Changing profile of infective endocarditis: results of a 1-year survey in France.
BACKGROUND
Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991.


OBJECTIVE
To update information gained from the 1991 study on the epidemiology of IE in France.


METHODS
Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants).


METHODS
Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria.


METHODS
Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes.


RESULTS
The annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P =.67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P =.97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P =.08).


CONCLUSIONS
Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.
Hoen
Bruno
B
Service de Maladies Infectieuses et Tropicales, University of Besançon Medical Center, Centre Hospitalier Universitaire de Besançon, F-25030 Besançon Cedex, France. bruno.hoen@ufc-chu.univ-fcomte.fr
Alla
François
F
Selton-Suty
Christine
C
Béguinot
Isabelle
I
Bouvet
Anne
A
Briançon
Serge
S
Casalta
Jean-Paul
JP
Danchin
Nicolas
N
Delahaye
François
F
Etienne
Jerome
J
Le Moing
Vincent
V
Leport
Catherine
C
Mainardi
Jean-Luc
JL
Ruimy
Raymond
R
Vandenesch
François
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006331:Heart Diseases; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance