title: Infective endocarditis in New Zealand: data from the International Collaboration on Endocarditis Prospective Cohort Study.
abstract: OBJECTIVE
  The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) collected worldwide data on the presentation, management and outcome of infective endocarditis (IE). We present data from patients with endocarditis enrolled from New Zealand.
  
  
  METHODS
  Patients who fulfilled the Duke criteria for definite or probable endocarditis were enrolled from five district health boards: Auckland, Counties Manukau, Waitemata, Capital and Coast, and Canterbury, between June 2000 and September 2005.
  
  
  RESULTS
  There were 336 New Zealand patients enrolled in the ICE-PCS. Prosthetic valve endocarditis occurred in 31%. Underlying medical conditions were present in 28% of patients, but only 4% of patients had rheumatic heart disease. Forty patients (12%) had healthcare-associated endocarditis. Viridans streptococci were the most common cause of IE (32%), followed by Staphylococcus aureus (24%). Patients with S. aureus IE were more likely to present within a week of symptom onset than those with viridans streptococcus IE (OR 4.18, 95% CI 2.36-7.42). Surgery was performed in 33% of patients. In total, 20 patients (6%) died in hospital. Those with endocarditis caused by coagulase-negative staphylococci had an increased risk of death compared with those viridans streptococcus endocarditis (RR 4.7, 95% CI 1.2-17). The risk of stroke was higher in those with endocarditis caused by S. aureus and coagulase-negative staphylococci (RR 2.7, 95% CI 1.2-6.05, and 4.9, 95% CI 1.9-13, respectively).
  
  
  CONCLUSIONS
  While viridans streptococci remain the predominant causative organisms of IE in New Zealand, many 'traditional' clinical and management aspects of this disease no longer apply. This paper provides a reference for local practitioners assessing and managing IE.
authors.affiliation: Department of Infectious Diseases, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand. Genevieve.Walls@middlemore.co.nz.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Walls
authors.forename: Stephen
authors.initials: S
authors.lastname: McBride
authors.forename: Nigel
authors.initials: N
authors.lastname: Raymond
authors.forename: Kerry
authors.initials: K
authors.lastname: Read
authors.forename: Christin
authors.initials: C
authors.lastname: Coomarasamy
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Morris
authors.forename: Stephen
authors.initials: S
authors.lastname: Chambers
authors.forename: David
authors.initials: D
authors.lastname: Holland
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D013293:Enterococcus faecalis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D034363:Viridans Streptococci; D055815:Young Adult