title: Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey.
abstract: BACKGROUND
  Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE.
  
  
  METHODS
  A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death.
  
  
  RESULTS
  The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]).
  
  
  CONCLUSIONS
  S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.
authors.affiliation: Cardiologie, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.forename: Marie
authors.initials: M
authors.lastname: Célard
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Christophe
authors.initials: C
authors.lastname: Strady
authors.forename: Matthieu
authors.initials: M
authors.lastname: Revest
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.forename: Anne
authors.initials: A
authors.lastname: Bouvet
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011379:Prognosis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013210:Staphylococcus / Q000472:pathogenicity; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D055815:Young Adult