Rate Of Infective Endocarditis Research Articles

1817. Characteristics and Outcomes in Patients with Staphylococcus lugdunensis Bacteremia Compared with Staphylococcus aureus and Staphylococcus epidermidis Bacteremia

Abstract Background Staphyococcus lugudnensis (SL) is a coagulase negative Staphylococcus species with a potential to cause invasive infection. Few studies have evaluated characteristics and outcomes of SL bacteremia (SLB) compared with Staphylococcus aureus (SA) and Staphylococcus epidermidis (SE). Methods We performed a single center retrospective case-control study of patients > =18 years of age with SLB with at least two sets of positive blood cultures at Kyoto University Hospital, Japan from January 2005 to December 2021. Patients who had SA bacteremia (SAB) with at least one set of positive blood culture and those who had SE bacteremia (SEB) with at least two sets of positive blood cultures were randomly selected in a 1:5:5 (SL:SA:SE) ratio during the same period. Characteristics and clinical outcomes of SLB were compared with those of SAB and SEB. Results A total of 24 patients with SLB, 120 patients with SAB, and 120 patients with SEB were included. Patients’ median age (interquartile range) was 69 (60, 75), 68 (49, 77) and 65 (51, 73) in order of SL, SA, and SE. The rate of hospital-acquired infection in SL was similar to that of SA (54% vs 64%; p=0.86), lower than that of SE (54% vs 91%; p< 0.01). Rates of methicillin resistance and intravascular catheterization were higher in SE (83% and 92%, respectively). Patients with SLB were more likely to be on hemodialysis (25%). Rates of polymicrobial bacteremia and blood cancer was lower in SA (7% and 8%, respectively). Echocardiography was done for 14 patients in SL, lower than in SA (58% vs 82%; p=0.01). The rate of infective endocarditis (IE) (primary and secondary) was not significantly different among three groups (SL 8.5%, SA 6.5%, SE 2%). There was no significant difference in rate of metastatic lesions between SL and SA (17% vs 20%, p=0.9), statically lower in SE than in SL (17% vs 4%; p< 0.01). Seven-day mortality was similar between SL and SA (8% vs 7%; p=0.77), lower in SE than in SL (8% vs 0.5%; p=0.02). Thirty-day mortality in SL was not significantly different in other groups (SL 17%, SA 18%, SE 10%). Conclusion The rates of metastatic lesions and 7-day mortality in SL were similar to that of SA, higher than that of SE. Appropriate evaluation and treatment that are recommended for SAB may be warranted for patients with SLB. Disclosures All Authors: No reported disclosures.

Abstract 13084: Occurrence of Infective Endocarditis After Transcatheter versus Surgical Pulmonary Valve Implantation: Results of a Nationwide Administrative Database

Background: It is unclear if the risk of infective endocarditis (IE) differs between transcatheter (TPVI) and surgical (SPVR) pulmonary valve implantation. We sought to address this question using administrative data including a large nationwide patient population. Methods: All congenital heart disease (CHD) patients ≥4 years of age who underwent isolated pulmonary valve implantation were identified in the BARMER Health Insurance Company database (≈9 million members, representative of the German population). Data from 01/2005 to 12/2018 were analyzed with regard to overall survival and complications particularly focusing on IE. Results: Overall, 461 pulmonary valve implantations were performed in 413 patients (59.4% male, median age 18.6 years (IQR 12.8-31.3)). Of those, 38.4% (n=177) underwent TPVI, while 61.6% (n=284) were treated with SPVR. Overall, IE was diagnosed in 8.0% (n=37) of cases after a median of 1.3 years (IQR 0.2-3.7). In the TPVI cohort, IE occurred in 10.2% (n=18) of cases, while IE was diagnosed in 6.7% (n=19) of cases with SPVR ( p =0.217). Furthermore, 5.0% (n=23) of all patients died during follow-up (of those n=4 within 90 days after diagnosis of IE). On multivariable Cox-regression analysis, previous diagnosis of IE was associated with a higher risk of re-IE ( p =0.025), but no association between IE and age ( p =0.17), sex ( p =0.34) or type of CHD was found ( p =0.71). While the overall rate of IE was not dependent on the treatment modality, there were significant time-dependent differences: Within the first year of follow-up, freedom from IE or death was significantly higher in the TPVI cohort (HR 5.26 [95% CI 1.59-16.67], p =0.006) compared to SPVR), but within the 3-10 year period the probability reversed in favor of the SPVR cohort (HR 10.07 [95% CI 3.41-29.76], p <0.001) compared to TPVI). Conclusion: In a cohort of 413 patients undergoing pulmonary valve implantation, infective endocarditis occurred in 8.0% of cases. The overall rate of infective endocarditis was not significantly different between surgical and interventional pulmonary valve procedures. However, while early endocarditis was more often related to surgical procedures, the mid-term IE risk was significantly lower in surgically treated patients.

53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

BackgroundCoronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies.MethodsWe reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-flow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia.ResultsA total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day.Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures ConclusionThe incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab.Disclosures All Authors: No reported disclosures

MIGHTY MITIS

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Transcatheter Aortic Valve Replacement (TAVR) is the mainstay treatment of severe aortic stenosis especially in the elderly with multiple comorbidities and is emerging as an alternative to surgical aortic valve replacement (SAVR). (1) The rate of infective endocarditis (IE) following TAVR has been reported to be around 1.5%.(2) Herein, we describe a case where the patient developed prosthetic valve endocarditis (PVE) 2 months after undergoing TAVR. CASE PRESENTATION: A 73-year-old male presented to the emergency with cough, chills, and bilateral lower extremity swelling for a week. His medical history was significant for hypertension, hyperlipidemia, type 2 diabetes mellitus, bradycardia status post dual lead pacemaker (2013), and severe aortic stenosis status post TAVR (26mm SAPIEN 3 valve via right femoral artery- TAVR was done 2 months prior to this presentation). The patient underwent a dental procedure 3 weeks after the TAVR and did not receive any antibiotic prophylaxis prior to the dental procedure. Duke Criteria indicated ‘Possible infective endocarditis (IE)’. Transthoracic echocardiogram (TTE) did not show any vegetation. Blood cultures yielded Streptococcus mitis/ oralis. Transesophageal echocardiogram (TEE) showed 0.6 X 0.2cm vegetation on the left coronary cusp of the prosthetic aortic valve and mild paravalvular aortic insufficiency. The pacemaker was vegetation-free. He was started on intravenous (IV) ceftriaxone, responded well to it, and was discharged with a 6weeks course of IV ceftriaxone and he was referred to cardiothoracic surgery for further evaluation. DISCUSSION: IE is an uncommon complication after TAVR. PVE associated with TAVR is difficult to diagnose and has a dismal prognosis so TAVR- IE deserves prompt diagnosis and treatment. PVE presents with fever, new or changing heart murmur, new or worsening heart failure, or new or progressive cardiac conduction abnormalities. The most frequently encountered pathogens in early PVE (within two months of TAVR) are S. aureus and coagulase-negative staphylococci followed by gram-negative bacilli and fungi. The most frequently encountered pathogens in intermediate PVE (2 to 12 months after TAVR) and late PVE (more than 12 months after TAVR) are streptococci and S. aureus followed by coagulase-negative staphylococci and enterococci. The main sources of PVE are dental interventions and respiratory, skin, urological, and gastrointestinal infections.(2) Studies have shown that men are found to be affected by IE more often than women. (3) CONCLUSIONS: As per the American Heart Association (AHA) and the European Society for Cardiology (ESC) guidelines, PVE should be treated with a bactericidal agent for at least six weeks. Guidelines recommend early surgery in complicated cases including those with heart failure, perivalvular complications, and high risk of embolism. Emphasis should also be given on any pre-procedure prophylaxis. Reference #1: Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. Reference #2: Amat-Santos IJ, Ribeiro HB, Urena M, Allende R, Houde C, Bédard E, Perron J, Delarochellière R, Paradis JM, Dumont E, Doyle D, Mohammadi S, Côté M, San Roman JA, Rodés-Cabau J. Prosthetic valve endocarditis after transcatheter valve replacement: A systematic review. JACC Cardiovasc Interv. 2015;8:334–346. Reference #3: Olsen NT, Backer O De, Thyregod HGH, Vejlstrup N, Bundgaard H, Søndergaard L. Structural Heart Disease Prosthetic Valve Endocarditis After Transcatheter Aortic Valve Implantation. 2015;1–9. DISCLOSURES: No relevant relationships by Sanya Chandna, source=Web Response No relevant relationships by Kesavan Sankaramangalam, source=Web Response No relevant relationships by Monarch Shah, source=Web Response

Endocarditis risk with bioprosthetic and mechanical valves: systematic review and meta-analysis

ObjectiveBioprosthetic valves are being used with increased frequency for valve replacement, with controversy regarding risk:benefit ratio compared with mechanical valves in younger patients. However, prior studies have been too small...

Infective Endocarditis in Pregnancy During the Opioid Epidemic [16E

INTRODUCTION: To compare the incidence and complications of infective endocarditis among opioid-using pregnant women from 2006–08 and 2016–18. METHODS: We conducted a cross-sectional analysis of hospitalizations using a publicly available, all-payer inpatient database in Kentucky. Duplicate patients were identified and removed. RESULTS: From 2006–08, 187,178 hospitalizations involved pregnancy of which 1,311 were diagnosed with opioid dependence, use, or abuse. Three of these women had ICD codes for endocarditis (0.23%). From 2016–18, 166,756 hospitalizations involved pregnancy, of which 5,222 were diagnosed with opioid dependence, use, or abuse (+398%). Three of these patients had rheumatic disease, leaving 37 patients (0.71%) with endocarditis related to their opioid use alone, P=.047. The 2016–18 population with endocarditis were white (100%); lived primarily in metropolitan counties (61%); and 57.1% were less than 30 years old. 11% of admissions were in the 1st trimester, 16.2% in the 2nd, 43.2% in the 3rd, and 16.2% postpartum, P=.012. 14% had a spontaneous or missed abortion. The median length of stay was 22.5 days. Ten deliveries were complicated by endocarditis, six by cesarean section. Five women underwent valvular surgery in 2016–18: four valve replacements and one total valve excision. Of the hospitalizations with a maternal mortality for 2016–18, three were complicated by endocarditis. CONCLUSION: A four-fold increase in hospitalization complicated by opioid use was observed as well as a significant increase in the rate of infective endocarditis in this population. Endocarditis contributed to maternal mortality, life-threatening morbidities, prolonged hospital stay, and increased cost.

Numerous outbreaks amongst homeless and injection drug-using populations raise concerns of an evolving syndemic in London, Canada.

London, Ontario is a mid-sized Canadian city which appears to be experiencing a syndemic predominately amongst its marginalized populations. Since 2014, rates of HIV, hepatitis A (HAV), hepatitis C (HCV), and invasive group A streptococcal disease have climbed well above provincial rates amid increasing use of injection drugs. Rates of infective endocarditis have also been on the rise. Extensive public health and community-based efforts were taken in response to these concurrent outbreaks. These efforts included establishing improved client care pathways, creating specialized teams to engage underhoused clients, providing mass immunization, and developing new health promotion campaigns. Rates of HIV and HAV were subsequently controlled locally while rates of HCV, iGAS and infective endocarditis remain high within the community and throughout the province.

An Antimicrobial Stewardship Intervention Improves Adherence to Standard of Care for Staphylococcus aureus Bloodstream Infection.

Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system. Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions. A stewardship intervention was then begun for all patients with SABSI recommending infectious diseases consultation, transesophageal echocardiography (TEE), source control, and preliminary antibiotic changes. A retrospective review was performed for all SABSI cases 2 years before and after implementation of the SABSI intervention. Two hundred forty-three cases before intervention and 259 after intervention were included. An increase in obtaining follow-up negative blood cultures (79.8% vs. 89.6%), infectious diseases consultation (52.7% vs. 86.5%), TEE (25.5% vs. 54.8%), beta-lactam switch for methicillin-susceptible S. aureus (55.2% vs. 74.4%), and source control (41.2% vs. 57.9%) was demonstrated. We demonstrated similar durations of bacteremia, length of stay, relapse, mortality, and rates of infective endocarditis. Adherence to standard of care for patients with SABSI can be dramatically improved through provider education, leveraging antimicrobial stewardship resources, and infectious diseases consultation.

Rates of Infective Endocarditis in Substance Use Disorder and Associated Costs in Ontario

ABSTRACTRésumé Objectives: Infective endocarditis (IE) is a serious complication of substance use disorder (SUD). Limited data exist on IE and SUD prevalence in Canada. We report the number of IE cases and associated hospital costs using population-based administrative healthcare data for Ontario. Methods: The cohort included patients hospitalized for IE between 1997 and 2014. IE patients with a diagnosis of SUD within 4 years of hospitalization were classified as SUD. IE patients without such a diagnosis were classified as non-SUD (NSUD). The annual number of cases and mean percent change by region were determined. Mean patient cost and total annual hospital costs were also examined. Results: The number of IE cases in SUD patients increased 5-fold from 1997 to 2014, while there was little change in NSUD patients with IE. All regions in Ontario had a similar relative increase in the number of SUD with IE. The mean per patient hospitalization cost increased by $572 [95% confidence interval (CI): −$50, $1193] per year for SUD, and by $2086 (95% CI: $763, $3409) per year for NSUD. The annual total hospitalization cost for SUD increased by $593,152 per year (95% CI: $388,286, $798,018) and for NSUD by $931,422 per year (95% CI: $517,408, $1345,437). Conclusions: This population-based study is the first to report a substantial increase in IE cases in Canada. The total annual hospital costs related to IE increased in SUD due to the rising number of affected patients, while increasing costs in NSUD were due to increases in the per patient cost of care. Objectifs: L’endocardite infectieuse (EI) est une complication grave du trouble lié à l’usage de substances psycho-actives. Il existe peu de données sur la prévalence des EI et des SUD au Canada. Nous rapportons le nombre de cas d’EI et les coÛts hospitaliers associés à l’aide de données administratives basées sur la population de l’Ontario. Méthodes: Le groupe étudié incluait des patients hospitalisés pour une EI entre 1997 et 2014. Les patients ayant un diagnostic de DPS diagnostiqués dans les 4 ans précédant leur hospitalisation ont été classés dans la catégorie de DSP. Les patients IE sans diagnostic de ce type ont été classés dans la catégorie des troubles non liés à une substance (NSUD). Le nombre annuel de cas et le pourcentage moyen de variation par région ont été déterminés. Le coÛt moyen par patient et les coÛts hospitaliers annuels totaux ont également été examinés. Résultats: Entre 1997 et 2014, le nombre de cas d’EI chez les patients atteints de DUS a augmenté cinq fois plus, alors qu’il y avait peu de changement chez les patients NSUD atteints d’EI. Toutes les régions de l’Ontario ont connu une augmentation relative similaire du nombre de TUE avec IE. Le coÛt moyen d’hospitalisation par patient a augmenté de 572$ (IC à 95%: - 50$ – 1,193$) par an pour le SUD et de 2,086$ (IC à 95%: 763$ – 3,409$ USD) par an pour le NSUD. Le coÛt total annuel des hospitalisations pour le SUD a augmenté de 593,152 dollars par an (IC à 95%: 388,286 dollars – 798,018 dollars) et de 931,422 dollars pour le NSUD (IC à 95%: 517,408 dollars – 1,344,437 dollars). Conclusions: Cette étude basée sur la population est la première à rapporter une augmentation substantielle de l’incidence de l’EI au Canada. Les coÛts hospitaliers annuels totaux liés à l’EI ont augmenté en DUS en raison du nombre croissant de patients affectés, tandis que les coÛts en augmentation dans le NSUD étaient dus à une augmentation du coÛt des soins par patient.

Mo1864 – Increasing Rates of Infective Endocarditis in Patients with Inflammatory Bowel Disease

Mo1864 – Increasing Rates of Infective Endocarditis in Patients with Inflammatory Bowel Disease

INFECTIVE ENDOCARDITIS IN PEOPLE WHO INJECT DRUGS: AN ASSESSMENT OF LEFT SIDED AND NON-LEFT SIDED DISEASE

Over the last decade, the opioid crisis has led to a significant increase in the rate of infective endocarditis (IE) related to injection drug use (IDU). IDU has traditionally been associated with right sided IE, however, data describing IE in persons who inject drugs (PWID) in the “contemporary

Twenty-Year Secular Trends in Infective Endocarditis in a Teaching Hospital

BackgroundThe purpose of this study was to analyze the secular trends of infective endocarditis in a teaching hospital between January 1996 and December 2015.MethodsWe report on a single-center retrospective study of patients with left-side valve infective endocarditis. We performed an analysis of secular trends in the main epidemiological and etiological aspects, as well as clinical outcomes, in 5 successive 4-year periods (P1 to P5).ResultsIn total, 595 episodes of infective endocarditis were included, of which 76% were community-acquired and 31.3% involved prosthetic valves. Among the cases, 70% occurred in men, and the mean age (SD) was 64.1 (14.3) years. A significant increase in older patients (age ≥70 years) between P1 (15.332%) and P5 (51.9%; P < .001) was observed. The rate of infective endocarditis on biological prostheses also increased in the prosthetic group, accounting for 30% in P1 and 67.3% in P5 (P < .001). By contrast, there were significant decreases in vascular and immunological phenomena over the study period, with decreases in the presence of moderate to severe valvular insufficiency (75.9% in P1 to 52.6% in P5; P < .001) and valvular surgery (43% in P1 vs 29.6% in P5; P = .006). Finally, overall mortality was 23.9%, and although it was highest in P1, it subsequently remained stable through P2 to P5 (38% in P1 to 20% in P5; P = .004).ConclusionsThere has been a significant increase in infective endocarditis in older patients. The decrease in moderate to severe valve regurgitation at diagnosis could explain the stable mortality despite the increase in the mean age of patients over time.

Trends in infective endocarditis hospitalisations at United States children's hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines.

National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown. Children (5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations. A total of 841 cases were identified. The median age was 13 years (interquartile range 9-15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results. We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children's hospitals.

Nuclear medicine in diagnosis of prosthetic valve endocarditis: an update.

Over the past decades cardiovascular disease management has been substantially improved by the increasing introduction of medical devices as prosthetic valves. The yearly rate of infective endocarditis (IE) in patient with a prosthetic valve is approximately 3 cases per 1,000 patients. The fatality rate of prosthetic valve endocarditis (PVE) remains stable over the years, in part due to the aging of the population. The diagnostic value of echocardiography in diagnosis is operator-dependent and its sensitivity can decrease in presence of intracardiac devices and valvular prosthesis. The modified Duke criteria are considered the gold standard for diagnosing IE; their sensibility is 80%, but in clinical practice their diagnostic accuracy in PVE is lower, resulting inconclusively in nearly 30% of cases. In the last years, these new imaging modalities have gained an increasing attention because they make it possible to diagnose an IE earlier than the structural alterations occurring. Several studies have been conducted in order to assess the diagnostic accuracy of various nuclear medicine techniques in diagnosis of PVE. We performed a review of the literature to assess the available evidence on the role of nuclear medicine techniques in the diagnosis of PVE.

Clinical Features and Rate of Infective Endocarditis in Non-Faecalis and Non-faecium Enterococcal Bacteremia

Non-faecalis and non-faecium enterococci are an occasional cause of bacteremia, and some cases of infective endocarditis caused by these pathogens have been reported. However, the rate of infective endocarditis in non-faecalis and non-faecium enterococcal bacteremia is still undetermined. We compared the clinical features and the rate of infective endocarditis of 70 cases of non-faecalis and non-faecium enterococcal bacteremia with those of 65 cases of Enterococcus faecalis bacteremia. Non-faecalis and non-faecium enterococcal bacteremia was more frequently associated with biliary tract infection and polymicrobial bacteremia, and was less frequently associated with infective endocarditis, than was E. faecalis bacteremia (57% vs. 28%, p<0.01; 47% vs. 31%, p=0.05; 1% vs. 14%, p<0.01, respectively).

Enterococcus gallinarum endocarditis in a diabetic patient

Recent studies pointed out the increasing rate of infective endocarditis (IE) in diabetic patients. As diabetes mellitus (DM) prevalence is expected to increase in the coming years, infective endocarditis could be more frequently reported in these patients. We here describe a rare case of Enterococcus gallinarum endocarditis developing on normal native heart valve in an elderly diabetic woman. Therapeutic options were restricted due to resistance factors of the microorganism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, adequate antibiotic therapy led to the patient's recovery.

Incidence and complication rate of infective endocarditis in the Dutch region of Walcheren: a 3-year retrospective study

Objective — To measure the incidence of infective endocarditis (IE) in the region of Walcheren and to estimate the complication and comorbidity rate of IE, we conducted a 3-year retrospective study of IE in the only hospital (Ziekenhuis Walcheren) of the region between January, 2002 and December, 2004.Results — The total number of cases was 32.The calculated yearly incidence of IE was 9.61 cases per 100.000 inhabitants per year. The median age was 64 years (range 36-81 years).When applying the Duke criteria 28 patients (87.5%) were classified as definite IE and 4 patients (12.5%) as possible IE. Blood cultures were positive in 27 patients (84.4%).The most commonly isolated organisms were streptococci (37.5%). Staphylococcus aureus was isolated in 31.3% of positive blood cultures. Enteroccocus faecalis was identified in 3 cases (9.4%).In only 15.6% of the cases was the course of IE uncomplicated. The most frequent complications were heart failure (59.4%) and embolic events (34.4%). Cardiac surgery was performed in 37.5% of the cases. Concomitant morbidity was found in 75% of the patients. Especially, the high incidences of diabetes mellitus (28.1%), chronic renal failure (28.1%) and chronic obstructive pulmonary disease (21.9%) were remarkable.Conclusion — The calculated incidence of IE of 9.61 cases per 100,000 inhabitants per year was more than five times higher than the one reported in a nation-wide Dutch study of 1992.The present study demonstrates that IE remains a disease with a considerable mortality and complication rate. The majority of the patients with IE had non-cardiac comorbidity. Especially, the prevalence of diabetes mellitus and chronic renal failure in our population of patients with IE is remarkable.