New trends in the epidemiological and clinical features of infective endocarditis: results of a multicenter prospective study.
BACKGROUND
The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE.


METHODS
From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants).


RESULTS
A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8% of cases, with prosthetic valve involvement in 27 (18%). The incidence of injection drug use was 10%. Twenty-two cases (15%) were related to invasive procedures. Causative microorganisms included: streptococci 37.4% (oral streptococci 17.7%, group D streptococci 9.5%, pyogenic streptococci 3.4%, enterococci 6.8%), staphylococci 34%, other pathogens 28.5%. Blood cultures were negative in 25% of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p < 0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 +/- 7.4 days after admission). Valve surgery was performed in 31% of patients. The in-hospital mortality was 14% and that at 3 months 18%.


CONCLUSIONS
In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.
Cecchi
Enrico
E
Cardiology Department, Maria Vittoria Hospital, Turin, Italy. cecchi.enrico@tin.it
Forno
Davide
D
Imazio
Massimo
M
Migliardi
Alessandro
A
Gnavi
Roberto
R
Dal Conte
Ivano
I
Trinchero
Rita
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies