[Variations of the profile of infective endocarditis in France. Results of an epidemiologic survey carried out during a year].

Since the first modern clinical description of the infective endocarditis by Osler at the late 19th century, the profile of this disease never stopped changing, which has been well described by several epidemiological studies, especially the one performed in France in 1991. The aim of this study was to update data obtained in 1991 on the epidemiology of infective endocarditis in France. This is a transversal survey conducted between January and December 1999 in all hospitals of 6 French regions representing 26% of the whole population (16 million inhabitants). Among them 390 subjects presented the diagnosis of definite infective endocarditis according to the Duke criteria. The age- and sex-adjusted annual incidence was at 31 cases per million (95% interval confidence 28-35). In 47% of cases, no pre-existing cardiac disease was known for the patient. The rate of prosthetic valve endocarditis was at 16%. Micro-organisms involved were distributed as follows: streptococci 48% (D-group 25%, oral streptococci 17%, pyogenic streptococci 6%); enterococci 8%, Abiotrophia sp.: 2%, staphylococci 29%, others or multiple micro-organisms: 8%. Blood cultures were negative in 9% of cases and neither micro-organism was identified in 5% of cases. Early valvular surgery was performed in 49% of them. The in-hospital mortality was at 16%. Compared to the 1991 study, this one highlights a decrease of endocarditis incidence in patients with known cardiac disease (20.6 cases per million vs. 15.1 cases per million, p < 0.001) and a decrease of the incidence of endocarditis due to oral streptococci, which is partially counter-balanced by an increase of the proportion of endocarditis due to D-group streptococci (5.3 cases per million vs. 6.2 cases per million, p = 0.67) and to staphylococci (4.9 cases per million vs. 5.7 cases per million, p = 0.97), an increased rate of surgery in the in-hospital period (31.2% vs. 49.7%, p < 0.001), a decrease of hospital mortality (21.6% vs. 16.6%, p = 0.008). Even though the global incidence of endocarditis did not change significantly, this study highlights important modification in the infective endocarditis profile, especially concerning the culprit agents, the underlying cardiac disease, the therapeutic strategies engaged and the prognosis.