Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci.
BACKGROUND
The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy.


METHODS
We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010.


RESULTS
We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%.


CONCLUSIONS
The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures.
Department of Cardiology, Maria Vittoria Hospital, Torino, Italy.
Enrico
E
Cecchi
Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
Fabio
F
Chirillo
SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy.
Anna
A
Castiglione
Department of Cardiology, University of Brescia, Brescia, Italy.
Pompilio
P
Faggiano
Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy.
Moreno
M
Cecconi
Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy.
Antonella
A
Moreo
Department of Cardiac Surgery, Sacco Hospital, Milano, Italy.
Alessandro
A
Cialfi
Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy.
Mauro
M
Rinaldi
Department of Cardiac Surgery, Mauriziano Hospital, Torino, Italy.
Stefano
S
Del Ponte
Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera - Universitaria di Parma, Parma, Italy.
Angelo
A
Squeri
Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy.
Silvia
S
Corcione
Ospedale di Chieri, Italy.
Francesca
F
Canta
Department of Cardiology, Reggio Emilia Hospital, Reggio Emilia, Italy.
Oscar
O
Gaddi
Department of Cardiology, Cervello Hospital, Palermo, Italy.
Francesco
F
Enia
Department of Cardiology, Maria Vittoria Hospital, Torino, Italy.
Davide
D
Forno
Department of Cardiology, Giovanni Bosco Hospital, Torino, Italy.
Piera
P
Costanzo
Department of Cardiology, Firenze Hospital, Firenze, Italy.
Alfredo
A
Zuppiroli
Department of Cardiology, Ivrea Hospital, Ivrea, Italy.
Giuliana
G
Ronzani
Department of Cardiology, Rimini Hospital, Rimini, Italy.
Flavio
F
Bologna
Department of Cardiology, Senigallia Hospital, Senigallia, Italy.
Anna
A
Patrignani
Department of Cardiology, Maria Vittoria Hospital, Torino, Italy.
Riccardo
R
Belli
SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy.
Giovannino
G
Ciccone
Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy.
Francesco Giuseppe
FG
De Rosa
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D016983:Enterococcus / Q000302:isolation & purification; D004866:Equipment Contamination; D005260:Female; D006350:Heart Valve Prosthesis / Q000382:microbiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification
Clinical presentation; Enterococcal endocarditis; Epidemiology; Infective endocarditis