Changes in the epidemiology and management of infective endocarditis

Lejko-Zupanc, T.


Objective: To study the changes in epidemiology, prognosis and management of infective endocarditis in time period from1984 to 2000. Material and methods: All the patients treated for infective endocarditis at the Department of Infectious Diseases in Ljubljana in the years 1984-2000 were prospectively studied. The following data were recorded: type of underlying heart disease, other concomitant diseases, isolated pathogens, outcome of the disease and type of management. The periods 1984-93 and 1994-2000 were then compared. The statistical analysis was performed using EpiInfo6 programme. Results: In the period of 1984-93 there were 146 patients with IE (90 male/56 female). 115 patients had native valve endocarditis (NVE) and 31 prosthetic valve endocarditis (PVE). Mean age in this group was 49.9 years. The most common causative agents were viridans streptococci in 32.8% patients followed by S. aureus in 14. 3%. Rheumatic heart disease was the most common underlying heart disease present in 23% of the patients with native valve. Eleven patients were operated in the active phase of the disease with postoperative mortality of 7.5%. The overall mortality rate was 21%. In the time period of 1994-2000 143 patients were treated of infective endocarditis (113 NVE, 30 PVE). The mean age in this group was 56.8 years. The most common underlying disease was degenerative valvular disease in 34% patients. S. aureus was predominant causative agent (28%). 24% of the patients were operated in the active phase with postoperative mortality rate of 20%. Overall mortality was 27%. There were significant differences between the two time periods. Rheumatic heart disease has significantly decreased as an underlying heart disease (P 0.05). In the time period 1994-2000 significantly more patients had a severe underlying disease such as diabetes, malignancy or previous invasive procedure (P 0.001). S. aureus has significantly increased in frequency in the period 1993-2000 (P 0.03). Although more patients were operated in the active phase the mortality was reduced only in patients with staphylococcal endocarditis (P 0.05) (61% vs. 30%).

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11th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 11th (2001)