wewnątrzszpitalną obejmują:1
- Wiek
- Wcześniejsza operacja serca
- Choroby naczyniowo-mózgowe
- Migotanie przedsionków
- Etiologia Staphylococcus lub Candida
- Powikłania wewnątrzsercowe
- Niewydolność serca
- Wstrząs septyczny
Z kolei niezależne czynniki ryzyka śmiertelności jednorocznej to:2
- Wiek (iloraz szans [OR], 1,02)
- Nowotwór (OR, 2,46)
- Niewydolność nerek (OR, 1,59)
- Niewydolność serca (OR, 4,42)
Powikłania zatorowe występują u 12-40% pacjentów z zapaleniem wsierdzia i mogą dotyczyć każdego narządu lub tkanki z zaopatrzeniem tętniczym, w tym ośrodkowego układu nerwowego (najczęściej), płuc (szczególnie w przypadku prawostronnego zapalenia wsierdzia), śledziony, nerek, wątroby i układu mięśniowo-szkieletowego.1
Nadzór i zapobieganie
Biorąc pod uwagę zmiany w epidemiologii zapalenia wsierdzia, kluczowe znaczenie ma skuteczny nadzór i strategie zapobiegawcze. Obecne wytyczne podkreślają znaczenie wczesnej interwencji chirurgicznej u wielu pacjentów z zapaleniem wsierdzia, co może zmniejszyć chorobowość i śmiertelność związaną z tą chorobą.12
Aktualna literatura potwierdza korzyści z multidyscyplinarnego podejścia do leczenia zapalenia wsierdzia, co prowadzi do znacznego zmniejszenia ogólnej śmiertelności wewnątrzszpitalnej i przeżywalności jednorocznej. Z tego powodu obecne wytyczne zalecają, aby specjalistyczny zespół (tzw. Zespół ds. Zapalenia Wsierdzia) był zinstytucjonalizowany w ośrodkach referencyjnych do leczenia pacjentów z zapaleniem wsierdzia.1
Badanie obserwacyjne pacjentów z zapaleniem wsierdzia związanym z używaniem narkotyków (DUA-IE) w Północnej Karolinie wykazało, że trzyletnie ryzyko śmiertelności lub hospitalizacji z powodu poważnego zakażenia wynosiło 38%. Ryzyko wystąpienia zakażenia wzrastało w ciągu trzech lat obserwacji, przy czym skumulowana częstość hospitalizacji z powodu poważnego zakażenia wynosiła odpowiednio 18%, 23% i 29% po jednym, dwóch i trzech latach.1
Przyszłe trendy
Przewiduje się, że w najbliższej przyszłości epidemiologia zapalenia wsierdzia będzie nadal ewoluować. Rosnąca liczba zabiegów wewnątrznaczyniowych i wewnątrzsercowych związanych z implantacją urządzeń prawdopodobnie przyczyni się do zwiększenia liczby pacjentów z grupy ryzyka.1
Ponadto, ze względu na starzenie się populacji i zwiększoną częstość występowania chorób zwyrodnieniowych zastawek, można oczekiwać dalszego przesunięcia epidemiologii zapalenia wsierdzia w kierunku starszych grup wiekowych.1
Wyzwaniem pozostaje również rosnąca liczba przypadków zapalenia wsierdzia związanego z dożylnym używaniem narkotyków, szczególnie w kontekście trwającej epidemii opioidowej.1 Zmiany te wymagają dostosowania strategii profilaktycznych i terapeutycznych w celu skutecznego zwalczania zmieniającego się profilu epidemiologicznego zapalenia wsierdzia.
Przegląd danych epidemiologicznych
| Parametr epidemiologiczny | Wartość/Charakterystyka | Trendy |
|---|---|---|
| Globalna częstość występowania | 2,6-9 przypadków na 100 000 mieszkańców rocznie | Tendencja wzrostowa w ostatnich dekadach |
| Częstość występowania w USA | 11-15 przypadków na 100 000 mieszkańców | Wzrost z 11 do 15 na 100 000 między 2000 a 2011 |
| Częstość występowania w Europie | 2,72-5,77 na 100 000 mieszkańców (Hiszpania) | Wzrost z 2,72 do 3,49 na 100 000 między 2003-2014 |
| Mediana wieku pacjentów | 58-69 lat | Wzrost w porównaniu z 30-40 lat w erze przedantybiotykowej |
| Stosunek płci (M:K) | 1,7:1 do 3:1 | Stabilny, z tendencją do zmniejszania różnic |
| Śmiertelność wewnątrzszpitalna | 14-30% | Utrzymująca się wysoka pomimo postępów w leczeniu |
| Śmiertelność jednoroczna | Do 40% | Utrzymująca się wysoka |
| IE związane z opieką zdrowotną | 24-50% wszystkich przypadków | Znaczący wzrost w ostatnich dekadach |
| Główny patogen przed 1960 | Paciorkowce z grupy viridans | Spadek udziału procentowego |
| Główny patogen obecnie | Staphylococcus aureus | Wzrost do około 40% przypadków |
| IE u dożylnych użytkowników narkotyków | 2 przypadki na 1000 osób | Wzrost w kontekście epidemii opioidowej |
| Hemodializa jako czynnik ryzyka | Do 25% przypadków IE | Wzrost w związku ze zwiększającą się populacją pacjentów z ESRD |
Nowe wyzwania w nadzorze epidemiologicznym
Zmieniający się obraz epidemiologiczny zapalenia wsierdzia stwarza nowe wyzwania dla systemów nadzoru i monitorowania. Dokładne oszacowanie częstości występowania IE jest trudne, ponieważ definicje przypadków zmieniały się w czasie między autorami i ośrodkami klinicznymi.1 Dodatkowo, częstość występowania czynników predysponujących, takich jak choroba reumatyczna serca czy dożylne używanie narkotyków, jest zmienna w czasie i między regionami geograficznymi.2
W celu poprawy nadzoru epidemiologicznego, w 2008 roku utworzono w Hiszpanii krajową grupę badawczą do spraw zapalenia wsierdzia (GAMES), we współpracy z Międzynarodową Współpracą ds. Zapalenia Wsierdzia (ICE). Jej celami była poprawa opieki nad pacjentami z IE i prowadzenie badań w Hiszpanii.1 Podobne inicjatywy w innych krajach mogłyby przyczynić się do lepszego zrozumienia regionalnych różnic w epidemiologii zapalenia wsierdzia i dostosowania strategii profilaktycznych i terapeutycznych do lokalnych potrzeb.
Kolejnym wyzwaniem jest monitorowanie przypadków zapalenia wsierdzia związanego z nowymi procedurami, takimi jak przezcewnikowa implantacja zastawki aortalnej (TAVR). Badania wykazały, że częstość występowania IE wynosiła 1,93% dla balonowo rozprężalnych i 0,45% dla samorozprężalnych przezcewnikowych zastawek serca.1 Wraz z rosnącą popularnością tych procedur, konieczne będzie ścisłe monitorowanie ryzyka zapalenia wsierdzia i opracowanie skutecznych strategii profilaktycznych.
Wpływ zmian epidemiologicznych na praktykę kliniczną
Zmiany w epidemiologii zapalenia wsierdzia mają istotne implikacje dla praktyki klinicznej. Ponieważ szpitalne zapalenie wsierdzia staje się coraz bardziej powszechne, konieczne jest wdrożenie bardziej rygorystycznych środków zapobiegania bakteriemii związanej z opieką zdrowotną.1
Ponadto, wraz ze wzrostem liczby przypadków zapalenia wsierdzia u osób starszych z wieloma chorobami współistniejącymi, konieczne jest dostosowanie podejścia diagnostycznego i terapeutycznego do tej populacji. U tych pacjentów częściej występują nietypowe objawy kliniczne, a leczenie może być bardziej skomplikowane ze względu na choroby współistniejące i ryzyko interakcji lekowych.12
Wreszcie, wzrost liczby przypadków zapalenia wsierdzia związanego z dożylnym używaniem narkotyków wymaga specjalnego podejścia do tej populacji, uwzględniającego zarówno leczenie infekcji, jak i uzależnienia. Badania wykazały, że osoby z zapaleniem wsierdzia związanym z używaniem narkotyków są narażone na wysokie ryzyko śmiertelności i przyszłej hospitalizacji z powodu zakażeń bakteryjnych, w tym zapalenia wsierdzia, zakażeń skóry i tkanek miękkich oraz bakteriemii.1
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Materiały źródłowe
- #1 Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Managementhttps://www.mdpi.com/2075-1729/13/2/377
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. […] The incidence of IE is estimated to be around 3â7/100,000 person-years, which has apparently been increasing over the last decades. The in-hospital mortality rate is high, ranging from 14 to 22%, with a high incidence of per year mortality (up to 15â30%) and a five-year survival rate, similar or even worse, than some cancers. […] The increasing incidence of IE in the last 30 years, in the absence of improvement in outcomes and mortality, makes it a disease with a high impact on public health resources in terms of hospitalization and treatment costs.
- #1 Bacterial Endocarditis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK470547/
In developed countries, the incidence of endocarditis ranges from 2.6 to 7 cases per 100,000 population per year. The median age of patients with endocarditis is 58 years. […] Age greater than 60 years, male gender, injection drug use, history of prior infective endocarditis, poor dentition or dental procedure, presence of a prosthetic valve or intracardiac device, history of valvular disease (rheumatic heart disease, mitral valve prolapse, aortic valve disease, mitral regurgitation, etc), congenital heart disease (aortic stenosis, bicuspid aortic valve, pulmonary stenosis, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot), indwelling intravenous catheter, immunosuppression, hemodialysis patients.
- #1 Native valve endocarditis: Epidemiology, risk factors, and microbiology – UpToDatehttps://www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology
Native valve endocarditis: Epidemiology, risk factors, and microbiology […] The epidemiology, risk factors, and microbiology of native valve infective endocarditis (IE) will be reviewed here. Issues related to the epidemiology of prosthetic valve IE are discussed separately. […] Infective endocarditis (IE) may be acquired in the community or in the context of health care exposure. Community-associated IE refers to IE that develops in the absence of recent contact with a health care setting, with diagnosis established within 48 hours of hospital admission. Health care-associated IE refers to IE that develops in the context of recent contact with a health care setting, with onset of symptoms â¥48 hours after hospitalization. […] Between 2000 and 2011, the incidence of IE in the United States increased from 11 per 100,000 population to 15 per 100,000 population. The precise incidence of IE is difficult to ascertain because case definitions have varied over time between authors and between clinical centers. In addition, the incidence of predisposing conditions such as rheumatic heart disease or injection drug use is variable over time and between regions and in low- and high-income countries.
- #1 Infective Endocarditis: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/216650-overview
In the United States, the incidence of IE is approximately 12.7 cases per 100,000 persons per year. The incidence of IE in other countries is similar to that in the United States. The proportion of patients with intracardiac devices has increased from 13.3% to 18.9%, whereas the proportion of cases with a background of HIV infection has decreased. […] The mean age of patients has increased from 58.6 to 60.8 years and continues to rise; more than 50% of patients are older than 50 years. Mendiratta and colleagues, in their retrospective study of hospital discharges of patients aged 65 years and older with a primary or secondary diagnosis of IE, found that hospitalizations for IE increased 26%, from 3.19 per 10,000 elderly patients to 3.95 per 10,000. IE is 3 times more common in males than in females. There appears to be no racial predilection.
- #1 Native valve endocarditis: Epidemiology, risk factors, and microbiology – UpToDatehttps://www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology
For example, the incidence of IE among patients admitted to Philadelphia-area hospitals from 1988 to 1990 was approximately 11.6 cases per 100,000 person-years. In contrast, the incidence of IE in a Minnesota county between 1970 and 2006 was 5.0 to 7.9 cases per 100,000 person-years. During this time span, the incidence of IE in men remained stable (8.6 to 12.7 cases/100,000 person-years) while the incidence of IE in women increased (from 1.4 to 6.7 cases/100,000 person-years). Other studies have reported incidence rates for IE ranging from 0.6 to 6.0 cases per 100,000 person-years. […] A population-based observational study in France in 2008 noted the annual incidence of IE was 33.8 cases per million. The incidence was highest in men 75 to 79 years and the majority of patients had no known prior heart disease; health care-associated IE accounted for 27 percent of cases. Similarly, an observational study in Spain noted an increase in the incidence of IE between 2003 and 2014, from 2.72 to 3.49 per 100,000 person-years; the rise was higher among older adults.
- #1 Infective Endocarditis: Etiology, Epidemiology and Current Recommendations for the Dental Practitioner | JCDAhttps://jcda.ca/o4
IE affects 15 in 100 000 individuals in the United States, with its incidence increasing annually. The ESCs 2019 estimated global incidence is similar at 13.8 cases per 100 000 and 0.87 deaths per 100 000 population annually. These numbers are increasing: a 17-year study from Italy also demonstrated an increasing annual incidence of IE of 4.6/100 000 population; the dominant reasons for increasing incidence and mortality were cited as an aging population and more cases of staphylococcus and other infections associated with invasive procedures. The prognosis for IE tends to be poor, with a mortality rate of ~30% after 30 days of disease progression. Furthermore, health care-associated IE accounts for 25-30% of cases because of greater use of IV lines and intracardiac devices. IE tends to be more common in men than women, and its incidence increases with age. […] In addition to the physical consequences of IE, psychological affects often go unnoticed and are rarely discussed in the literature. People who survive IE demonstrate a decreased quality of life and evidence of posttraumatic stress disorder.
- #1 Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Managementhttps://www.mdpi.com/2075-1729/13/2/377
In developed countries, the epidemiology of IE has undergone significant changes, with emerging risk factors such as the presence of intracardiac devices (defibrillators and pacemakers mainly) and degenerative valvular disease, thus shifting the incidence of IE towards an older age (â¥65 years old). […] Moreover, the last opioid epidemic has considerably affected the current epidemiology of IE in developed countries, especially in the USA, where there is an increased incidence of tricuspid valve endocarditis due to injection drug use, mainly affecting women and young people. […] The current literature supports the benefits of the multidisciplinary management of IE, which results in a significative reduction in the overall in-hospital mortality and 1-year survival. For this reason, current guidelines recommend that a specialized team (Endocarditis Team) is institutionalized in reference centers for the management of patients with IE.
- #1 Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditishttps://pmc.ncbi.nlm.nih.gov/articles/PMC10488693/
Infective endocarditis (IE) has experienced enormous changes in recent decades. This Special Issue in the Journal of Clinical Medicine (JCM) is dedicated to the epidemiology, microbiology, diagnostics, and treatment of IE. […] The epidemiology of IE has also changed dramatically, mainly due to population aging. Most patients now have multiple comorbidities, and there has been a clear increase in nosocomial and healthcare-related IE in recent decades. […] According to Biezma et al., the prevalence of diabetes mellitus among patients with IE is increasing and has already surpassed 30%. […] Healthcare-associated IE already accounts for half of all cases and is expected to grow in the near future. […] Overall, 34% of the patients tested positive for HIV, and 33% of them had a CD4 level 200/mm3. […] Despite recent advances, the IE outcome remains poor. IE continues to be a disease with high morbidity and mortality rates. The combination of clinical, microbiological, and cardiac imaging evaluations is essential for the early diagnosis and risk stratification of IE.
- #1 Epidemiology of Infective Endocarditis | IntechOpenhttps://www.intechopen.com/chapters/52185
The proportion of acute cases of IE has increased from approximately 20% in the pre-antibiotic era, to more than 75% in the majority of high-income countries today. […] Chronic rheumatic heart disease was considered a primary risk factor for IE until the widespread introduction of antibiotics; nevertheless, this finding prevails for low-income countries. […] Current behavior in industrialized countries portraits different risk groups including prosthetic valve recipients, intravenous (IV) drug users, individuals with intravenous catheters, patients undergoing hemodialysis, and elderly people with degenerative valve lesions. […] Health-care-associated endocarditis includes nosocomial IE as well as community IE after a recent hospitalization or as a consequence of long-term indwelling devices.
- #1 Epidemiology of Infective Endocarditis | IntechOpenhttps://www.intechopen.com/chapters/52185
Health-care-associated IE accounts for 24 to 34% of cases not related to current cardiac surgery, and it involves an even larger proportion of cases in the United States. […] The risk of IE can be as high as 10% in cases of catheter-induced S. aureus bacteremia. […] The incidence of IE was 1.93% for balloon-expandable and 0.45% for self-expandable transcatheter heart valves. […] The incidence of children IE provides limited data, mostly based on inpatient admission which could not represent accurately the general population. […] The incidence of IE slightly decreased, ranging from 0.005 to 0.12 cases per 1000 pediatric admissions. […] An important condition related to IE in the elderly is the congenital bicuspid aortic valve. […] All estimations of IE incidence in drug abusers are hindered because there are no enough data reporting the exact number of victims of illicit drug-abuse epidemic.
- #1 Infective endocarditis | Radiology Reference Article | Radiopaedia.orghttps://radiopaedia.org/articles/infective-endocarditis?lang=us
Infective endocarditis has an estimated general prevalence of 3 to 9 cases per 100,000. Intravenous drug users are at increased risk with approximately 2 cases per 1000 in this patient group. It is more common in men than women (2:1). In the general population, it affects more individuals older than 65 years 1. […] Infective endocarditis is a disease with high morbidity and mortality, even with appropriate diagnosis and therapy 3. With treatment, which includes antibiotics and surgery, the mean in-hospital mortality of infective endocarditis is 15-20% with 1-year mortality approaching 40% 1. If untreated, infective endocarditis is invariably fatal. […] Septic emboli occur in 12-40% of infective endocarditis cases 3. They can affect any organ or tissue in the body with an arterial supply: central nervous system (most common), lungs (especially in right-sided infective endocarditis), spleen, kidneys, liver, musculoskeletal system.
- #1 Epidemiology of Infective Endocarditis in Rural Upstate New York, 2011 – 2016 | Fatima | Journal of Clinical Medicine Researchhttps://www.jocmr.org/index.php/JOCMR/article/view/3131
Epidemiology of Infective Endocarditis in Rural Upstate New York, 2011 – 2016 […] The epidemiology of infective endocarditis (IE) depends on a number of host factors whose prevalence can vary globally. The usual patient population affected by IE is sicker and older, often with many comorbid conditions. The risk is growing in younger populations due to the emerging epidemic of intravenous (IV) drug use. […] Total incidence of IE was 3.5 cases per 100,000 person years in the total population and 4.4 if we consider total population = 18 years in the denominator. A significant (P = 0.022) increase in incidence of IE from 2011 to 2016 was seen by univariate analysis. Incidence was higher in males (P = 0.029) and for those aged 65 or older (P = 0.0003). IV drug use among cases is noted to be more prevalent in 2015 and 2016 compared to previous years.
- #1 Epidemiology and pathophysiology of infective endocarditis | Thoracic Keyhttps://thoracickey.com/epidemiology-and-pathophysiology-of-infective-endocarditis/
Prior to 1960 and 1970s, viridans group streptococci accounted for the majority of cases. […] However in the last few decades, staphylococcal species have now supplanted viridans streptococci, now accounting for up to 40% of cases, with S. aureus as the predominant organism. […] This change in pattern is attributed to a growing immunocompromised population such as those on long-term steroids and other immunosuppressive medications, and those with solid organ or bone marrow transplants. […] This change also parallels a rise in the use of long-term dwelling catheters, increase in invasive procedures such as transcatheter aortic valve replacement (TAVR), and the ubiquity of prosthetic devices including prosthetic valves and CIEDs. […] The percentage makeup of rare organisms such as gram-negatives, fungus, and atypical bacteria remain low.
- #1 Infective Endocarditis in the 21st Century | USC Journalhttps://www.uscjournal.com/articles/infective-endocarditis-21st-century?language_content_entity=en
Infective endocarditis (IE) continues to be a disease characterized by high mortality and morbidity that has not been affected by significant advances in the last century. […] Significant changes in epidemiology and microbiology have increased the differences between patients seen in the US and Europe and those in countries with a higher incidence of rheumatic heart disease, such as South America and India. Therefore, specific regional approaches to IE are necessary. […] Geographic differences in the epidemiology of IE are becoming more evident. In developing countries, due to the high incidence of rheumatic fever and poor dental care, IE is still a subacute or chronic disease occurring primarily in younger patients with rheumatic valvular abnormalities. In stark contrast, IE is changing rapidly in the US and Europe, presenting few of the classic clinical findings traditionally associated with IE.
- #1 Infective Endocarditis in the 21st Century | USC Journalhttps://www.uscjournal.com/articles/infective-endocarditis-21st-century?language_content_entity=en
An emerging population at risk for IE in developed countries consists of patients with healthcare-associated infections. Overall, IE was attributed to a healthcare-related exposure in nearly 25% of the patients. […] These changes in patients and pathogens have important implications for the diagnosis and management of IE. As nosocomial endocarditis is on the rise, stricter measures for prevention of bloodstream infections must be enforced in hospitals. […] Improvements in access to medical and dental care, associated with aggressive primary prophylaxis of rheumatic fever, have the potential to markedly reduce the incidence of IE in developing countries. […] In conclusion, IE remains a deadly disease, frequently associated with a difficult and tricky diagnosis. Significant changes in epidemiology and microbiology have increased differences between patients seen in the US and Europe and those in countries with a higher incidence of rheumatic heart disease, such as South America and India. Therefore, specific regional approaches to IE are necessary.
- #1 Regional differences in infective endocarditis epidemiology and outcomes in Spain. A contemporary population-based study – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-regional-differences-in-infective-endoca-articulo-S1885585724000380
Our aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]). […] A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. […] Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. […] We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes.
- #1 The Evolving Epidemiology of Infective Endocarditis: An Observational Study from Western India | medRxivhttps://www.medrxiv.org/content/10.1101/2024.08.08.24311684v1.full-text
Over the last few decades, the epidemiology and the management of infective endocarditis (IE) is undergoing significant evolution and advancements respectively. […] To study demography, risk factors, microbiological spectrum, clinical profile, management, and outcome of IE in a tertiary care setup in western India. […] 93.3% cases were community-acquired, 6.7% were hospital acquired. […] 62.2% had an underlying cardiac illness, with congenital heart disease (CHD) being the most common (18.9%) followed by rheumatic heart disease (RHD) (16.5%). […] Compared to the western world, the epidemiology, clinical profile, and microbiologic spectrum of IE is different in India. […] Though the causes of IE in the western part of the world have now shifted to be largely due to intravenous (IV) drug abuse, presence of prosthetic valves, hemodialysis and presence of intra-cardiac devices; in India, many studies have found traditional risk factors such as RHD and CHD as the leading causes of IE.
- #1 Infective Endocarditis – Cardiovascular Disorders – MSD Manual Professional Editionhttps://www.msdmanuals.com/professional/cardiovascular-disorders/endocarditis/infective-endocarditis
Infective endocarditis can occur at any age. Male individuals are affected about twice as often as female individuals. Incidence of infection and mortality increase with increasing age. Patients who use illicit intravenous drugs, patients who are immunocompromised, and patients with prosthetic heart valves and other intracardiac devices are at highest risk. There is also an increased risk in patients with indwelling intravascular catheters. […] The disease develops in 3 stages: Bacteremia: Microorganisms are present in the blood, Adhesion: The microorganism adheres to abnormal or damaged endothelium via surface adhesions, Colonization: Proliferation of the organism together with inflammation, leading to a mature vegetation. […] Overall, the in-hospital mortality rate for endocarditis is 15 to 20%, with a 1-year mortality rate approaching 40%. Untreated, infective endocarditis is always fatal. Even with treatment, death is more likely and the prognosis is generally poorer for older patients and patients who have infection with resistant organisms, an underlying disorder, a long delay in treatment, aortic valve or multiple valve involvement, large vegetations, polymicrobial bacteremia, prosthetic valve infections, mycotic aneurysms, valve ring abscess, or major embolic events. […] Preventive dental examination and therapy before surgery to repair heart valves or congenital heart lesions is recommended. Measures to reduce health care-acquired bacteremia aim to curb the rising incidence of iatrogenic bacteremia and subsequent endocarditis are also recommended.
- #1https://journals.lww.com/md-journal/fulltext/2015/10270/current_epidemiology_and_outcome_of_infective.37.aspx
The aim of the study was to describe the epidemiologic and clinical characteristics and identify the risk factors of short-term and 1-year mortality in a recent cohort of patients with infective endocarditis (IE). […] Overall, 1804 patients were diagnosed. The median age was 69 years (interquartile range, 5577), 68.0% were men, and 37.1% of the cases were nosocomial or health care-related IE. […] Risk factors for in-hospital mortality were age, previous heart surgery, cerebrovascular disease, atrial fibrillation, Staphylococcus or Candida etiology, intracardiac complications, heart failure, and septic shock. […] The 1-year independent risk factors for mortality were age (odds ratio [OR], 1.02), neoplasia (OR, 2.46), renal insufficiency (OR, 1.59), and heart failure (OR, 4.42). […] IE remains a severe disease with a high rate of in-hospital (28.9%) and 1-year mortality (11.2%).
- #1https://link.springer.com/article/10.1007/s11886-018-1043-2
Infective endocarditis remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. […] This review addresses changes in the epidemiology of infective endocarditis, along with current diagnostic imaging modalities, treatment recommendations, and mortality trends. […] Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. […] Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition. […] A cohort of 363 cases with endocarditis from 2007 to 2015 provide current epidemiological data on risk factors and mortality.
- #1 Study Shows Drug Use-Associated Endocarditis Increases Hospital Risk For Bacterial Infections | Institute for Global Health and Infectious Diseaseshttps://globalhealth.unc.edu/2024/05/study-shows-drug-use-associated-endocarditis-increases-hospital-risk-for-bacterial-infections/
Rosen-Schranz-drug use-associated-endocarditisDavid Rosen, PhD, MD, and Asher Schranz, MD, MPH, members of the Institute for Global Health and Infectious Diseases, found people with drug use-associated infective endocarditis are at high risk of mortality and future hospitalization for bacterial infections, including endocarditis, skin and soft tissue infections and bacteremia. […] The researchers performed a retrospective cohort study of patients discharged after hospitalization for drug-use associated infectious endocarditis (DUA-IE) in North Carolina, including all documented adult patients in the state with a DUA-IE hospitalization between 2016 and 2020 and who had their first documented DUA-IE hospital discharge between Jan. 1, 2017, and Sept. 30, 2020. […] The 3-year risk of mortality or hospitalization for a serious infection was 38%. The risk of incident infection rose over the 3 years of follow-up years, with the 1-year, 2-year and 3-year cumulative incidence of a subsequent hospitalization for a serious infection being 18%, 23%, and 29%, respectively.
- #1https://journals.lww.com/md-journal/fulltext/2015/10270/current_epidemiology_and_outcome_of_infective.37.aspx
In 2008, in association with the International Collaboration on Endocarditis (ICE), we created a national cooperative endocarditis study group, The Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en Espaa (GAMES), with the objectives of improving the care of IE patients and conducting research in Spain. […] The objective of the present study was to define the characteristics of IE in a prospective multicenter, nationwide study, performed in 25 centers of Spain and to identify risk factors of early and late mortality. […] The study sample comprises total of 1804 IE cases from 25 centers, located throughout Spain. […] Therefore, we estimated an annual incidence of at least 3.5 cases of IE per 100,000 inhabitants. […] In our series, including population-based studies of endocarditis recruited from 1960 to 2008, incidence rates range from 3 to 10 cases/100,000 habitants, and our figure of 3.5 IE cases/100,000 habitants is concordant with that. […] In our series, 28% of the episodes were classified as nosocomial; this percentage is similar to that reported by Fernandez-Hidalgo et al.
- #2 Infective endocarditis requiring ICU admission: epidemiology and prognosis | Annals of Intensive Care | Full Texthttps://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-015-0091-7
The annual incidence of infective endocarditis (IE) in France at the beginning of the 21st century is around 33 cases per million inhabitants. Despite advances in diagnosis and medico-surgical treatment, the in-hospital mortality rate remains high, since ranging from 15 to 22 %. Most recent data underline that now Staphylococcus aureus is the most common cause of IE and that approximately 50 % of patients underwent early valve replacement or repair. […] Mortality in patients admitted to ICU for left-sided IE remains high, especially in cases of endocarditis due to methicillin resistant Staphylococcus aureus, when organ failures occur and ICU scores are high. […] We report the results of a retrospective multicenter study on 248 patients with severe, active, definite and left-sided IE requiring ICU admission. Main causative pathogens are equally represented by streptococci and staphylococci. During ICU stay, surgery was indicated for 75 % of patients but only 53 % of them underwent surgical procedures during ICU stay. Overall in-hospital mortality was 41.5 %. Independent factors associated with prognosis were SAPS II on ICU admission 35, SOFA on ICU admission 8, IE due to methicillin resistant Staphylococcus aureus and native IE.
- #2 Epidemiology and pathophysiology of infective endocarditis | Thoracic Keyhttps://thoracickey.com/epidemiology-and-pathophysiology-of-infective-endocarditis/
Infectious endocarditis remains a rare disease, with an incidence of 210 cases per 100,000 people, and varies according to world regions, country, and even different areas within a nations borders. […] In countries with consistent reporting, the overall incidence appears to be at least stable, if not slightly increasing. […] Despite these statistics, the epidemiology has changed significantly over the years. Infectious endocarditis in the preantibiotic era predominantly affected those in their 30 to 40s, often in the setting of rheumatic valvulopathy, and with Streptococcus spp. as the predominant pathogen. […] However, beginning in the 20th century, as the nations of the world began to diverge in terms of industrialization and wealth, so too have the features of infective endocarditis between low- and high-income countries. Low-income countries continue to retain their preantibiotic era features, with rheumatic disease remaining a key risk factor, affecting up to two-thirds of cases.
- #2 Native valve endocarditis: Epidemiology, risk factors, and microbiology – UpToDatehttps://www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology
For example, the incidence of IE among patients admitted to Philadelphia-area hospitals from 1988 to 1990 was approximately 11.6 cases per 100,000 person-years. In contrast, the incidence of IE in a Minnesota county between 1970 and 2006 was 5.0 to 7.9 cases per 100,000 person-years. During this time span, the incidence of IE in men remained stable (8.6 to 12.7 cases/100,000 person-years) while the incidence of IE in women increased (from 1.4 to 6.7 cases/100,000 person-years). Other studies have reported incidence rates for IE ranging from 0.6 to 6.0 cases per 100,000 person-years. […] A population-based observational study in France in 2008 noted the annual incidence of IE was 33.8 cases per million. The incidence was highest in men 75 to 79 years and the majority of patients had no known prior heart disease; health care-associated IE accounted for 27 percent of cases. Similarly, an observational study in Spain noted an increase in the incidence of IE between 2003 and 2014, from 2.72 to 3.49 per 100,000 person-years; the rise was higher among older adults.
- #2 Infective Endocarditis: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/216650-overview
In the United States, the incidence of IE is approximately 12.7 cases per 100,000 persons per year. The incidence of IE in other countries is similar to that in the United States. The proportion of patients with intracardiac devices has increased from 13.3% to 18.9%, whereas the proportion of cases with a background of HIV infection has decreased. […] The mean age of patients has increased from 58.6 to 60.8 years and continues to rise; more than 50% of patients are older than 50 years. Mendiratta and colleagues, in their retrospective study of hospital discharges of patients aged 65 years and older with a primary or secondary diagnosis of IE, found that hospitalizations for IE increased 26%, from 3.19 per 10,000 elderly patients to 3.95 per 10,000. IE is 3 times more common in males than in females. There appears to be no racial predilection.
- #2 Endocarditis epidemiology and demographics – wikidochttps://www.wikidoc.org/index.php/Endocarditis_epidemiology_and_demographics
The incidence of native valve infective endocarditis is approximately 1.7-6.2 cases per 100,000 individuals per year in the United States and Europe. […] The incidence of infective endocarditis increases with age; the median age of patients is 47 to 69 years. […] There is an increased incidence of infective endocarditis in persons 65 years of age and older. […] Males are more commonly affected with endocarditis than females. […] The male to female ratio is approximately 1.7:1.
- #2https://link.springer.com/article/10.1007/s11886-018-1043-2
Infective endocarditis remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. […] This review addresses changes in the epidemiology of infective endocarditis, along with current diagnostic imaging modalities, treatment recommendations, and mortality trends. […] Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. […] Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition. […] A cohort of 363 cases with endocarditis from 2007 to 2015 provide current epidemiological data on risk factors and mortality.
- #2 Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Managementhttps://www.mdpi.com/2075-1729/13/2/377
In developed countries, the epidemiology of IE has undergone significant changes, with emerging risk factors such as the presence of intracardiac devices (defibrillators and pacemakers mainly) and degenerative valvular disease, thus shifting the incidence of IE towards an older age (â¥65 years old). […] Moreover, the last opioid epidemic has considerably affected the current epidemiology of IE in developed countries, especially in the USA, where there is an increased incidence of tricuspid valve endocarditis due to injection drug use, mainly affecting women and young people. […] The current literature supports the benefits of the multidisciplinary management of IE, which results in a significative reduction in the overall in-hospital mortality and 1-year survival. For this reason, current guidelines recommend that a specialized team (Endocarditis Team) is institutionalized in reference centers for the management of patients with IE.
- #2https://journals.lww.com/infectdis/fulltext/2024/03000/changing_paradigms_in_epidemiology,_microbiology,.17.aspx
Infective endocarditis (IE), a systemic disease with diverse and multiorgan clinical manifestations, was first described by Osler in 1885. […] Over the past 4 decades, changing epidemiology and microbiology has led to the mortality rate reports between 14% and 37%. […] Chronic hemodialysis is the most common risk factor, followed by intravenous drug use. […] The incidence of IE has been reported to be 1.7 to 11.2 per 100.000 population per year in the western world. […] The American Heart Association estimates the annual number of new cases in the United States to be 100,000 to 200,000. […] Compared with the preantibiotic era, the percentage of acute IE cases has increases significantly from 20% to 75%. […] The second change is the advancing age, increasing medical comorbidities, and exposure to health care environments leading to change in the microbial etiology of IE.
- #2 Epidemiology and pathophysiology of infective endocarditis | Thoracic Keyhttps://thoracickey.com/epidemiology-and-pathophysiology-of-infective-endocarditis/
Prior to 1960 and 1970s, viridans group streptococci accounted for the majority of cases. […] However in the last few decades, staphylococcal species have now supplanted viridans streptococci, now accounting for up to 40% of cases, with S. aureus as the predominant organism. […] This change in pattern is attributed to a growing immunocompromised population such as those on long-term steroids and other immunosuppressive medications, and those with solid organ or bone marrow transplants. […] This change also parallels a rise in the use of long-term dwelling catheters, increase in invasive procedures such as transcatheter aortic valve replacement (TAVR), and the ubiquity of prosthetic devices including prosthetic valves and CIEDs. […] The percentage makeup of rare organisms such as gram-negatives, fungus, and atypical bacteria remain low.
- #2 Infective endocarditis: diagnosis, treatment and prevention – The Pharmaceutical Journalhttps://pharmaceutical-journal.com/article/ld/infective-endocarditis-diagnosis-treatment-and-prevention
Infective endocarditis (IE) is defined as an infection of the endocardial surface, the cardiac valves (native or prosthetic) or an indwelling cardiac device. IE is associated with high morbidity and mortality; in-hospital mortality rates range from 15â30% while the five-year mortality rate can reach 40%. Patient outcomes are worse in the presence of certain factors. Approximately 40â50% of infected patients require valve surgery. […] In low-income countries, IE is frequently seen in young adults with rheumatoid fever, which is precipitated by recent oral streptococcal infection. Cases are generally lower in high-income countries (around 3â9 cases per 100,000 population each year) owing to high antibacterial usage; however, increasing antimicrobial resistance and an ageing population has made management more complex. Incidence of IE within the UK appears to be on the rise, with completed consultant episodes increasing from 3,969 to 10,097 from 2009/2010 to 2019/2020. The rise in cases of IE is likely to be multifactorial, owing to patient longevity, an increasing number of implantable cardiac devices, prosthetic valves and indwelling catheters, improved diagnostic modalities and more frequent hospital-acquired infections. High-risk activities, such as intravenous drug usage, increase the risk of IE.
- #2https://journals.lww.com/md-journal/fulltext/2015/10270/current_epidemiology_and_outcome_of_infective.37.aspx
The aim of the study was to describe the epidemiologic and clinical characteristics and identify the risk factors of short-term and 1-year mortality in a recent cohort of patients with infective endocarditis (IE). […] Overall, 1804 patients were diagnosed. The median age was 69 years (interquartile range, 5577), 68.0% were men, and 37.1% of the cases were nosocomial or health care-related IE. […] Risk factors for in-hospital mortality were age, previous heart surgery, cerebrovascular disease, atrial fibrillation, Staphylococcus or Candida etiology, intracardiac complications, heart failure, and septic shock. […] The 1-year independent risk factors for mortality were age (odds ratio [OR], 1.02), neoplasia (OR, 2.46), renal insufficiency (OR, 1.59), and heart failure (OR, 4.42). […] IE remains a severe disease with a high rate of in-hospital (28.9%) and 1-year mortality (11.2%).
- #2https://link.springer.com/article/10.1007/s11886-018-1043-2
Updated guidelines for endocarditis continue to recommend early surgical intervention in many patients with endocarditis as summarized in the text. […] Examination of a cohort of 164 episodes of infective endocarditis in adult patients with congenital heart disease with specific analysis of the incidence and predisposing factors for development of infective endocarditis, treatment strategies used, and clinical outcomes. […] Evaluation of 454 infective endocarditis patients to determine differences in 1 year mortality, microbiology, complications (specifically embolic, among others), and treatment between patients 65 years old, 6579 years old, and greater than or equal to 80 years old. […] Infective endocarditis epidemiology over five decades: a systematic review. […] Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN. […] Current European guidelines for diagnosis and management of infective endocarditis.
- #2 Native valve endocarditis: Epidemiology, risk factors, and microbiology – UpToDatehttps://www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology
Native valve endocarditis: Epidemiology, risk factors, and microbiology […] The epidemiology, risk factors, and microbiology of native valve infective endocarditis (IE) will be reviewed here. Issues related to the epidemiology of prosthetic valve IE are discussed separately. […] Infective endocarditis (IE) may be acquired in the community or in the context of health care exposure. Community-associated IE refers to IE that develops in the absence of recent contact with a health care setting, with diagnosis established within 48 hours of hospital admission. Health care-associated IE refers to IE that develops in the context of recent contact with a health care setting, with onset of symptoms â¥48 hours after hospitalization. […] Between 2000 and 2011, the incidence of IE in the United States increased from 11 per 100,000 population to 15 per 100,000 population. The precise incidence of IE is difficult to ascertain because case definitions have varied over time between authors and between clinical centers. In addition, the incidence of predisposing conditions such as rheumatic heart disease or injection drug use is variable over time and between regions and in low- and high-income countries.
- #2 Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditishttps://pmc.ncbi.nlm.nih.gov/articles/PMC10488693/
Infective endocarditis (IE) has experienced enormous changes in recent decades. This Special Issue in the Journal of Clinical Medicine (JCM) is dedicated to the epidemiology, microbiology, diagnostics, and treatment of IE. […] The epidemiology of IE has also changed dramatically, mainly due to population aging. Most patients now have multiple comorbidities, and there has been a clear increase in nosocomial and healthcare-related IE in recent decades. […] According to Biezma et al., the prevalence of diabetes mellitus among patients with IE is increasing and has already surpassed 30%. […] Healthcare-associated IE already accounts for half of all cases and is expected to grow in the near future. […] Overall, 34% of the patients tested positive for HIV, and 33% of them had a CD4 level 200/mm3. […] Despite recent advances, the IE outcome remains poor. IE continues to be a disease with high morbidity and mortality rates. The combination of clinical, microbiological, and cardiac imaging evaluations is essential for the early diagnosis and risk stratification of IE.
- #3 Epidemiology and pathophysiology of infective endocarditis | Thoracic Keyhttps://thoracickey.com/epidemiology-and-pathophysiology-of-infective-endocarditis/
Prior to 1960 and 1970s, viridans group streptococci accounted for the majority of cases. […] However in the last few decades, staphylococcal species have now supplanted viridans streptococci, now accounting for up to 40% of cases, with S. aureus as the predominant organism. […] This change in pattern is attributed to a growing immunocompromised population such as those on long-term steroids and other immunosuppressive medications, and those with solid organ or bone marrow transplants. […] This change also parallels a rise in the use of long-term dwelling catheters, increase in invasive procedures such as transcatheter aortic valve replacement (TAVR), and the ubiquity of prosthetic devices including prosthetic valves and CIEDs. […] The percentage makeup of rare organisms such as gram-negatives, fungus, and atypical bacteria remain low.