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Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis-Prospective Cohort Study.
Murdoch, David R. MD, MSc; Corey, Ralph G. MD; Hoen, Bruno MD; Miro, Jose M. MD, PhD; Fowler, Vance G. Jr MD, MHS; Bayer, Arnold S. MD; Karchmer, Adolf W. MD; Olaison, Lars MD, PhD; Pappas, Paul A. MS; Moreillon, Philippe MD, PhD; Chambers, Stephen T. MD, MSc; Chu, Vivian H. MD, MHS; Falco, Vicenc MD; Holland, David J. MB, ChB, PhD; Jones, Philip MD; Klein, John L. MD; Raymond, Nigel J. MB, ChB; Read, Kerry M. MB, ChB; Tripodi, Marie Francoise MD; Utili, Riccardo MD; Wang, Andrew MD; Woods, Christopher W. MD, MPH; Cabell, Christopher H. MD, MHS; for the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators
[Article] Archives of Internal Medicine. 169(5):463-473, March 9, 2009.

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Background: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.

Methods: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005.

Results: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk.

Conclusions: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Arch Intern Med. 2009;169(5):463-473