Abstract
BackgroundDespite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. Although recent studies have provided evidence of changing trends in IE epidemiology, few studies examine patterns within urban minority populations. Here we present the epidemiology, risk factors, and outcomes of IE among an underserved African American population in Brooklyn, New York, compared to the general population.MethodsThis is a retrospective study which included 67 patients with IE diagnosed at The Brooklyn Hospital Center from 2009 to 2015. Patients were selected according to the modified Duke Criteria for definite IE. Various epidemiological parameters were examined via chi-square and Fisher’s exact test using SPSS 24 software (IBM Corp., Armonk, NY).ResultsThe mean age of the 67 patients was 63 years and 46.3% of the patients were men. The majority of patients (70.1%) were African American while Hispanics and Caucasians were 17.9% and 7.5%, respectively. Healthcare-associated IE (58.2%, n=39) outnumbered community-acquired IE (41.8%, n=28). The sites of vegetation were the mitral valve (62.7%, n=42), tricuspid valve (22.4%, n=15), aortic valve (11.9%, n=8), and intravenous catheter (3%, n=2). In valves, 13.4% of the cases were found in prosthetic valves while the majority occurred in native valves. The most common pathogens of IE were the Staphylococcus (50.8%, n=34) species, followed by Streptococcus species (32.8%, n=22). Overall, the in-hospital mortality was 38.8% (n=26) with higher mortality observed for healthcare-associated IE than community-acquired IE (P = .049). Embolic complications were associated with significant mortality (P < .001).ConclusionOur study demonstrated that the common causative pathogens for IE among African Americans trends towards Staphylococcus species followed by Streptococcus species, similar to the contemporary epidemiology of IE. Healthcare-associated IE outnumbered community-acquired IE and was associated with higher mortality. Embolic complications were significantly associated with high mortality. Therefore, efforts made to control healthcare-associated infections are expected to decrease the trend of IE.
Highlights
Infective endocarditis (IE) is a life-threatening disease characterized by infection of the endocardial surface of the heart
Our study demonstrated that the common causative pathogens for infective endocarditis (IE) among African Americans trends towards Staphylococcus species followed by Streptococcus species, similar to the contemporary epidemiology of IE
The main purpose of this study is to examine the temporal trend in the epidemiology, microbiology, management, and complications of IE among an underserved African American population in an urban setting in comparison to the general population
Summary
Infective endocarditis (IE) is a life-threatening disease characterized by infection of the endocardial surface of the heart. Numbers for rheumatic fever and rheumatic heart disease have been trending down over the last decades, the epidemiology of IE has experienced substantial changes especially in causative organisms and drugresistant organisms. This could be a part of an increasing elderly population and the emergence of new risk factors including intracardiac or intravenous devices, immunosuppressive conditions such as diabetes, hemodialysis, and intravenous drug use [1,2,3,4,5,6]. Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. We present the epidemiology, risk factors, and outcomes of IE among an underserved African American population in Brooklyn, New York, compared to the general population
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