Clinical features and outcome analysis of infective endocarditis in elderly patients

Diagnosis and management of infective endocarditis (IE) in elderly patients remains a difficult problem. This study evaluated the clinical and microbiologic characteristics and outcome of IE in elderly patients.

From 1996 to 2002, clinical and microbiologic data from 67 patients with IE aged > or = 65 years at National Taiwan University Hospital were reviewed and analyzed.

The median age of the 67 patients was 74 years (range, 66 to 95 years). Staphylococci and streptococci were the 2 leading etiologies of IE. Forty seven of the cases were defined as community-acquired. IE had not been diagnosed at admission in nearly two-thirds of cases. Of the 20 episodes of nosocomial IE, the median interval to development of IE after hospitalization was 30 days. Staphylococci constituted 90% of causative pathogens in nosocomial IE. The in-hospital mortality rate was 29.9%. Univariate analysis revealed that staphylococci as the causative pathogen and nosocomial IE were predictors of fatal outcome (p <0.05). When significant variables related to a fatal outcome on univariate analysis, i.e., staphylococcal IE, nosocomial IE, acute renal failure and cardiac complications, were entered in the multivariate analysis, acute renal failure and development of congestive heart failure or new conduction disturbance were both significantly associated with in-hospital death.

Diagnosis of IE in the elderly was often delayed and a substantial proportion of patients died during hospitalization. Staphylococcal IE and nosocomial IE were significant predictors of in-hospital death.