title: Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study.
abstract: OBJECTIVE
  The aim here is to analyse epidemiology, optimal treatment, and predictors of 6-month mortality in infective endocarditis (IE).
  
  
  RESULTS
  A prospective observational cohort study included 193 patients with 203 episodes of definite IE by the modified Duke criteria. Thirty-four percent of episodes involved prosthetic valves. Thirty-three percent of episodes were nosocomial. Forty-three percent included staphylococci, 26% streptococci, and 17% enterococci. At least one complication occurred in 79% of the episodes and 63% had surgical intervention. Six-month mortality was 22%: 33% for staphylococci, 24% for enterococci, and 8% for streptococci. Seventy-four percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 16% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P=0.03), the causative microorganism (P=0.04), and treatment group (P<0.001).
  
  
  CONCLUSIONS
  Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus and Enterococcus faecalis were predominant microorganisms. Age, staphylococci, and a contraindication to surgery predicted 6-month mortality. Nearly half of deaths had a contraindication to surgery. Six-month mortality did not differ significantly between patients who received surgical treatment as against those who received medical treatment without a contraindication to surgery.
authors.affiliation: Department of Internal Medicine-Infectious Diseases, K.U. Leuven, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuve Belgium.
authors.forename: Evelyn E
authors.initials: EE
authors.lastname: Hill
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.forename: Steven
authors.initials: S
authors.lastname: Vanderschueren
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013203:Staphylococcal Infections / Q000401:mortality*; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000401:mortality*