Contemporary clinical profile and outcome of prosthetic valve endocarditis.
BACKGROUND
Prosthetic valve endocarditis (PVE) is associated with significant mortality and morbidity. The contemporary clinical profile and outcome of PVE are not well defined.


OBJECTIVE
To describe the prevalence, clinical characteristics, and outcome of PVE, with attention to health care-associated infection, and to determine prognostic factors associated with in-hospital mortality.


METHODS
Prospective, observational cohort study conducted at 61 medical centers in 28 countries, including 556 patients with definite PVE as defined by Duke University diagnostic criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to August 2005.


METHODS
In-hospital mortality.


RESULTS
Definite PVE was present in 556 (20.1%) of 2670 patients with infective endocarditis. Staphylococcus aureus was the most common causative organism (128 patients [23.0%]), followed by coagulase-negative staphylococci (94 patients [16.9%]). Health care-associated PVE was present in 203 (36.5%) of the overall cohort. Seventy-one percent of health care-associated PVE occurred within the first year of valve implantation, and the majority of cases were diagnosed after the early (60-day) period. Surgery was performed in 272 (48.9%) patients during the index hospitalization. In-hospital death occurred in 127 (22.8%) patients and was predicted by older age, health care-associated infection (62/203 [30.5%]; adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.08-2.44; P = .02), S aureus infection (44/128 [34.4%]; adjusted OR, 1.73; 95% CI, 1.01-2.95; P = .05), and complications of PVE, including heart failure (60/183 [32.8%]; adjusted OR, 2.33; 95% CI, 1.62-3.34; P<.001), stroke (34/101 [33.7%]; adjusted OR, 2.25; 95% CI, 1.25-4.03; P = .007), intracardiac abscess (47/144 [32.6%]; adjusted OR, 1.86; 95% CI, 1.10-3.15; P = .02), and persistent bacteremia (27/49 [55.1%]; adjusted OR, 4.29; 95% CI, 1.99-9.22; P<.001).


CONCLUSIONS
Prosthetic valve endocarditis accounts for a high percentage of all cases of infective endocarditis in many regions of the world. Staphylococcus aureus is now the leading cause of PVE. Health care-associated infection significantly influences the clinical characteristics and outcome of PVE. Complications of PVE strongly predict in-hospital mortality, which remains high despite prompt diagnosis and the frequent use of surgical intervention.
Wang
Andrew
A
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. a.wang@duke.edu
Athan
Eugene
E
Pappas
Paul A
PA
Fowler
Vance G
VG
Olaison
Lars
L
Paré
Carlos
C
Almirante
Benito
B
Muñoz
Patricia
P
Rizzi
Marco
M
Naber
Christoph
C
Logar
Mateja
M
Tattevin
Pierre
P
Iarussi
Diana L
DL
Selton-Suty
Christine
C
Jones
Sandra Braun
SB
Casabé
José
J
Morris
Arthur
A
Corey
G Ralph
GR
Cabell
Christopher H
CH
D000368:Aged; D003428:Cross Infection / Q000453:epidemiology; D004697:Endocarditis, Bacterial / Q000453:epidemiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012042:Registries; D013203:Staphylococcal Infections / Q000453:epidemiology