title: Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.
abstract: BACKGROUND
  We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.
  
  
  METHODS
  Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005.
  
  
  RESULTS
  The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk.
  
  
  CONCLUSIONS
  In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.
authors.affiliation: Department of Pathology, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand. david.murdoch@cdhb.govt.nz
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Bayer
authors.forename: Adolf W
authors.initials: AW
authors.lastname: Karchmer
authors.forename: Lars
authors.initials: L
authors.lastname: Olaison
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pappas
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreillon
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chambers
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Chu
authors.forename: Vicenç
authors.initials: V
authors.lastname: Falcó
authors.forename: David J
authors.initials: DJ
authors.lastname: Holland
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.forename: John L
authors.initials: JL
authors.lastname: Klein
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Raymond
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Read
authors.forename: Marie Francoise
authors.initials: MF
authors.lastname: Tripodi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
mesh_terms: D000328:Adult; D000368:Aged; D004696:Endocarditis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*