Trends In Infective Endocarditis Research Articles

Trends of Infective Endocarditis at Two Teaching Hospitals: A 12-Year Retrospective Cohort Study in Rio de Janeiro, Brazil.

Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.

Gender, Age, and Regional Disparities in the Incidence and Mortality Trends of Infective Endocarditis in the United States Between 1990 and 2019

The incidence of infective endocarditis (IE) has increased globally in the past decades, including in the United States. However, little is known about the differences in trends across states, gender, and age groups within the United States. Using the Global Burden of Disease database, we analyzed the incidence and mortality trends of IE in the United States between 1990 and 2019 using Joinpoint regression analyses, and compared between states, gender, and age groups. The age-standardized incidence rate (ASIR) of IE in the United States increased from 10.2/100,000 population in 1990 to 14.4 in 2019. The increase in ASIR was greater among men than women (45.8% vs 34.1%). The incidence increase was driven by 55+ year-olds (112.7% increase), with rapid increases in the 1990s and early 2000s, followed by a plateau around the mid-2000s. In contrast, the incidence among 5-to-19-year-olds decreased by -36.6% over the 30-year period. The incidence increased among all age groups in the last 5years of observation (2015 to 2019), with the largest increase in 5-to-19-year-olds (3.3% yearly). The 30-year increase in ASIR was greatest in Utah (66.2%) and smallest in California (30.2%). The overall age-standardized mortality attributable to IE increased in the United States by 126% between 1990 and 2019 versus 19.6% globally. In conclusion, although the overall incidence and mortality of IE increased over the past 30years in the United States, there are significant differences between regions, gender, and age groups. These findings indicate unevenly distributed disease burden of IE across the nation.

The Global, Regional, and National Burden and Trends of Infective Endocarditis From 1990 to 2019: Results From the Global Burden of Disease Study 2019.

IntroductionInfective endocarditis (IE) presents with increasing incidence and mortality in some regions and countries, as well as serious socioeconomic burden. The current study aims to compare and interpret the IE burden and temporal trends globally and in different regions from 1990 to 2019.MethodsData on the incidence, deaths and disability-adjusted life years (DALYs) caused by IE were extracted and analyzed from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPC) were adopted to quantify the change trends of age-standardized rates (ASRs). Besides, potential contributors of serious IE burden were also evaluated including age, gender, social-demographic index (SDI), and age-standardized incident rate (ASIR) in 1990.ResultsGlobally, the number of IE cases and deaths has increased sharply during the past 30 years from 478,000 in 1990 to 1,090,530 in 2019 and from 28,750 in 1990 to 66,320 in 2019, and both presented an upward temporal trend annually (EAPC:1.2 for incidence and 0.71 for death). However, the EAPC of age-standardized DALYs demonstrated a negative temporal trend despite increasing DALYs from 1,118,120 in 1990 to 1,723,590 in 2019. Moreover, older patients and men were more severely affected. Meanwhile, different SDI regions had different disease burdens, and correlation analyses indicated that SDI presented a positive association with ASIR (R = 0.58, P < 0.0001), no association with age-standardized death rate (R = −0.06, P = 0.10), and a negative association with age-standardized DALYs (R = −0.40, P < 0.0001). In addition, the incidence of IE increased in most countries during the past 30 years (190 out of 204 countries). However, the change trends of deaths and DALYs were heterogeneous across regions and countries. Finally, we discovered positive associations of the EAPC of ASRs with the SDI in 2019 among 204 countries and territories but few associations with the ASIR in 1990.ConclusionGenerally, the global burden of IE is increasing, and there is substantial heterogeneity in different genders, ages and regions, which may help policy-makers and medical staff respond to IE and formulate cost-effective interventional measures.

Endocarditis: An overview of serious cardiac disease for healthcare professionals

Background: Infective endocarditis (IE) is a severe cardiac condition primarily caused by various pathogens, including bacteria and fungi, that invade the bloodstream and affect heart valves. Historically linked to rheumatic fever, the epidemiology of IE has evolved, with healthcare-associated infective endocarditis (HCAIE) now representing a significant portion of cases due to increased use of intravenous devices. Despite advances in diagnosis and treatment, mortality rates remain high, emphasizing the need for a comprehensive understanding of IE. Aim: This article aims to evaluate the epidemiological trends of IE, discuss the latest diagnostic and management guidelines, and explore future directions to improve treatment outcomes. Methods: A thorough review of recent literature, epidemiological data, and current guidelines related to IE was conducted, analyzing global trends, causative agents, risk factors, and changing prevention strategies. Results: The incidence of IE has increased significantly, from 478,000 cases in 1990 to over 1 million in 2019, with a corresponding rise in mortality. Staphylococcus aureus has emerged as the leading pathogen, particularly in healthcare settings, while the epidemiology varies across regions, especially in developing countries. Conclusion: The multifaceted nature of IE requires a multidisciplinary approach for effective management.

Temporal changes in cardiovascular disease and infections in dialysis across a 22-year period: a nationwide study

BackgroundCardiovascular diseases (CVD) and infections are recognized as serious complications in patients with end stage kidney disease. However, little is known about the change over time in incidence of these complications. This study aimed to investigate temporal changes in CVD and infective diseases across more than two decades in chronic dialysis patients.MethodsAll patients that initiated peritoneal dialysis (PD) or hemodialysis (HD) between 1996 and 2017 were identified and followed until outcome (CVD, pneumonia, infective endocarditis (IE) or sepsis), recovery of kidney function, end of dialysis treatment, death or end of study (December 31st, 2017). The calendar time was divided into 5 periods with period 1 (1996–2000) being the reference period. Adjusted rate ratios were assessed using Poisson regression.ResultsIn 4285 patients with PD (63.7% males) the median age increased across the calendar periods from 65 [57–73] in 1996–2000 to 69 [55–76] in 2014–2017, (p < 0.0001). In 9952 patients with HD (69.2% males), the overall median age was 71 [61–78] without any changes over time.Among PD, an overall non-significant decreasing trend in rate ratios (RR) of CVD was found, (p = 0,071). RR of pneumonia increased significantly throughout the calendar with an almost two-fold increase of the RR in 2014–2017 (RR 1.71; 95% CI 1.46–2.0), (p < 0.001), as compared to the reference period. The RR of IE decreased significantly until 2009 (RR 0.43; 95% CI 0.21–0.87), followed by a return to the reference level in 2010–2013 (RR 0.87; 95% CI 0.47–1.60 and 2014–2017 (RR 1.1; 95% CI 0.59–2.04). A highly significant (p < 0.001) increase in sepsis was revealed across the calendar periods with an almost 5-fold increase in 2014–2017 (RR 4.69 95% CI 3.69–5.96).In HD, the RR of CVD decreased significantly (p < 0.001) from 2006 to 2017 (RR 0.85; 95% CI 0.79–0.92). Compared to the reference period, the RR for pneumonia was high during all calendar periods (p < 0.05). The RR of IE was initially unchanged (p = 0.4) but increased in 2010–2013 (RR 2.02; 95% CI 1.43–2.85) and 2014–2017 (RR 3.39; 95% CI 2.42–4.75). No significant changes in sepsis were seen.ConclusionAcross the two last decades the RR of CVD has shown a decreasing trend in HD and PD patients, while RR of pneumonia increased significantly, both in PD and in HD. Temporal trends of IE in HD, and particularly of sepsis in PD were upwards across the last decades.

Evolving trends in infective endocarditis over three decades in a developing country

Abstract Introduction Infective endocarditis (IE) is a rare serious disease for which diagnosis and treatment and prophylaxis continue to develop. Purpose The aim of our work were to analyze evolution in its epidemiologic, clinical, and microbiologic characteristics, as well as the outcomes. Methods This study compare data from a retrospective study conducted by Bennis and Al based on 157 cases of infectious endocarditis admitted in tertiary care Hospital between January 1983 and December 1994, theses cases are referred as Group A; and 103 cases of infective endocarditis according to Duke criteria admitted to the same center three decades afterwards from december 2013 to January 2020, which are referred as Group B. Results The mean age of the patients has became older over decades, with a mean of 27.5 years (11–65 years) in the group A versus 39.2 years [13–84] in the group B, with preservation of the male predominance (62.8% in group A vs 62.1% in group B). Infectious endocarditis secondary to rheumatic valvular heart disease has significantly decreased from 63.% of patients in group A to 27.5% in group B. Mitral or mitro-aortic valve involvement stayed predominant in both groups with a increase of mechanical prosthetic valve involvement with 9.7% in group B. A portal of entry of the infection was identified in 63% of patients in group A versus 41% in group B, we noted a significant decrease of dental-related cases from 64% in group A to 29% in group B, and a predominance of invasive procedure/devices cases in group B with 36% of identified cases. In group A Blood cultures were positive in 42% of cases with a predominance of Staphylocci (30%) and coagulase-negative Staphylococci (25.7% of cases) whilst in group B blood cultures were positive in 30% of cases with a predominance of Staphylococci (36.6%) and Streptococci (20% of cases). Echocardiography as a useful diagnostic tool demonstrated specific lesions of infectious endocarditis (abcess or vegetations) in 73.2% of cases in group A and 82% in group B. The clinical course in group A was complicated by congetive heart failure CHF (47.8%) or neurological lesions (11.5%) while in group B CHF was noted in 35% of cases and 8% of neurological lesions and The global mortality went from 28.7% in group A to 15% in group B related mostly to cardiogenic shock. Conclusion Our work demonstrated changes in the epidemiologic characteristics of IE that parallel changes in demographic and risk factors. The progress of diagnosis and treatement options in developing countries explains the better prognosis for this condition today. Funding Acknowledgement Type of funding sources: None.

A RARE CASE OF SUCCESSFUL TREATMENT OF PROSTHETIC MITRAL VALVE INFECTIVE ENDOCARDITIS WITH A NONSURGICAL APPROACH

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Infective endocarditis (IE) is an infection of the endocardial surface of the valve, native or prosthetic. Primary treatment for IE involving a prosthetic valve is surgical intervention (1, 2) and if left untreated can be fatal. Incidence rate of deaths associated with IE is 4.6/100,000/year (1). We present a case of a 64-year-old male who was successfully treated medically without any surgical intervention for prosthetic mitral valve IE. CASE PRESENTATION: This is a 64-year-old male with known past medical history of aortic valve replacement, tricuspid and mitral valve repair, atrial fibrillation status post cardioversion and ablation, and hypertension who complained of fevers, palpitations, and dyspnea for a day. He was started on vancomycin and piperacillin-tazobactam pending blood cultures. The initial and repeat blood cultures were positive for methicillin sensitive Staphylococcus aureus (MSSA) and the antibiotics were switched to nafcillin. Due to persistent bacteremia, transesophageal echocardiography (TEE) was recommended which showed filamentous echodensity on the mitral annuloplasty ring. Patient had an allergic reaction to nafcillin therefore on discharge antibiotics were switched to Ceftriaxone 2 gm intravenously (IV) and Daptomycin 600 mg IV daily for 6 weeks. TEE was repeated six weeks later, which showed no vegetations or abscesses. DISCUSSION: Cases of IE caused by Staphylococcus aureus are 'almost always surgical diseases,' according to the American Heart Association/American College of Cardiology/American Thoracic Society guidelines for the management of valvular heart disease (2). Since this patient refused surgery after having multiple heart surgeries in the past, the risks/benefits of surgery needed to be carefully evaluated. Daptomycin and Ceftriaxone were used because Daptomycin exerts rapid bactericidal activity against S. aureus, including strains tolerant or resistant to other agents. When used in combination with Daptomycin, Ceftriaxone improves bactericidal activity through synergistic effects. There is evidence that rapid bacterial killing has potential clinical advantages over bacteriostatic therapy in certain infections (3). The combination of beta lactams with Daptomycin also have an effect on enhanced bacterial clearance (3). This case report provides evidence that medical therapy is a viable alternative to surgical treatment. To our knowledge, this is the first report of successful treatment of prosthetic mitral valve infective endocarditis with a non-surgical approach. CONCLUSIONS: With the correct combination of antibiotics and routine follow up, non surgical candidates can be managed medically. While conclusions can be made based on the improvement and clearance of bacteremia of this patient, future studies are needed to strengthen evidence showing the benefit of medical treatment over surgical approaches for prosthetic valve endocarditis. REFERENCE #1: Cresti A, Chiavarelli M, Scalese M, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther. 2017;7(1):27-35. REFERENCE #2: Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease). Circulation 2008;2013:e523–661. REFERENCE #3: Dhand A, Bayer AS, Pogliano J, et al. Use of antistaphylococcal beta-lactams to increase daptomycin activity in eradicating persistent bacteremia due to methicillin-resistant Staphylococcus aureus: Role of enhanced daptomycin binding.Clin Infect Dis 2011;53:158-163. DISCLOSURES: No relevant relationships by Dilesha Kumanayaka, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by monica mutyala, source=Web Response No relevant relationships by Fayez Shamoon, source=Web Response Speaker/Speaker's Bureau relationship with Gilead Please note: $5001 - $20000 by jihad slim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with ViiV Please note: $5001 - $20000 by jihad slim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Abbvie Please note: $5001 - $20000 by jihad slim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with merck Please note: $5001 - $20000 by jihad slim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Jansen Please note: $5001 - $20000 by jihad slim, source=Web Response, value=Honoraria

An epidemiological study to define the recent clinical characteristics and outcomes of infective endocarditis in southern Turkey

The aim of this study was to characterise the recent features of patients with infective endocarditis (IE) at one referral centre in southern Turkey, in order to be able to identify the high-risk subgroup and revise preventative measures and management strategies. Medical records of patients 18 years and older, who had been diagnosed with IE according to the Duke criteria between January 2009 and October 2019, were retrospectively evaluated in a referral general hospital. The total of 139 IE cases comprised 59.7% males and 40.3% females, with a mean age of 55 ± 16 years. The most encountered symptom was fever (55.4%) and the mitral valve (54%) was the most frequently involved. The most common causative micro-organisms were coagulase-negative staphylococci (30.2%). The in-hospital mortality rate was 30.2%, with congestive heart failure, chronic renal disease and chronic dialysis found to be significantly associated with in-hospital mortality. The study results demonstrate the recent epidemiological features of IE in southern Turkey that are important for clinicians to manage diagnostic and therapeutic processes successfully. Older age, the predominance of staphylococci and higher surgery rates are consistent with the changing trends of IE in some parts the world.

Recent Trends in Infective Endocarditis Among Patients with and Without Injection Drug Use: An Eight-Year Single Center Study

BackgroundInfective endocarditis (IE) is associated with considerable morbidity and mortality. Given the opioid crisis and emergence of drug-resistant organisms, we sought to examine annual trends in hospitalization rates for IE and potential epidemiologic shift in the causative microorganisms among patients with and without injection drug use (IDU). MethodsThis was a single-center retrospective cohort study of hospitalized adults with IE. Annual trends in hospitalization rates were calculated (2011-2018), and patient characteristics and clinical outcomes were compared according to IDU status. ResultsOur cohort of 244 hospitalized patients with IE had a subset of 112 with IDU. The annual hospitalization rate for IE increased almost four-fold and was most notable among patients with IDU. The highest increase occurred in patients with Staphylococcus aureus-associated IE. Patients with IDU were younger, and more likely to be women with tricuspid valve vegetations and have IE due to methicillin-sensitive and methicillin-resistant Staphylococcus aureus. Patients without IDU were more likely to have central venous catheters with mitral and aortic valve vegetations and have IE due to Streptococcus and coagulase-negative Staphylococcus species. Patients without IDU had a higher requirement for cardiac surgery and higher 90-day mortality. Age was the only independent variable associated with 90-day mortality. ConclusionsThe rising incidence of IE in younger and older persons is driven in part by the opioid public health crisis and higher prevalence of indwelling central venous catheters, respectively. Timely treatment of opioid use disorders and stewardship surrounding use of central venous catheters is urgently needed.

Optimizing outcomes in infective endocarditis: A comprehensive literature review.

Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included 'Endocarditis', 'IE', 'Infection', 'Vegetation', 'Duke criteria', 'native valve infection', 'prosthetic valve', 'valve infection', 'endocarditis outcome' and 'endocarditis bacteriology'. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. All the relevant findings are summarized in specified tables and within appropriate sections. It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.

P265 Infective endocarditis:think global, act local:changing trends in infective endocarditis-integrating antibiotic stewardship program: data from developing world

Abstract Despite improvements in diagnostic and therapeutic strategies, both the incidence, severity &amp; mortality of Infective Endocarditis (IE) seem to be unchanged.The pattern of the disease in terms of host, agent &amp; environment changing rapidly.The successful integration of antibiotic stewardship program along with the appropriate use of antibiotic agents has made a huge difference in the treatment strategy &amp; cost reduction in patient care for IE. Materials &amp; Methods: A single centre, retrospective &amp; prospective study done between 2009 to 2018. The diagnosis of infective endocarditis was done as per the modified Duke’s Criteria. 355 patients were analysed and baseline demographic data with echocardiographic, microbiologic,complications, treatment &amp; outcomes noted. All blood cultures processing was done with BACTEC and BacTAlert using standard precautions.Antibiotic stewardship program was initiated since February 2016 as per international protocol. Results: The mean age of the study population was 46.7+-3 years. Predominanlty streptococcus species ( 21.4%) was isolated in the culture.A definite rise in atypical (17.9%) organism was noted in 2018 over the period of study as compared to 2009 : Presence of Burkholderia, Candida, Atypical Mycobacterium spp increased. Despite the advances in diagnostic modalities,there has been no change in mortality associated with IE (10.3%) over the period of 2009-2018. There is a predominantly native Mitral Valve involvement (53.7%) &amp; a definite rise in Prosthetic Valve endocarditis (19.6%) noted in the last 5 years. Conclusion:This study is the largest study &amp; data on Infective Endocarditis so far from a single centre in a developing world with a study population of 355 patients. Risk factors for IE have changed over time.Newer paradigms in treating IE and integration of antibiotic stewardship program has successfully brought down the cost and increased care in this part of the developing world. Changing trends : Organism Profile in IE Year Strept(%) Staph(%) Entero(%) Atypical(%) 2009 26.2 2.4 7.1 7.1 2011 24 8 12 16 2013 20 10 10 17.5 2015 27.3 12.7 3.6 20 2016 13.6 31.8 4.5 18.2 2017 27.6 13.8 10.3 34.5 2018 21.4 17.9 10.7 17.9 Abstract P265 Figure. Changing Epidemiological trends in IE

Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?

BackgroundStaphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear.AimTo examine the epidemiological trends of infective endocarditis in a developing nation.MethodsSingle-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period.ResultsThe analysis included 182 patients (n = 153 Duke’s definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%).ConclusionStaphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.

140. Trends of Infective Endocarditis at a Northern New England Academic Medical Center, From 2011 to 2017: A Case for Improved Methods to Reliably Identify Associated Substance Use

BackgroundInfective endocarditis (IE) is a morbid and often lethal complication of injection drug use. There is an urgent need for accurate surveillance for IE related to substance use (SU) to support control strategies.MethodsWe conducted a retrospective comparative analysis of 3 datasets evaluating patients aged ≥16 years admitted to an academic medical center in New England with an ICD-9/10 discharge diagnosis of IE from April 2011 to December 2017. The 3 datasets included the hospital’s electronic medical record (EMR); the hospital’s Outpatient Parenteral Antibiotic Therapy (OPAT) program dataset; and the New Hampshire Uniform Hospital Discharge Data Set (UHDDS). We analyzed the number of admissions for IE per year, stratified by SU. We developed a SU composite measure by incorporating multiple sources of data from the EMR, and then verified accuracy of both the SU and IE diagnoses through manual chart review.ResultsThe EMR documented 472 hospital admissions for IE, representing 385 unique patients. The median age was 56 years and 59% were men. Admissions increased 67%, from 56 in 2012 to 84 in 2017. SU was coded as a discharge diagnosis in 27% of these admissions; however, based on our composite measure of SU, 45% IE admissions were possibly associated with SU. The proportion of IE patients who had evidence of SU increased from 20% in 2011 to 49% in 2017 (P = 0.002). Patients with SU compared with those without were younger (40.5 vs. 65.2 years, P < 0.001) and more likely to be on Medicaid (59% vs. 8%, P < 0.001). They had higher average charges ($146,633 vs. $107,223, P = 0.002) and lengths of stay (19.1 vs. 13.4 days, P < 0.001). The UHDDS and EMR datasets identified a similar numbers of patients with a diagnosis of IE; however, manual chart review revealed that IE was over-coded in ~one-fifth of admissions.ConclusionThe rate of IE in our hospital increased dramatically between 2011 and 2017, with a rising proportion associated with SU. Despite these trends, we found that discharge diagnosis coding alone substantially underestimated associated SU and overestimated IE disease burden. Our findings suggest public health administrative datasets, such as the UHDDS, can contribute to surveillance of IE disease burden with consideration of these important limitations, especially for assessing disease trends.Disclosures All authors: No reported disclosures.

1026. Trends in Infective Endocarditis During the Substance Use Disorder Epidemic at an Academic Medical Center

BackgroundIn many areas of the United States, substance use disorders (SUD) have increased dramatically over the past decade. Overdose deaths have increased as well, and Kentucky ranks among the nation’s leaders in deaths per 100,000 population. Infective endocarditis (IE) is a well-known complication of intravenous drug use, contributing to significant morbidity and mortality, but few studies have evaluated the effect of the current SUD epidemic on rates and demographics of IE. We sought to examine the trends in IE and IE with SUD at our institution.MethodsWe collected data from patients admitted to a large academic medical center in Kentucky between January 1, 2013 and December 31, 2016. Patients were classified according to the International Classification of Diseases, Tenth Revision. Patients were considered to have IE if they received codes I33 or I38. Patients were considered to have an SUD if they received codes F11.10, F15.10, F14.10, F19.10, or Z86.59. Data were collected through the TriNetX database (TriNetX, Cambridge, MA).ResultsThere were 2,100 cases of IE during the study period. The mean (SD) age was 53 years (21). Of those, 440 also had an SUD. The mean (SD) age of these patients was 41 years (11). Patients in both the IE and IE/SUD categories were primarily male (54% and 55%) and white (94% and 94%). The number of cases of IE increased from 190 in 2013 to 430 in 2016 (R2 = 0.9877). The number of IE cases diagnosed as having an SUD increased from 30 (16% of all IE cases) in 2013 to 130 (30% of all IE cases) in 2016 (R2 = 0.7352 for the trend). This increase in cases corresponds to a 333% increase in the number of cases of IE with SUD.ConclusionBetween 2014 and 2016, opioid overdose deaths in Kentucky rose from 24.7 to 33.5 per 100,000 population, a 35.6% increase. During a similar timeframe, the number of IE cases associated with SUD at our institution rose 333%. While it is possible that increased coding of substance use disorders factored into this dramatic increase, it appears that the number of IE cases associated with SUD is rising at a disproportionately rapid rate.Disclosures All authors: No reported disclosures.

Invited Commentary

Invited Commentary

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.

Infective endocarditis in Western Norway: a 20-year retrospective survey

Background: To investigate epidemiological trends of infective endocarditis (IE) in western Norway a retrospective study was performed.Methods: Characteristics of 706 IE admissions from 1996 to 2005 and 2006 to 2015 were analysed and compared using the Chi-square test for categorical variables and the t-test for age. Survival was analysed by multiple Cox regression and reported by the hazard ratio (HR).Results: Mean annual incidence rates increased from 4.6 to 7.4 per 100,000 inhabitants (rate ratio: 1.97, 95% confidence interval: 1.52–2.56, p < .001). Non-viridans streptococci, enterococci and Staphylococcus aureus (S. aureus), were all independently associated with increased mortality. The frequency of IE caused by enterococci increased from 3.7 to 13.0% (p < .001). The proportion of intravenous drug users (IVDU) increased from 16.5 to 23.5% (p = .015) and had increasing aortic valve involvement (p = .023). Prosthetic valve endocarditis (PVE) constituted 30% of IE cases in both decades with biological PVE increasing from 9.4 to 22.1% (p < .001) and mechanical PVE decreasing from 18.7 to 8.9% (p < .001). In the last decade, valve replacement surgery was performed in 37.6% of the patients, of which 85.5% received a bioprosthesis.Conclusions: The incidence of IE increased significantly. Non-viridans streptococci, enterococci and S. aureus were all significantly associated with increased mortality. The increased number of enterococcal IE and the increased number of IVDUs with left-sided IE constituted new challenges. Biological implants were preferred in a majority of patients requiring surgery.

The Evolving Nature of Infective Endocarditis in Spain: A Population-Based Study (2003 to 2014)

BackgroundLittle information exists regarding population-based epidemiological changes in infective endocarditis (IE) in Europe. ObjectivesThis study sought to analyze temporal trends in IE in Spain from 2003 to 2014. MethodsThis retrospective, population-based, temporal trend study analyzed the incidence, epidemiological and clinical characteristics, and outcome of all patients discharged from hospitals included in the Spanish National Health System with a diagnosis of IE, from January 2003 to December 2014. ResultsOverall, 16,867 episodes of IE were identified during the study period, 66.3% in men. The rate of IE significantly increased, from 2.72 in 2003 to 3.49 per 100,000 person-years in 2014, and this rise was higher among older adults. The most frequent microorganisms were staphylococci (28.7%), followed by streptococci (20.4%) and enterococci (13.1%). Twenty-three percent of patients underwent cardiac surgery. The in-hospital mortality rate was 20.4%. Throughout the study period, the proportion of patients with previously known heart valve disease and diabetes mellitus significantly increased, whereas the prevalence of intravenous drug use decreased. Regarding microorganisms, Staphylococcus aureus and streptococci slightly declined, whereas coagulase-negative staphylococci and enterococci consistently increased over the years. In-hospital complications and cardiac surgery rates significantly increased across the years. The risk-adjusted in-hospital mortality rate diminished (0.2% per year) during the study period. ConclusionsThe incidence of IE episodes significantly increased over the decade of the study period, particularly among older adults. Relevant changes in clinical and microbiological profile included older patients with more comorbidity and a rise in enterococci and coagulase-negative staphylococcal infections. Adjusted mortality rates slightly declined over the study period.

Trends in Infective Endocarditis Complicated by Congestive Heart Failure: Data From the National Inpatient Sample From 1999-2014

Trends in Infective Endocarditis Complicated by Congestive Heart Failure: Data From the National Inpatient Sample From 1999-2014

Trends in Infective Endocarditis in California and New York State, 1998-2013

ImportanceProphylaxis and treatment guidelines for infective endocarditis have changed substantially over the past decade. In the United States, few population-based studies have explored the contemporary epidemiology and outcomes of endocarditis.ObjectiveTo quantify trends in the incidence and etiologies of infective endocarditis in the United States.Design, Setting, and ParticipantsRetrospective population epidemiology study of patients hospitalized with a first episode of endocarditis identified from mandatory state databases in California and New York State between January 1, 1998, and December 31, 2013.ExposureInfective endocarditis.Main Outcomes and MeasuresOutcomes were crude and standardized incidence of endocarditis and trends in patient characteristics and disease etiology. Trends in acquisition mode, organism, and mortality were analyzed.ResultsAmong 75 829 patients with first episodes of endocarditis (mean [SD] age, 62.3 [18.9] years; 59.1% male), the standardized annual incidence was stable between 7.6 (95% CI, 7.4 to 7.9) and 7.8 (95% CI, 7.6 to 8.0) cases per 100 000 persons (annual percentage change [APC], −0.06%; 95% CI, −0.3% to 0.2%; P = .59). From 1998 through 2013, the proportion of patients with native-valve endocarditis decreased (from 74.5% to 68.4%; APC, −0.7%; 95% CI, −0.9% to −0.5%; P < .001). Prosthetic-valve endocarditis increased (from 12.0% to 13.8%; APC, 1.3%; 95% CI, 0.8% to 1.7%; P < .001), and cardiac device–related endocarditis increased (from 1.3% to 4.1%; APC, 8.8%; 95% CI, 7.8% to 9.9%; P < .001). The proportion of patients with health care–associated nosocomial endocarditis decreased (from 17.7% to 15.3%; APC, −1.0%; 95% CI, −1.4% to −0.7%; P < .001). The proportion of patients with health care–associated nonnosocomial endocarditis increased (from 32.1% to 35.9%; APC, 0.8%; 95% CI, 0.5% to 1.1%; P < .001). The incidence of oral streptococcal endocarditis did not increase (unadjusted: APC, −0.1%; 95% CI, −0.8% to 0.6%; P = .77; adjusted: APC, −1.3%; 95% CI, −1.8% to −0.7%; P < .001). Crude 90-day mortality was unchanged (from 23.9% to 24.2%; APC, −0.3%; 95% CI, −1.0% to 0.4%; P = .44); adjusted risk of 90-day mortality decreased (adjusted hazard ratio per year, 0.982; 95% CI, 0.978 to 0.986; P < .001).Conclusions and RelevanceIn California and New York State, the overall standardized incidence of infective endocarditis was stable from 1998 through 2013, with changes in patient characteristics and etiology over this time.