title: Profile of infective endocarditis at a tertiary-care hospital in Japan over a 14-year period: characteristics, outcome and predictors for in-hospital mortality.
abstract: OBJECTIVE
  The aims of this study were to describe the epidemiological features and clinical characteristics of infective endocarditis (IE) at a tertiary-care hospital in Japan and to identify the factors associated with in-hospital mortality.
  
  
  METHODS
  A retrospective observational study was conducted at a 925-bed tertiary-care teaching hospital in Japan. All adult patients diagnosed with definite IE between August 2000 and July 2014 according to the modified Duke criteria were included.
  
  
  RESULTS
  A total of 180 patients (60.6% men; mean age, 69.1 years) with definite IE were included. The most common pathogen was Staphylococcus aureus (27.2%). Nine patients (5.0%) had culture-negative IE. Transthoracic and transoesophageal echocardiography were performed in 180 (100%) and 132 patients (73.3%), respectively, and vegetations were detected in 128 patients (71.1%). Surgical therapy was performed in 31 patients (17.2%). Overall, the in-hospital mortality rate was 26.1%. The independent predictors of in-hospital mortality were methicillin-resistant S. aureus (MRSA), vascular phenomena, health care-associated IE and heart failure.
  
  
  CONCLUSIONS
  MRSA, vascular phenomena, health care-associated IE and heart failure were independent predictors of in-hospital mortality. The unique characteristics in our cohort were the very high mean age, low rate of culture-negative IE, high rate of definite IE without detected vegetations and predominance of S. aureus.
authors.affiliation: Department of Infectious Diseases, Kameda Medical Center. Electronic address: ryota510@hotmail.com.
authors.forename: Ryota
authors.initials: R
authors.lastname: Hase
authors.affiliation: Department of Laboratory Medicine, Kameda Medical Center.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Otsuka
authors.affiliation: Department of Epidemiology, Harvard School of Public Health.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Infectious Diseases, Kameda Medical Center.
authors.forename: Naoto
authors.initials: N
authors.lastname: Hosokawa
mesh_terms: D000368:Aged; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers
keywords: Infective endocarditis; Staphylococcus aureus; elderly population; predictors for in-hospital mortality; proactive infectious diseases consultation