Profile of infective endocarditis in a referral hospital over the last 24 years

SummaryObjectivesTo describe changes in demographic, clinical and micro-biological characteristics of infective endocarditis (IE), and to assess factors associated with an increased risk of death.MethodsEpisodes fulfilling the Duke criteria for definite IE were included. Data collected in 1980–1991, and 1992–2003 from IVDU and non-IVDU patients' records were collected, and changes within each group and between the groups analysed.ResultsThere were 169 episodes of IE in IVDUs, and 114 in non-IVDUs. HIV-infected patients were 86 (82 IVDUs). Site of involvement, need for surgery, and case fatality rate (15.6% among IVDUs and 11.3% non-IVDUs) did not change in both groups over time.Staphylococci and streptococci were the most commonly isolated organisms among IVDUs and non-IVDU, respectively; independent predictors of mortality among IVDUs were negative blood cultures [adjusted OR (AOR) 7.85], and fungal etiology (AOR 21.33). Among non-IVDUs prosthetic heart valves had an AOR of 2.22 (95% CI 0.48–10.21); the proportion of negative blood cultures significantly increased. An higher case-fatality rate was observed among HIV-positive patients (AOR 2.64 95% CI 0.85–8.20).ConclusionsLate diagnosis and lack of etiological definition continue to represent the most important obstacles to an effective management of IE, suggesting the need for a wider use of molecular techniques in patients with suspected IE.