title: Infective endocarditis epidemiology over five decades: a systematic review.
abstract: OBJECTIVE
  To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades.
  
  
  RESULTS
  We searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011.
  Einstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over each of the last 5 decades (p<0.001) and Staphylococcus aureus (SA) in the last decade (21% to 30%; p<0.05). Streptococcus viridans (SV) and culture negative (CN) IE frequency decreased over time (p<0.001), while enterococcal IE increased in the last decade (p<0.01). Patient age and male predominance increased over time as well. In subgroup analysis, SA frequency increased in North America, but not the rest of the world. This was due, in part, to an increase in intravenous drug abuse IE in North America (p<0.001). Among population-based studies (n=18; 3,477 patients) no significant changes were found.
  
  
  CONCLUSIONS
  Important changes occurred in IE epidemiology over the last half-century, especially in the last decade. Staphylococcal and enterococcal IE percentage increased while SV and CN IE decreased. Moreover, mean age at diagnosis increased together with male:female ratio. These changes should be considered at the time of decision-making in treatment of and prophylaxis for IE.
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America ; Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: Leandro
authors.initials: L
authors.lastname: Slipczuk
authors.affiliation: Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America.
authors.forename: J Nicolas
authors.initials: JN
authors.lastname: Codolosa
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America.
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Davila
authors.affiliation: Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America.
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America ; Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Jeong
authors.initials: J
authors.lastname: Yun
authors.affiliation: Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
authors.affiliation: Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America ; Jefferson Medical College, Philadelphia, Pennsylvania, United States of America.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D004696:Endocarditis / Q000453:epidemiology* / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D011159:Population Surveillance; D012737:Sex Factors