title: Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia.
abstract: OBJECTIVE
  Institutional-based studies of infective endocarditis (IE) are limited by referral bias. Longitudinal population-based data were used to overcome such bias to provide a contemporary profile of IE and specifically investigate the importance of health care-associated IE and age.
  
  
  RESULTS
  Between 2000 and 2006, 1536 consecutive adult admissions with IE were identified in the Australian state of New South Wales using a state-wide database. The annual incidence was 4.7 per 100 000 (95% CI 4.4-4.9) being highest in patients aged between 80 and 84 years. The most frequent causative organism was Staphylococcus aureus (32%). Surgery was performed in 20% and the 6-month mortality was 18%. During the study period, the median age of patients increased from 61 to 65 years (P = 0.02), but microbiology, surgery, and mortality rates remained stable. Health care-associated IE was identified in 30% and was associated with older age, diabetes, renal impairment, heart failure, and infection with methicillin-resistant Staphylococcus aureus and enterococcus. Even after adjustment for these differences, recent health care exposure was an independent predictor of mortality (hazard ratio 1.62, 95% CI 1.34-1.96).
  
  
  CONCLUSIONS
  Contemporary IE contributes to health care-related infection, occurs in an increasingly elderly population, and remains a condition with unacceptably high mortality.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, Sydney South Western Area Health Service, University of Sydney, 3rd floor West, Hospital Rd, Concord, NSW 2139, Australia.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Sy
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D017714:Community-Acquired Infections / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D004697:Endocarditis, Bacterial / Q000401:mortality*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D013203:Staphylococcal Infections / Q000401:mortality; D013211:Staphylococcus aureus