Cited by 2,362Infective Endocarditis Diagnosis and ManagementCardiac Valve Diseases and TreatmentsStreptococcal Infections and Treatments

Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis–Prospective Cohort Study

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Murdoch, David R.·2009·Archives of Internal Medicine

Abstract

BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. CONCLUSIONS: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

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  • The increase in S aureus infective endocarditis is primarily a consequence of healthcare contact such as intravascular catheters, surgical wounds, indwelling prosthetic devices, and hemodialysis.

    “This increase is primarily a consequence of healthcare contact (eg, intravascular catheters, surgical wounds, indwelling prosthetic devices, hemodialysis) 6,8,9”

    From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [8]

    The ‘Changes in Microbiologic Characteristics of IE’ section attributes the shift toward S aureus IE in part to health care contact and invasive procedures, but also names intravenous drug use. It does not say health care contact is the primary cause of the increase. The Definitions section includes wound care and hemodialysis as forms of health care contact; it does not establish the full list of examples as causes of the increase. Page numbers were not available in our copy. (LLM, conf=0.87)

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  • Other studies suggest that the risk of neurological deterioration during cardiac surgery after a stroke is lower than previously assumed, particularly in patients with silent cerebrovascular emboli.

    “Other studies [6][7][8] suggest that the risk of neurological deterioration during cardiac surgery after a stroke is lower than previously assumed, particularly in patients with silent cerebrovascular emboli.”

    From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [8]

    The Results and In-Hospital Mortality sections (page numbers unavailable) report that surgery was associated with lower in-hospital mortality in patients with infective endocarditis. They do not assess neurological deterioration during surgery after stroke or outcomes in patients with silent cerebrovascular emboli. Searches for those terms found no passage addressing the claim. (LLM, conf=0.76)

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Research works printed but not linked: 3

  1. [3]3. Osler W. Gulstonian lectures on malignant endocarditis: lecture III. Lancet. 1885; 1(3212):505-508.
  2. [32]32. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003; 290(22):2976-2984.
  3. [35]35. Whitener CJ, Park SY, Browne FA, et al. Vancomycin-resistant Staphylococcus aureus in the absence of vancomycin exposure. Clin Infect Dis. 2004;38(8): 1049-1055.

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Authors
Murdoch, D. R.
Affiliations
University of Otago (NZ)
Corresponding author
Murdoch, David R.
Venue
Archives of Internal Medicine
Published
2009-03-09
Volume
169
Issue
5
Pages
463
ISSN
0003-9926 (ISSN-L)
OpenAlex
W2135173846
Cited by
2,362
References
44
Citations by year
2026: 106 · 2025: 169 · 2024: 177 · 2023: 181 · 2022: 193 · 2021: 197 · 2020: 177 · 2019: 183 · 2018: 128 · 2017: 149 · 2016: 109 · 2015: 134 · 2014: 126 · 2013: 112 · 2012: 86
FWCI
48.56
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • IRIS (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • HAL (submittedVersion)
  • Own your potential (DEAKIN) (submittedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion, other-oa)
Funders
  • American Heart Association
  • Generalitat de Catalunya
  • National Institutes of Health
  • Instituto de Salud Carlos III (RD06/0008)
  • National Heart, Lung, and Blood Institute (K23 HL70861-01, K23HL070861)
  • National Institute of Allergy and Infectious Diseases (AI-068804, R01AI068804)
  • Duke Clinical Research Institute
Topics
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
Keywords
infective endocarditis, clinical features, etiology, Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus viridans, prosthetic valve endocarditis, mitral valve, aortic valve, embolization, stroke, heart failure, in-hospital mortality, risk factors
MeSH terms
Adult, Aged, Endocarditis, Female, Humans, Male, Middle Aged, Prospective Studies, Staphylococcal Infections, Staphylococcus aureus

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