Incidence, predisposing factors, and aetiology of infective endocarditis in the Czech Republic

Abstract

The aim of this study was to evaluate the incidence and epidemiological characteristics of infective endocarditis (IE) in the Czech Republic. These results represent the first data on the epidemiology of IE from the post-communist countries. This was a prospective multi-centre observational study monitoring the occurrence of IE in the catchment areas of 29 hospitals during a 12-month period. The total monitored territory involved a population of 3.9 million people (37.7% of the total Czech population). Patients were included in the study if they had a diagnosis of possible or definite endocarditis according to the modified Duke criteria. One hundred and thirty-four episodes of IE in 132 patients were reported. Thus the crude incidence of IE was 3.4 cases/100,000 inhabitants/y. Vegetations were most frequently found on the aortic and mitral valves. The most frequent agent was Staphylococcus aureus (29.9%). The aetiology remained unexplained in 33.6% of cases, mainly because of previous antibiotic therapy. Surgical intervention during antibiotic therapy was performed in 36 patients (27.5%). Thirty-six patients died during hospitalization (in-hospital mortality rate 27.5%). The most common predisposing cardiac factors were remote cardiac surgery (19.4%) and degenerative valvular changes (11.9%). The most common extracardiac factors were pyogenic infections of skin and soft tissues (13.0%) and chronic haemodialysis (8.2%). Our results document the changing epidemiological characteristics of IE, namely an increasing incidence of the disease and an increasing role of Staphylococcus aureus as a major pathogen. A shift was evident in predisposing factors for IE: almost 39% of IE episodes were associated with both cardiac and extracardiac modern medical procedures.