OBJECTIVES: To describe changes in demographic, clinical and micro-biological characteristics of infective endocarditis (IE), and to assess factors associated with an increased risk of death. METHODS: Episodes fulfilling the Duke criteria for definite IE were included. Data collected in 1980-1991, and 1992-2003 from IVDU and non-IVDU patients' records were collected, and changes within each group and between the groups analysed. RESULTS: There were 169 episodes of IE in IVDUs, and 114 in non-IVDUs. HIV-infected patients were 86 (82 IVDUs). Site of involvement, need for surgery, and case fatality rate (15.6% among IVDUs and 11.3% non-IVDUs) did not change in both groups over time. Staphylococci and streptococci were the most commonly isolated organisms among IVDUs and non-IVDU, respectively; independent predictors of mortality among IVDUs were negative blood cultures [adjusted OR (AOR) 7.85], and fungal etiology (AOR 21.33). Among non-IVDUs prosthetic heart valves had an AOR of 2.22 (95% CI 0.48-10.21); the proportion of negative blood cultures significantly increased. An higher case-fatality rate was observed among HIV-positive patients (AOR 2.64 95% CI 0.85-8.20). CONCLUSIONS: Late diagnosis and lack of etiological definition continue to represent the most important obstacles to an effective management of IE, suggesting the need for a wider use of molecular techniques in patients with suspected IE.
OBJECTIVES: To describe changes in demographic, clinical and micro-biological characteristics of infective endocarditis (IE), and to assess factors associated with an increased risk of death. METHODS: Episodes fulfilling the Duke criteria for definite IE were included. Data collected in 1980-1991, and 1992-2003 from IVDU and non-IVDU patients' records were collected, and changes within each group and between the groups analysed. RESULTS: There were 169 episodes of IE in IVDUs, and 114 in non-IVDUs. HIV-infectedpatients were 86 (82 IVDUs). Site of involvement, need for surgery, and case fatality rate (15.6% among IVDUs and 11.3% non-IVDUs) did not change in both groups over time. Staphylococci and streptococci were the most commonly isolated organisms among IVDUs and non-IVDU, respectively; independent predictors of mortality among IVDUs were negative blood cultures [adjusted OR (AOR) 7.85], and fungal etiology (AOR 21.33). Among non-IVDUs prosthetic heart valves had an AOR of 2.22 (95% CI 0.48-10.21); the proportion of negative blood cultures significantly increased. An higher case-fatality rate was observed among HIV-positivepatients (AOR 2.64 95% CI 0.85-8.20). CONCLUSIONS: Late diagnosis and lack of etiological definition continue to represent the most important obstacles to an effective management of IE, suggesting the need for a wider use of molecular techniques in patients with suspected IE.
Authors: Leandro Slipczuk; J Nicolas Codolosa; Carlos D Davila; Abel Romero-Corral; Jeong Yun; Gregg S Pressman; Vincent M Figueredo Journal: PLoS One Date: 2013-12-09 Impact factor: 3.240