Nosocomial Vs. Community-Acquired Infective Endocarditis in Spain: Location, Trends, Clinical Presentation, Etiology, and Survival in the 21st Century.

Christian Ortega-Loubon,Mario Lorenzo-López,Pablo Jorge-Monjas,Álvaro Tamayo-Velasco,Irene Andrés García,Juan Bustamante-Munguira,Salvador Resino,Eduardo Tamayo,María Heredia-Rodríguez,Esther Gómez-Sánchez,Francisco Javier Álvarez,María Fe Muñoz-Moreno

doi:10.3390/jcm8101755

Abstract

Major changes have occurred in the epidemiology and etiology of infective endocarditis (IE). Nevertheless, the differences between nosocomial infective endocarditis (NIE) and community-acquired infective endocarditis (CIE) have not been addressed in a population-based study. We conducted a retrospective, nationwide, temporal trend study from 1997 to 2014 analyzing the epidemiology, clinical, geographical, meteorological characteristics of patients diagnosed with IE in Spain, to distinguish NIE from CIE. Among 25,952 patients with IE (62.2 ± 18·6 years; 65.9% men), 45.9% had NIE. The incidence of IE increased from 2.83 to 3.73 due to the NIE incidence increment with a decline in CIE. Patients with NIE were older (63.8 years vs. 60.8 years, p < 0·001), presented a higher Charlson index (1.22 vs. 1.03, p < 0.001), a greater history of implanted cardiac devices (8.7% vs. 4.6%, p < 0.001), and higher mortality (31.5% vs. 21.7%, p < 0.001). The most frequent microorganism for both NIE and CIE was Staphylococcus (p < 0.001), and the North reported a higher incidence (p < 0.001). Risk factors of mortality for NIE were age, Charlson index, hemodialysis, shock, heart failure, and stroke. Risk factors for CIE included female sex, renal disease, and cardiac-device carriers. The etiology of IE shifted from community origins to mostly nosocomial-associated infections. Higher morbidity, mortality, and poorer outcomes are associated with NIE.

Highlights

Infective endocarditis (IE) has a low incidence but is associated with a high degree of morbidity and mortality despite adequate antimicrobial management and cardiac surgery
Our study aimed to describe the global trend of infective endocarditis (IE) in Spain, compare the characteristics between nosocomial infective endocarditis (NIE) and community-acquired infective endocarditis (CIE), and determine their mortality associated risk factors
The overall incidence of IE in Spain gradually increased during the study period, given the consistently increasing NIE incidence along with a decline in the incidence of CIE

Summary

Introduction

Infective endocarditis (IE) has a low incidence but is associated with a high degree of morbidity and mortality despite adequate antimicrobial management and cardiac surgery. The epidemiology of the disease has changed since William Osler’s 1885 study established a standard for clinical and pathophysiological correlation [1,2]. Today we have a better understanding of IE’s epidemiology due to changes in the prevalence of risk factors and better diagnostic tools and treatment [3,4]. There has been a reduction in rheumatic heart disease cases due to Streptococcus spp., principally in younger women, and an increase in the incidence of acute staphylococcal endocarditis in older men [2,5]. Several factors have profoundly impacted the clinical spectrum of IE: hemodialysis, diabetes mellitus, intravenous drug use, human immunodeficiency virus, increased survival of the population at risk for IE, increased incidence of degenerative heart disease, interventional procedures, and increased use of intracardiac devices [6]. It is important to determine the updated guidelines’ direct consequences on the overall incidence of IE, which have not yet been described in Spain

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