Definition and Epidemiology of Infective Endocarditis

Abstract

The term “endocarditis” was used for the first time in 1835 by Jean-Baptiste Bouillaud in France for a disease that underwent endless development throughout the nineteenth century. Infective endocarditis (IE) discoveries were provided by the synthesis of clinical medicine, pathology, and, after the proof and acceptance of germ theory, with the use of microbiology. Numerous observations by several scientists associated valvular lesions, point of entry, circulating microorganisms, fever, and extra cardiac manifestations with IE. The first animal endocarditis model was developed in 1878 in Poland by Ottomar Rosenbach. Since the end of the nineteenth century until today, significant advances have been made in understanding the pathophysiology, diagnostic modalities, and therapeutic options of the disease. Incidence of IE varies widely, ranging from 1.5 to 11.6 cases per 100,000 person-years. However, the incidence is largely unknown from many parts of the world due to lack of representative data. Globally, IE was responsible for 35,900 thousand deaths in 1990, increasing to 48,300 in 2010. IE is traditionally linked to rheumatic and congenital heart diseases, prosthetic valves, and previous episodes of IE; however, other emerging risk factors, such as intravenous drug abuse, intracardiac devices, HIV infection, and hemodialysis have been identified, and are surpassing the traditional risk factors, particularly in industrialized countries. Epidemiological surveys from several countries have confirmed that the epidemiological profile of IE has changed substantially. Although the overall IE incidence has remained stable, Staphylococcus aureus is now the most common causative organism in most of the industrialized world. IE patients have also shifted towards having an increased mean age, due to a higher prevalence of prosthetic valves and other cardiac devices, and a decreasing prevalence of rheumatic heart disease. Moreover, the proportion of IE patients undergoing surgery has increased over time to reach approximately 50 %. Despite advances in medical knowledge, diagnostic modalities, antimicrobial therapy, and surgical procedures, mortality from IE continues to be high.