Incidence, microbiology and outcomes in patient hospitalised with infective endocarditis

Shah, A. S.V. et al. (2020) Incidence, microbiology and outcomes in patient hospitalised with infective endocarditis. Circulation, 141(25), pp. 2067-2077. (doi: 10.1161/CIRCULATIONAHA.119.044913) (PMID:32410460)

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Background: Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology and outcomes of infective endocarditis and the impact of changes in national antibiotic prophylaxis guidelines on incident infective endocarditis. Methods: Using a Scotland-wide, individual-level linkage approach, all patients hospitalized with infective endocarditis from 1990 until 2014 were identified and linked to national microbiology, prescribing and morbidity and mortality datasets. Linked data were used to evaluate trends in the crude and age- and sex-adjusted incidence and outcomes of infective endocarditis hospitalizations. From 2008, microbiology data and associated outcomes adjusted for patient demographics and comorbidity were also analyzed. An interrupted time series analysis was performed to evaluate incidence before and after changes to national antibiotic prophylaxis guidelines. Results: There were 7,638 hospitalizations (65±17 years, 51% females) with infective endocarditis. The estimated crude hospitalization rate increased from 5.3/100,000 (95% confidence interval [CI] 4.8-5.9) to 8.6/100,000 (95% CI 8.1-9.1) between 1990 and 1995 but remained stable thereafter. There was no change in crude incidence following the 2008 change in antibiotic prophylaxis guidelines (relative risk of change 1.06, 95% CI 0.94-1.20). The incidence rate in patients >80 years doubled from 1990 to 2014 (17.7/100,000 [95% CI 13.4-23.3] to 37.9/100,000 [95% CI 31.5-45.5]). The predicted 1 year age- and comorbidity-adjusted case fatality rate for a 65 year-old patient decreased in women (27.3% [95% CI 24.6-30.2] to 23.7% [95% CI 21.1 to 26.6]) and men (30.7% [95% CI 27.7-33.8] to 26.8% [95% CI 24.0-29.7]) from 1990 to 2014. Blood culture data were available from 2008 (n=2,267/7,638, 30%), with positive blood cultures recorded in 42% (950/2,267). Staphylococcus (403/950, 42.4%) and streptococcus (337/950, 35.5%) species were most common. Staphylococcus aureus and enterococcus had the highest 1 year mortality (adjusted odds ratio 4.34 [95% CI 3.12-6.05] and 3.41 [95% CI 2.04-5.70], respectively). Conclusions: Despite changes in antibiotic prophylaxis guidelines, the crude incidence of infective endocarditis has remained stable. However, the incidence rate has doubled in the elderly. Positive blood cultures were observed in less than half of patients, with Staphylococcus aureus and enterococcus bacteremia associated with worse outcomes.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McAllister, Professor David and Rodriguez Perez, Dr Jesus and Newby, Professor David
Authors: Shah, A. S.V., McAllister, D. A., Gallacher, P., Astengo, F., Rodríguez Pérez, J. A., Hall, J., Lee, K. K., Bing, R., Anand, A., Nathwani, D., Mills, N. L., Newby, D. E., Marwick, C., and Cruden, N. L.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:Circulation
Publisher:American Heart Association
ISSN (Online):1524-4539
Published Online:15 May 2020
Copyright Holders:Copyright © 2020 American Heart Association, Inc.
First Published:First published in Circulation 141:2067–2077
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
173492Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZInstitute of Health & Wellbeing