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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21<sup>st</sup>
Century: The International Collaboration on Endocarditis-Prospective Cohort Study</title>
<author><name sortKey="Murdoch, David R" sort="Murdoch, David R" uniqKey="Murdoch D" first="David R." last="Murdoch">David R. Murdoch</name>
</author>
<author><name sortKey="Corey, G Ralph" sort="Corey, G Ralph" uniqKey="Corey G" first="G. Ralph" last="Corey">G. Ralph Corey</name>
</author>
<author><name sortKey="Hoen, Bruno" sort="Hoen, Bruno" uniqKey="Hoen B" first="Bruno" last="Hoen">Bruno Hoen</name>
</author>
<author><name sortKey="Mir, Jose M" sort="Mir, Jose M" uniqKey="Mir J" first="José M." last="Mir">José M. Mir</name>
</author>
<author><name sortKey="Fowler, Vance G" sort="Fowler, Vance G" uniqKey="Fowler V" first="Vance G." last="Fowler">Vance G. Fowler</name>
</author>
<author><name sortKey="Bayer, Arnold S" sort="Bayer, Arnold S" uniqKey="Bayer A" first="Arnold S." last="Bayer">Arnold S. Bayer</name>
</author>
<author><name sortKey="Karchmer, Adolf W" sort="Karchmer, Adolf W" uniqKey="Karchmer A" first="Adolf W." last="Karchmer">Adolf W. Karchmer</name>
</author>
<author><name sortKey="Olaison, Lars" sort="Olaison, Lars" uniqKey="Olaison L" first="Lars" last="Olaison">Lars Olaison</name>
</author>
<author><name sortKey="Pappas, Paul A" sort="Pappas, Paul A" uniqKey="Pappas P" first="Paul A." last="Pappas">Paul A. Pappas</name>
</author>
<author><name sortKey="Moreillon, Philippe" sort="Moreillon, Philippe" uniqKey="Moreillon P" first="Philippe" last="Moreillon">Philippe Moreillon</name>
</author>
<author><name sortKey="Chambers, Stephen T" sort="Chambers, Stephen T" uniqKey="Chambers S" first="Stephen T." last="Chambers">Stephen T. Chambers</name>
</author>
<author><name sortKey="Chu, Vivian H" sort="Chu, Vivian H" uniqKey="Chu V" first="Vivian H." last="Chu">Vivian H. Chu</name>
</author>
<author><name sortKey="Falc, Vicenc" sort="Falc, Vicenc" uniqKey="Falc V" first="Vicenç" last="Falc">Vicenç Falc</name>
</author>
<author><name sortKey="Holland, David J" sort="Holland, David J" uniqKey="Holland D" first="David J." last="Holland">David J. Holland</name>
</author>
<author><name sortKey="Jones, Philip" sort="Jones, Philip" uniqKey="Jones P" first="Philip" last="Jones">Philip Jones</name>
</author>
<author><name sortKey="Klein, John L" sort="Klein, John L" uniqKey="Klein J" first="John L." last="Klein">John L. Klein</name>
</author>
<author><name sortKey="Raymond, Nigel J" sort="Raymond, Nigel J" uniqKey="Raymond N" first="Nigel J." last="Raymond">Nigel J. Raymond</name>
</author>
<author><name sortKey="Read, Kerry M" sort="Read, Kerry M" uniqKey="Read K" first="Kerry M." last="Read">Kerry M. Read</name>
</author>
<author><name sortKey="Tripodi, Marie Francoise" sort="Tripodi, Marie Francoise" uniqKey="Tripodi M" first="Marie Francoise" last="Tripodi">Marie Francoise Tripodi</name>
</author>
<author><name sortKey="Utili, Riccardo" sort="Utili, Riccardo" uniqKey="Utili R" first="Riccardo" last="Utili">Riccardo Utili</name>
</author>
<author><name sortKey="Wang, Andrew" sort="Wang, Andrew" uniqKey="Wang A" first="Andrew" last="Wang">Andrew Wang</name>
</author>
<author><name sortKey="Woods, Christopher W" sort="Woods, Christopher W" uniqKey="Woods C" first="Christopher W." last="Woods">Christopher W. Woods</name>
</author>
<author><name sortKey="Cabell, Christopher H" sort="Cabell, Christopher H" uniqKey="Cabell C" first="Christopher H." last="Cabell">Christopher H. Cabell</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">19273776</idno>
<idno type="pmc">3625651</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625651</idno>
<idno type="RBID">PMC:3625651</idno>
<idno type="doi">10.1001/archinternmed.2008.603</idno>
<date when="2009">2009</date>
<idno type="wicri:Area/Pmc/Corpus">001C98</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C98</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21<sup>st</sup>
Century: The International Collaboration on Endocarditis-Prospective Cohort Study</title>
<author><name sortKey="Murdoch, David R" sort="Murdoch, David R" uniqKey="Murdoch D" first="David R." last="Murdoch">David R. Murdoch</name>
</author>
<author><name sortKey="Corey, G Ralph" sort="Corey, G Ralph" uniqKey="Corey G" first="G. Ralph" last="Corey">G. Ralph Corey</name>
</author>
<author><name sortKey="Hoen, Bruno" sort="Hoen, Bruno" uniqKey="Hoen B" first="Bruno" last="Hoen">Bruno Hoen</name>
</author>
<author><name sortKey="Mir, Jose M" sort="Mir, Jose M" uniqKey="Mir J" first="José M." last="Mir">José M. Mir</name>
</author>
<author><name sortKey="Fowler, Vance G" sort="Fowler, Vance G" uniqKey="Fowler V" first="Vance G." last="Fowler">Vance G. Fowler</name>
</author>
<author><name sortKey="Bayer, Arnold S" sort="Bayer, Arnold S" uniqKey="Bayer A" first="Arnold S." last="Bayer">Arnold S. Bayer</name>
</author>
<author><name sortKey="Karchmer, Adolf W" sort="Karchmer, Adolf W" uniqKey="Karchmer A" first="Adolf W." last="Karchmer">Adolf W. Karchmer</name>
</author>
<author><name sortKey="Olaison, Lars" sort="Olaison, Lars" uniqKey="Olaison L" first="Lars" last="Olaison">Lars Olaison</name>
</author>
<author><name sortKey="Pappas, Paul A" sort="Pappas, Paul A" uniqKey="Pappas P" first="Paul A." last="Pappas">Paul A. Pappas</name>
</author>
<author><name sortKey="Moreillon, Philippe" sort="Moreillon, Philippe" uniqKey="Moreillon P" first="Philippe" last="Moreillon">Philippe Moreillon</name>
</author>
<author><name sortKey="Chambers, Stephen T" sort="Chambers, Stephen T" uniqKey="Chambers S" first="Stephen T." last="Chambers">Stephen T. Chambers</name>
</author>
<author><name sortKey="Chu, Vivian H" sort="Chu, Vivian H" uniqKey="Chu V" first="Vivian H." last="Chu">Vivian H. Chu</name>
</author>
<author><name sortKey="Falc, Vicenc" sort="Falc, Vicenc" uniqKey="Falc V" first="Vicenç" last="Falc">Vicenç Falc</name>
</author>
<author><name sortKey="Holland, David J" sort="Holland, David J" uniqKey="Holland D" first="David J." last="Holland">David J. Holland</name>
</author>
<author><name sortKey="Jones, Philip" sort="Jones, Philip" uniqKey="Jones P" first="Philip" last="Jones">Philip Jones</name>
</author>
<author><name sortKey="Klein, John L" sort="Klein, John L" uniqKey="Klein J" first="John L." last="Klein">John L. Klein</name>
</author>
<author><name sortKey="Raymond, Nigel J" sort="Raymond, Nigel J" uniqKey="Raymond N" first="Nigel J." last="Raymond">Nigel J. Raymond</name>
</author>
<author><name sortKey="Read, Kerry M" sort="Read, Kerry M" uniqKey="Read K" first="Kerry M." last="Read">Kerry M. Read</name>
</author>
<author><name sortKey="Tripodi, Marie Francoise" sort="Tripodi, Marie Francoise" uniqKey="Tripodi M" first="Marie Francoise" last="Tripodi">Marie Francoise Tripodi</name>
</author>
<author><name sortKey="Utili, Riccardo" sort="Utili, Riccardo" uniqKey="Utili R" first="Riccardo" last="Utili">Riccardo Utili</name>
</author>
<author><name sortKey="Wang, Andrew" sort="Wang, Andrew" uniqKey="Wang A" first="Andrew" last="Wang">Andrew Wang</name>
</author>
<author><name sortKey="Woods, Christopher W" sort="Woods, Christopher W" uniqKey="Woods C" first="Christopher W." last="Woods">Christopher W. Woods</name>
</author>
<author><name sortKey="Cabell, Christopher H" sort="Cabell, Christopher H" uniqKey="Cabell C" first="Christopher H." last="Cabell">Christopher H. Cabell</name>
</author>
</analytic>
<series><title level="j">Archives of internal medicine</title>
<idno type="ISSN">0003-9926</idno>
<idno type="eISSN">1538-3679</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">The aim of this study was to provide a contemporary picture of the presentation, etiology and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Prospective cohort study of 2781 adults with definite IE admitted to 58 hospitals in 25 countries between June 2000 and September 2005.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">The median age of the cohort was 57.9 (IQR 43.2–71.8) years and 72% had native valve IE. Most (77%) patients presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health-care exposure was found in one quarter of patients. <italic>Staphylococcus aureus</italic>
was the most common pathogen (31%). Mitral (41%) and aortic (38%) valves were infected most commonly. Complications were common: stroke (17%); embolization other than stroke (23%); heart failure (32%) and intracardiac abscess (14%). Surgical therapy was common (48%) and in-hospital mortality remained high (18%). Prosthetic valve involvement (OR 1.47, 95%CI 1.13–1.90), increasing age (OR 1.30, 95%CI 1.17–1.46 per 10-year interval), pulmonary edema (OR 1.79, 95%CI 1.39–2.30), <italic>S. aureus</italic>
infection (OR 1.54, 95%CI 1.14–2.08), coagulase-negative staphylococcal infection (OR 1.50, 95%CI 1.07–2.10), mitral valve vegetation (OR 1.34, 95%CI 1.06–1.68), and paravalvular complications (OR 2.25, 95%CI 1.64–3.09) were associated with increased risk of in-hospital death, while viridans streptococcal infection (OR 0.52, 95%CI 0.33–0.81) and surgery (OR 0.61, 95%CI 0.44–0.83) were associated with decreased risk.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">In the early 21<sup>st</sup>
century, IE is more often an acute disease, characterized by a high rate of <italic>S. aureus</italic>
infection. Mortality remains relatively high.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0372440</journal-id>
<journal-id journal-id-type="pubmed-jr-id">767</journal-id>
<journal-id journal-id-type="nlm-ta">Arch Intern Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Arch. Intern. Med.</journal-id>
<journal-title-group><journal-title>Archives of internal medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">0003-9926</issn>
<issn pub-type="epub">1538-3679</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">19273776</article-id>
<article-id pub-id-type="pmc">3625651</article-id>
<article-id pub-id-type="doi">10.1001/archinternmed.2008.603</article-id>
<article-id pub-id-type="manuscript">NIHMS451197</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21<sup>st</sup>
Century: The International Collaboration on Endocarditis-Prospective Cohort Study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Murdoch</surname>
<given-names>David R.</given-names>
</name>
<degrees>MD, MSc</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Corey</surname>
<given-names>G. Ralph</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Hoen</surname>
<given-names>Bruno</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Miró</surname>
<given-names>José M.</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Fowler</surname>
<given-names>Vance G.</given-names>
<suffix>Jr.</suffix>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Bayer</surname>
<given-names>Arnold S.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Karchmer</surname>
<given-names>Adolf W.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Olaison</surname>
<given-names>Lars</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Pappas</surname>
<given-names>Paul A.</given-names>
</name>
<degrees>MS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Moreillon</surname>
<given-names>Philippe</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Chambers</surname>
<given-names>Stephen T.</given-names>
</name>
<degrees>MD, MSc</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Chu</surname>
<given-names>Vivian H.</given-names>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Falcó</surname>
<given-names>Vicenç</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Holland</surname>
<given-names>David J.</given-names>
</name>
<degrees>MB, ChB, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Jones</surname>
<given-names>Philip</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Klein</surname>
<given-names>John L.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Raymond</surname>
<given-names>Nigel J.</given-names>
</name>
<degrees>MB, ChB</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Read</surname>
<given-names>Kerry M.</given-names>
</name>
<degrees>MB, ChB</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Tripodi</surname>
<given-names>Marie Francoise</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Utili</surname>
<given-names>Riccardo</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Wang</surname>
<given-names>Andrew</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Woods</surname>
<given-names>Christopher W.</given-names>
</name>
<degrees>MD, MPH</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Cabell</surname>
<given-names>Christopher H.</given-names>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><collab>The ICE Investigators</collab>
</contrib>
<aff id="A1">University of Otago, Christchurch, New Zealand (DRM, STC); Duke University Medical Center (GRC, VGF, VHC, CWW, AW, CHC) and Duke Clinical Research Institute, Durham, USA, (GRC, VGF, PAP, CHC); Hôpital Saint-Jacques, Besançon, France (BH); Hospital Clinic – Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain (JMM); UCLA-Harbor Medical Center, Torrance, USA (ASB); Beth Israel-Deaconess Medical Center, Boston, USA (AWK); Sahlgrenska University Hospital, Göteborg, Sweden (LO); Centre Hospitalier Universitaire, University of Lausanne, Switzerland (PM); Hospital Universitari Vall D'Hebron, Barcelona, Spain (VF); Middlemore Hospital, Auckland, New Zealand (DJH); University of New South Wales, Sydney, Australia (PJ); St Thomas' Hospital, London, United Kingdom (JLK); Wellington Hospital, Wellington, New Zealand (NJR); North Shore Hospital, Auckland, New Zealand (KMR); Second University of Naples, Naples, Italy (MFT, RU). The ICE-PCS Study Group Investigators are listed in the<xref ref-type="app" rid="APP1">appendix</xref>
</aff>
</contrib-group>
<author-notes><corresp id="CR1"><bold>Address for correspondence:</bold>
Prof. David Murdoch, Department of Pathology, University of Otago, Christchurch, P.O. Box 4345, Christchurch, New Zealand; Tel: +64 3 364 0590; Fax: +64 3 364 0009; <email>david.murdoch@cdhb.govt.nz</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>7</day>
<month>3</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub"><day>9</day>
<month>3</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>14</day>
<month>4</month>
<year>2013</year>
</pub-date>
<volume>169</volume>
<issue>5</issue>
<fpage>463</fpage>
<lpage>473</lpage>
<abstract><sec id="S1"><title>Background</title>
<p id="P1">The aim of this study was to provide a contemporary picture of the presentation, etiology and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Prospective cohort study of 2781 adults with definite IE admitted to 58 hospitals in 25 countries between June 2000 and September 2005.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">The median age of the cohort was 57.9 (IQR 43.2–71.8) years and 72% had native valve IE. Most (77%) patients presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health-care exposure was found in one quarter of patients. <italic>Staphylococcus aureus</italic>
was the most common pathogen (31%). Mitral (41%) and aortic (38%) valves were infected most commonly. Complications were common: stroke (17%); embolization other than stroke (23%); heart failure (32%) and intracardiac abscess (14%). Surgical therapy was common (48%) and in-hospital mortality remained high (18%). Prosthetic valve involvement (OR 1.47, 95%CI 1.13–1.90), increasing age (OR 1.30, 95%CI 1.17–1.46 per 10-year interval), pulmonary edema (OR 1.79, 95%CI 1.39–2.30), <italic>S. aureus</italic>
infection (OR 1.54, 95%CI 1.14–2.08), coagulase-negative staphylococcal infection (OR 1.50, 95%CI 1.07–2.10), mitral valve vegetation (OR 1.34, 95%CI 1.06–1.68), and paravalvular complications (OR 2.25, 95%CI 1.64–3.09) were associated with increased risk of in-hospital death, while viridans streptococcal infection (OR 0.52, 95%CI 0.33–0.81) and surgery (OR 0.61, 95%CI 0.44–0.83) were associated with decreased risk.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">In the early 21<sup>st</sup>
century, IE is more often an acute disease, characterized by a high rate of <italic>S. aureus</italic>
infection. Mortality remains relatively high.</p>
</sec>
</abstract>
<funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source>
<award-id>R01 AI068804 || AI</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
</record>
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