Incidence, Microbiology, and Outcomes in Patients Hospitalized With Infective Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Infective endocarditis (IE) continues to pose significant mortality and morbidity risks despite advancements in management.
• Understanding temporal trends in IE incidence, microbiology, and outcomes is crucial for refining treatment strategies.

Purpose of the Study:

• To analyze temporal changes in the incidence, microbiology, and outcomes of infective endocarditis in Scotland.
• To assess the impact of updated national antibiotic prophylaxis guidelines on IE incidence.

Main Methods:

• A Scotland-wide, individual-level linkage study identified patients hospitalized with IE from 1990 to 2014.
• Data were linked to national microbiology, prescribing, and mortality datasets for trend analysis.
• Interrupted time series analysis evaluated incidence changes before and after 2008 guideline updates.

Main Results:

• Crude IE hospitalization rates increased initially (1990-1995) then stabilized, with no significant change post-2008 guideline updates.
• The incidence rate in patients over 80 years old doubled between 1990 and 2014.
• Age- and comorbidity-adjusted case fatality rates decreased for both men and women over the study period.
• Staphylococcus and Streptococcus species were the most common pathogens identified in blood cultures (from 2008 onwards).
• Staphylococcus aureus and Enterococcus bacteremia were associated with significantly higher 1-year mortality.

Conclusions:

• The study found no change in crude infective endocarditis incidence following updated antibiotic prophylaxis guidelines.
• A notable increase in IE incidence was observed in elderly individuals (over 80 years).
• Staphylococcus aureus and Enterococcus infections present a higher risk of mortality in IE patients.