Journal Article

Preeminence of Staphylococcus aureus in Infective Endocarditis: A 1-Year Population-Based Survey

Duval, Xavier, Doco-Lecompte, Thanh, Chirouze, Catherine, Bouvet, Anne, Célard, Marie, Alla, François, Iung, Bernard, Strady, Christophe, Selton-Suty, Christine, Revest, Matthieu, Hoen, Bruno, Le Moing, Vincent, Vandenesch, François, Delahaye, François

2012

Overview

Background. Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. Methods. A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li—definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. Results. The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). Conclusions. S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.

• Publisher: Oxford University Press,Oxford University Press (OUP)
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / ARTICLES AND COMMENTARIES / Bacterial diseases / Biological and medical sciences / Cardiology. Vascular system / Cardiovascular diseases / Community-Acquired Infections / Community-Acquired Infections - epidemiology / Community-Acquired Infections - microbiology / Comorbidity / Cross Infection / Cross Infection - epidemiology / Cross Infection - microbiology / Earth Sciences / Endocardial and cardiac valvular diseases / Endocarditis / Endocarditis, Bacterial / Endocarditis, Bacterial - epidemiology / Endocarditis, Bacterial - microbiology / Female / France / France - epidemiology / Health care / Health care industry / Heart / Heart diseases / Hospitals / Human bacterial diseases / Humans / Incidence / Infectious diseases / Life Sciences / Male / Medical sciences / Microorganisms / Middle Aged / Mortality / Observational studies / Petrography / Population studies / Population Surveillance / Prognosis / Prosthetic heart valves / Regression analysis / Risk Factors / Sciences of the Universe / Staphylococcal Infections / Staphylococcal Infections - epidemiology / Staphylococcal Infections - microbiology / Staphylococcal infections, streptococcal infections, pneumococcal infections / Staphylococcus / Staphylococcus - pathogenicity / Staphylococcus aureus / Staphylococcus aureus - pathogenicity / Staphylococcus infections / Young Adult