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Three Separate Clinical Entities of Infective Endocarditis-A Population-Based Study From Southern Finland 2013-2017
Mika Halavaara1, Timi Martelius1, Veli-Jukka Anttila1
1Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
Health care-associated infective endocarditis (HAIE) and intravenous drug use-related IE (IDUIE) are significant groups. This study highlights their distinct clinical features and outcomes, emphasizing the need to recognize IDUIE as a separate risk group.
Area of Science:
- Infectious Diseases
- Cardiology
- Epidemiology
Background:
- Infective endocarditis (IE) encompasses health care-associated (HAIE) and intravenous drug use-related (IDUIE) forms.
- These groups represent major challenges in IE management.
- Their specific roles and clinical presentations require detailed investigation.
Purpose of the Study:
- To analyze the distinct clinical characteristics and outcomes of community-acquired IE (CAIE), HAIE, and IDUIE.
- To assess the epidemiological significance of IDUIE in a population-based setting.
- To inform clinical recognition and management strategies for different IE risk groups.
Main Methods:
- A population-based retrospective study of adult IE patients in Southern Finland (2013-2017).
- IE episodes were categorized into CAIE, HAIE, and IDUIE based on acquisition mode.
- Statistical analysis compared patient demographics, etiology, valve involvement, and mortality rates across groups.
Main Results:
- The study included 313 IE episodes with an overall incidence of 6.48/100,000 person-years.
- CAIE, HAIE, and IDUIE each accounted for approximately one-third of cases.
- IDUIE patients were younger, with higher rates of right-sided IE and Staphylococcus aureus etiology compared to CAIE.
- HAIE patients exhibited more comorbidities, prosthetic valve involvement, and significantly higher mortality rates than CAIE patients.
Conclusions:
- Intravenous drug use-related IE (IDUIE) should be recognized as a distinct major risk group, separate from community-acquired IE (CAIE), especially in regions with high drug use prevalence.
- Health care-associated IE (HAIE) presents with distinct risk factors and poorer outcomes compared to CAIE.
- A tripartite classification of IE (CAIE, HAIE, IDUIE) is crucial for understanding variable characteristics and outcomes.
Background:
Health care-associated infective endocarditis (HAIE) and intravenous drug use-related IE (IDUIE) have emerged as major groups in infective endocarditis (IE). We studied their role and clinical picture in a population-based survey.
Methods:
A population-based retrospective study including all adult patients diagnosed with definite or possible IE in Southern Finland in 2013-2017. IE episodes were classified according to the mode of acquisition into 3 groups: community-acquired IE (CAIE), HAIE, and IDUIE.
Results:
Total of 313 episodes arising from 291 patients were included. Incidence of IE was 6.48/100 000 person-years. CAIE accounted for 38%, HAIE 31%, and IDUIE 31% of IE episodes. Patients in the IDUIE group were younger, and they more frequently had right-sided IE (56.7% vs 5.0%; P < .001) and S. aureus as etiology (74.2% vs 17.6%; P < .001) compared with the CAIE group. In-hospital (15.1% vs 9.3%; P = .200) and cumulative 1-year case fatality rates (18.5% vs 17.5%; P = .855) were similar in CAIE and IDUIE. Patients with HAIE had more comorbidities, prosthetic valve involvement (29.9% vs 10.9%; P = .001), enterococcal etiology (20.6% vs 5.9%; P = .002), and higher in-hospital (27.8% vs 15.1%; P = .024) and cumulative 1-year case fatality rates (43.3% vs 18.5%; P < .001) than patients with CAIE. Staphylococcus aureus caused one-fifth of IE episodes in both groups.
Conclusions:
Our study indicates that in areas where injection drug use is common IDUIE should be regarded as a major risk group for IE, along with HAIE, and not seen as part of CAIE. Three different risk groups, CAIE, HAIE, and IDUIE, with variable characteristics and outcome should be recognized in IE.
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