title: Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: focus on the use of prosthetic material.
abstract: OBJECTIVE
  Adult congenital heart disease (ACHD) predisposes to infective endocarditis (IE). Surgical advancements have changed the ACHD population, whereas associated prosthetic material may constitute additional IE targets. We aimed to prospectively determine contemporary incidence, risk factors, and predictors of IE in a nationwide ACHD cohort, focusing on the presence of prosthetics.
  
  
  RESULTS
  We identified 14 224 patients prospectively followed in the CONCOR ACHD registry (50.5% female, median age 33.6years). IE incidence was determined using Poisson regression, risk factors and predictors using Cox regression. Overall incidence was 1.33 cases/1000 person-years (124 cases in 93 562 person-years). For risk-factor analysis, presence of prosthetics was forced-as separate time-updated variables for specific prosthetics-into a model with baseline characteristics univariably associated with IE. Valve-containing prosthetics were independently associated with greater risk both short- and long term after implantation [0-6 months: hazard ratio (HR) = 17.29; 7.34-40.70, 6-12 months: HR = 15.91; 6.76-37.45, beyond 12 months: HR = 5.26; 3.52-7.86], non-valve-containing prosthetics, including valve repair, only in the first 6 months after implantation (HR = 3.34; 1.33-8.41), not thereafter. A prediction model was derived and validated using bootstrapping techniques. Independent predictors of IE were baseline valve-containing prosthetics, main congenital heart defect, multiple defects, previous IE, and sex. The model had fair discriminative ability and provided accurate predictions up to 10 years.
  
  
  CONCLUSIONS
  This study provides IE incidence estimates, and determinants of IE risk in a nationwide ACHD cohort. Our findings, essentially informing IE prevention guidelines, indicate valve-containing prosthetics as a main determinant of IE risk whereas other prosthetics, including valve-repair, are not associated with increased risk long term after implantation.
authors.affiliation: Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.|Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands.
authors.forename: Joey M
authors.initials: JM
authors.lastname: Kuijpers
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
authors.forename: Dave R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.affiliation: Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
authors.forename: Kathinka C H
authors.initials: KCH
authors.lastname: Peels
authors.affiliation: Department of Cardiology, Alkmaar Medical Center, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
authors.forename: Constant L A
authors.initials: CLA
authors.lastname: Reichert
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
authors.forename: Marco C
authors.initials: MC
authors.lastname: Post
authors.affiliation: Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Bosker
authors.affiliation: Department of Cardiology, Medical Spectrum Twente, Koningsplein 1, 7512KZ, Enschede, The Netherlands.
authors.forename: Elly M C J
authors.initials: EMCJ
authors.lastname: Wajon
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.|Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands.
authors.forename: Barbara J M
authors.initials: BJM
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004696:Endocarditis / Q000150:complications / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords:  Congenital heart defect ; Adult ; Epidemiology; Prosthetic material ; Surgery 