Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study
Identifieur interne : 003169 ( PascalFrancis/Corpus ); précédent : 003168; suivant : 003170Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study
Auteurs : Emanuele Durante-Mangoni ; Suzanne Bradley ; Christine Selton-Suty ; Marie-Francoise Tripodi ; Bruno Barsic ; Emilio Bouza ; Christopher H. Cabell ; Auristela Isabel De Oliveira Ramos ; Vance Jr Fowler ; Bruno Hoen ; Pam Konecny ; Asuncion Moreno ; David Murdoch ; Paul Pappas ; Daniel J. Sexton ; Denis Spelman ; Pierre Tattevin ; José M. Miro ; Jan T. M. Van Der Meer ; Riccardo UtiliSource :
- Archives of internal medicine : (1960) [ 0003-9926 ] ; 2008.
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Abstract
Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P<.001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P<.001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.
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Format Inist (serveur)
| NO : | PASCAL 08-0537904 INIST |
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| ET : | Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study |
| AU : | DURANTE-MANGONI (Emanuele); BRADLEY (Suzanne); SELTON-SUTY (Christine); TRIPODI (Marie-Francoise); BARSIC (Bruno); BOUZA (Emilio); CABELL (Christopher H.); DE OLIVEIRA RAMOS (Auristela Isabel); FOWLER (Vance JR); HOEN (Bruno); KONECNY (Pam); MORENO (Asuncion); MURDOCH (David); PAPPAS (Paul); SEXTON (Daniel J.); SPELMAN (Denis); TATTEVIN (Pierre); MIRO (José M.); VAN DER MEER (Jan T. M.); UTILI (Riccardo) |
| AF : | Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II/Naples/Italie (1 aut., 4 aut., 20 aut.); Divisions of Geriatric Medicine and Infectious Diseases, University of Michigan Medical School/Ann Arbor/Etats-Unis (2 aut.); Department of Cardiology, Centre Hôpitalier Universitaire (CHU) Nancy-Brabois/Nancy/France (3 aut.); Intensive Care Unit, University Hospital for Infectious Diseases/Zagreb/Croatie (5 aut.); Department of Medical Microbiology, Hospital General Universitario Gregorio Maranon/Ciberes, Madrid/Espagne (6 aut.); Quintiles Transnational/Durham, North Carolina/Etats-Unis (7 aut.); Instituto Dante Pazzanese de Cardiologia/Sao Paulo/Brésil (8 aut.); Departments of Medicine, Duke University Medical Center/Durham/Etats-Unis (9 aut., 15 aut.); Department of Cardiology, Departments of Infectious Diseases, University Medical Center of Besançon/Besancon/France (10 aut.); St George Hospital/Sydney/Australie (11 aut.); Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona/Barcelona/Espagne (12 aut., 18 aut.); University of Otago/Christchurch/Nouvelle-Zélande (13 aut.); INC Research/Raleigh, North Carolina/Etats-Unis (14 aut.); Department of Infectious Disease, Alfred Hospital/Melbourne/Australie (16 aut.); CHU de Rennes/Rennes/France (17 aut.); University of Amsterdam/Amsterdam/Pays-Bas (19 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Archives of internal medicine : (1960); ISSN 0003-9926; Coden AIMDAP; Etats-Unis; Da. 2008; Vol. 168; No. 19; Pp. 2095-2103; Bibl. 26 ref. |
| LA : | Anglais |
| EA : | Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P<.001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P<.001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE. |
| CC : | 002B30A03C; 002B01; 002B12A04 |
| FD : | Endocardite; Personne âgée; Malade; Résultat; International; Monde; Prospective; Etude cohorte; Santé publique; Médecine |
| FG : | Homme; Pathologie de l'appareil circulatoire; Cardiopathie; Pathologie de l'endocarde |
| ED : | Endocarditis; Elderly; Patient; Result; International; World; Prospective; Cohort study; Public health; Medicine |
| EG : | Human; Cardiovascular disease; Heart disease; Endocardial disease |
| SD : | Endocarditis; Anciano; Enfermo; Resultado; Internacional; Mundo; Prospectiva; Estudio cohorte; Salud pública; Medicina |
| LO : | INIST-2040.354000185729670040 |
| ID : | 08-0537904 |
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Sexton</name><affiliation><inist:fA14 i1="08"><s1>Departments of Medicine, Duke University Medical Center</s1><s2>Durham</s2><s3>USA</s3><sZ>9 aut.</sZ><sZ>15 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Spelman, Denis" sort="Spelman, Denis" uniqKey="Spelman D" first="Denis" last="Spelman">Denis Spelman</name><affiliation><inist:fA14 i1="14"><s1>Department of Infectious Disease, Alfred Hospital</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>16 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Tattevin, Pierre" sort="Tattevin, Pierre" uniqKey="Tattevin P" first="Pierre" last="Tattevin">Pierre Tattevin</name><affiliation><inist:fA14 i1="15"><s1>CHU de Rennes</s1><s2>Rennes</s2><s3>FRA</s3><sZ>17 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Miro, Jose M" sort="Miro, Jose M" uniqKey="Miro J" first="José M." last="Miro">José M. Miro</name><affiliation><inist:fA14 i1="11"><s1>Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>12 aut.</sZ><sZ>18 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Van Der Meer, Jan T M" sort="Van Der Meer, Jan T M" uniqKey="Van Der Meer J" first="Jan T. M." last="Van Der Meer">Jan T. M. Van Der Meer</name><affiliation><inist:fA14 i1="16"><s1>University of Amsterdam</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>19 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Utili, Riccardo" sort="Utili, Riccardo" uniqKey="Utili R" first="Riccardo" last="Utili">Riccardo Utili</name><affiliation><inist:fA14 i1="01"><s1>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II</s1><s2>Naples</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>20 aut.</sZ></inist:fA14></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">08-0537904</idno><date when="2008">2008</date><idno type="stanalyst">PASCAL 08-0537904 INIST</idno><idno type="RBID">Pascal:08-0537904</idno><idno type="wicri:Area/PascalFrancis/Corpus">003169</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study</title><author><name sortKey="Durante Mangoni, Emanuele" sort="Durante Mangoni, Emanuele" uniqKey="Durante Mangoni E" first="Emanuele" last="Durante-Mangoni">Emanuele Durante-Mangoni</name><affiliation><inist:fA14 i1="01"><s1>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II</s1><s2>Naples</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>20 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Bradley, Suzanne" sort="Bradley, Suzanne" uniqKey="Bradley S" first="Suzanne" last="Bradley">Suzanne Bradley</name><affiliation><inist:fA14 i1="02"><s1>Divisions of Geriatric Medicine and Infectious Diseases, University of Michigan Medical School</s1><s2>Ann Arbor</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Selton Suty, Christine" sort="Selton Suty, Christine" uniqKey="Selton Suty C" first="Christine" last="Selton-Suty">Christine Selton-Suty</name><affiliation><inist:fA14 i1="03"><s1>Department of Cardiology, Centre Hôpitalier Universitaire (CHU) Nancy-Brabois</s1><s2>Nancy</s2><s3>FRA</s3><sZ>3 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Tripodi, Marie Francoise" sort="Tripodi, Marie Francoise" uniqKey="Tripodi M" first="Marie-Francoise" last="Tripodi">Marie-Francoise Tripodi</name><affiliation><inist:fA14 i1="01"><s1>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II</s1><s2>Naples</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>20 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Barsic, Bruno" sort="Barsic, Bruno" uniqKey="Barsic B" first="Bruno" last="Barsic">Bruno Barsic</name><affiliation><inist:fA14 i1="04"><s1>Intensive Care Unit, University Hospital for Infectious Diseases</s1><s2>Zagreb</s2><s3>HRV</s3><sZ>5 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Bouza, Emilio" sort="Bouza, Emilio" uniqKey="Bouza E" first="Emilio" last="Bouza">Emilio Bouza</name><affiliation><inist:fA14 i1="05"><s1>Department of Medical Microbiology, Hospital General Universitario Gregorio Maranon</s1><s2>Ciberes, Madrid</s2><s3>ESP</s3><sZ>6 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Cabell, Christopher H" sort="Cabell, Christopher H" uniqKey="Cabell C" first="Christopher H." last="Cabell">Christopher H. Cabell</name><affiliation><inist:fA14 i1="06"><s1>Quintiles Transnational</s1><s2>Durham, North Carolina</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="De Oliveira Ramos, Auristela Isabel" sort="De Oliveira Ramos, Auristela Isabel" uniqKey="De Oliveira Ramos A" first="Auristela Isabel" last="De Oliveira Ramos">Auristela Isabel De Oliveira Ramos</name><affiliation><inist:fA14 i1="07"><s1>Instituto Dante Pazzanese de Cardiologia</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>8 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Fowler, Vance Jr" sort="Fowler, Vance Jr" uniqKey="Fowler V" first="Vance Jr" last="Fowler">Vance Jr Fowler</name><affiliation><inist:fA14 i1="08"><s1>Departments of Medicine, Duke University Medical Center</s1><s2>Durham</s2><s3>USA</s3><sZ>9 aut.</sZ><sZ>15 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Hoen, Bruno" sort="Hoen, Bruno" uniqKey="Hoen B" first="Bruno" last="Hoen">Bruno Hoen</name><affiliation><inist:fA14 i1="09"><s1>Department of Cardiology, Departments of Infectious Diseases, University Medical Center of Besançon</s1><s2>Besancon</s2><s3>FRA</s3><sZ>10 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Konecny, Pam" sort="Konecny, Pam" uniqKey="Konecny P" first="Pam" last="Konecny">Pam Konecny</name><affiliation><inist:fA14 i1="10"><s1>St George Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>11 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Moreno, Asuncion" sort="Moreno, Asuncion" uniqKey="Moreno A" first="Asuncion" last="Moreno">Asuncion Moreno</name><affiliation><inist:fA14 i1="11"><s1>Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>12 aut.</sZ><sZ>18 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Murdoch, David" sort="Murdoch, David" uniqKey="Murdoch D" first="David" last="Murdoch">David Murdoch</name><affiliation><inist:fA14 i1="12"><s1>University of Otago</s1><s2>Christchurch</s2><s3>NZL</s3><sZ>13 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Pappas, Paul" sort="Pappas, Paul" uniqKey="Pappas P" first="Paul" last="Pappas">Paul Pappas</name><affiliation><inist:fA14 i1="13"><s1>INC Research</s1><s2>Raleigh, North Carolina</s2><s3>USA</s3><sZ>14 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Sexton, Daniel J" sort="Sexton, Daniel J" uniqKey="Sexton D" first="Daniel J." last="Sexton">Daniel J. Sexton</name><affiliation><inist:fA14 i1="08"><s1>Departments of Medicine, Duke University Medical Center</s1><s2>Durham</s2><s3>USA</s3><sZ>9 aut.</sZ><sZ>15 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Spelman, Denis" sort="Spelman, Denis" uniqKey="Spelman D" first="Denis" last="Spelman">Denis Spelman</name><affiliation><inist:fA14 i1="14"><s1>Department of Infectious Disease, Alfred Hospital</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>16 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Tattevin, Pierre" sort="Tattevin, Pierre" uniqKey="Tattevin P" first="Pierre" last="Tattevin">Pierre Tattevin</name><affiliation><inist:fA14 i1="15"><s1>CHU de Rennes</s1><s2>Rennes</s2><s3>FRA</s3><sZ>17 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Miro, Jose M" sort="Miro, Jose M" uniqKey="Miro J" first="José M." last="Miro">José M. Miro</name><affiliation><inist:fA14 i1="11"><s1>Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>12 aut.</sZ><sZ>18 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Van Der Meer, Jan T M" sort="Van Der Meer, Jan T M" uniqKey="Van Der Meer J" first="Jan T. M." last="Van Der Meer">Jan T. M. Van Der Meer</name><affiliation><inist:fA14 i1="16"><s1>University of Amsterdam</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>19 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Utili, Riccardo" sort="Utili, Riccardo" uniqKey="Utili R" first="Riccardo" last="Utili">Riccardo Utili</name><affiliation><inist:fA14 i1="01"><s1>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II</s1><s2>Naples</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>20 aut.</sZ></inist:fA14></affiliation></author></analytic><series><title level="j" type="main">Archives of internal medicine : (1960)</title><title level="j" type="abbreviated">Arch. intern. med. : (1960)</title><idno type="ISSN">0003-9926</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Archives of internal medicine : (1960)</title><title level="j" type="abbreviated">Arch. intern. med. : (1960)</title><idno type="ISSN">0003-9926</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cohort study</term><term>Elderly</term><term>Endocarditis</term><term>International</term><term>Medicine</term><term>Patient</term><term>Prospective</term><term>Public health</term><term>Result</term><term>World</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Endocardite</term><term>Personne âgée</term><term>Malade</term><term>Résultat</term><term>International</term><term>Monde</term><term>Prospective</term><term>Etude cohorte</term><term>Santé publique</term><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P<.001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P<.001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0003-9926</s0></fA01><fA02 i1="01"><s0>AIMDAP</s0></fA02><fA03 i2="1"><s0>Arch. intern. med. : (1960)</s0></fA03><fA05><s2>168</s2></fA05><fA06><s2>19</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study</s1></fA08><fA11 i1="01" i2="1"><s1>DURANTE-MANGONI (Emanuele)</s1></fA11><fA11 i1="02" i2="1"><s1>BRADLEY (Suzanne)</s1></fA11><fA11 i1="03" i2="1"><s1>SELTON-SUTY (Christine)</s1></fA11><fA11 i1="04" i2="1"><s1>TRIPODI (Marie-Francoise)</s1></fA11><fA11 i1="05" i2="1"><s1>BARSIC (Bruno)</s1></fA11><fA11 i1="06" i2="1"><s1>BOUZA (Emilio)</s1></fA11><fA11 i1="07" i2="1"><s1>CABELL (Christopher H.)</s1></fA11><fA11 i1="08" i2="1"><s1>DE OLIVEIRA RAMOS (Auristela Isabel)</s1></fA11><fA11 i1="09" i2="1"><s1>FOWLER (Vance JR)</s1></fA11><fA11 i1="10" i2="1"><s1>HOEN (Bruno)</s1></fA11><fA11 i1="11" i2="1"><s1>KONECNY (Pam)</s1></fA11><fA11 i1="12" i2="1"><s1>MORENO (Asuncion)</s1></fA11><fA11 i1="13" i2="1"><s1>MURDOCH (David)</s1></fA11><fA11 i1="14" i2="1"><s1>PAPPAS (Paul)</s1></fA11><fA11 i1="15" i2="1"><s1>SEXTON (Daniel J.)</s1></fA11><fA11 i1="16" i2="1"><s1>SPELMAN (Denis)</s1></fA11><fA11 i1="17" i2="1"><s1>TATTEVIN (Pierre)</s1></fA11><fA11 i1="18" i2="1"><s1>MIRO (José M.)</s1></fA11><fA11 i1="19" i2="1"><s1>VAN DER MEER (Jan T. M.)</s1></fA11><fA11 i1="20" i2="1"><s1>UTILI (Riccardo)</s1></fA11><fA14 i1="01"><s1>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II</s1><s2>Naples</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>20 aut.</sZ></fA14><fA14 i1="02"><s1>Divisions of Geriatric Medicine and Infectious Diseases, University of Michigan Medical School</s1><s2>Ann Arbor</s2><s3>USA</s3><sZ>2 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Cardiology, Centre Hôpitalier Universitaire (CHU) Nancy-Brabois</s1><s2>Nancy</s2><s3>FRA</s3><sZ>3 aut.</sZ></fA14><fA14 i1="04"><s1>Intensive Care Unit, University Hospital for Infectious Diseases</s1><s2>Zagreb</s2><s3>HRV</s3><sZ>5 aut.</sZ></fA14><fA14 i1="05"><s1>Department of Medical Microbiology, Hospital General Universitario Gregorio Maranon</s1><s2>Ciberes, Madrid</s2><s3>ESP</s3><sZ>6 aut.</sZ></fA14><fA14 i1="06"><s1>Quintiles Transnational</s1><s2>Durham, North Carolina</s2><s3>USA</s3><sZ>7 aut.</sZ></fA14><fA14 i1="07"><s1>Instituto Dante Pazzanese de Cardiologia</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="08"><s1>Departments of Medicine, Duke University Medical Center</s1><s2>Durham</s2><s3>USA</s3><sZ>9 aut.</sZ><sZ>15 aut.</sZ></fA14><fA14 i1="09"><s1>Department of Cardiology, Departments of Infectious Diseases, University Medical Center of Besançon</s1><s2>Besancon</s2><s3>FRA</s3><sZ>10 aut.</sZ></fA14><fA14 i1="10"><s1>St George Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>11 aut.</sZ></fA14><fA14 i1="11"><s1>Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>12 aut.</sZ><sZ>18 aut.</sZ></fA14><fA14 i1="12"><s1>University of Otago</s1><s2>Christchurch</s2><s3>NZL</s3><sZ>13 aut.</sZ></fA14><fA14 i1="13"><s1>INC Research</s1><s2>Raleigh, North Carolina</s2><s3>USA</s3><sZ>14 aut.</sZ></fA14><fA14 i1="14"><s1>Department of Infectious Disease, Alfred Hospital</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>16 aut.</sZ></fA14><fA14 i1="15"><s1>CHU de Rennes</s1><s2>Rennes</s2><s3>FRA</s3><sZ>17 aut.</sZ></fA14><fA14 i1="16"><s1>University of Amsterdam</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>19 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>International Collaboration on Endocarditis Prospective Cohort Study Group</s1><s3>INC</s3></fA17><fA20><s1>2095-2103</s1></fA20><fA21><s1>2008</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>2040</s2><s5>354000185729670040</s5></fA43><fA44><s0>0000</s0><s1>© 2008 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>26 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>08-0537904</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Archives of internal medicine : (1960)</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P<.001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P<.001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.</s0></fC01><fC02 i1="01" i2="X"><s0>002B30A03C</s0></fC02><fC02 i1="02" i2="X"><s0>002B01</s0></fC02><fC02 i1="03" i2="X"><s0>002B12A04</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Endocardite</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Endocarditis</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Endocarditis</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Personne âgée</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Elderly</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Anciano</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Malade</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Patient</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Enfermo</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Résultat</s0><s5>06</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Result</s0><s5>06</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Resultado</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>International</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>International</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Internacional</s0><s5>08</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Monde</s0><s2>NG</s2><s5>09</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>World</s0><s2>NG</s2><s5>09</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Mundo</s0><s2>NG</s2><s5>09</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Prospective</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Prospective</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Prospectiva</s0><s5>11</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Etude cohorte</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Cohort study</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Estudio cohorte</s0><s5>12</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Santé publique</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Public health</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Salud pública</s0><s5>17</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Médecine</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Medicine</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Medicina</s0><s5>18</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Homme</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Human</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Hombre</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Cardiopathie</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Heart disease</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Cardiopatía</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie de l'endocarde</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Endocardial disease</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Endocardio patología</s0><s5>39</s5></fC07><fN21><s1>350</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 08-0537904 INIST</NO><ET>Current Features of Infective Endocarditis in Elderly Patients : Results of the International Collaboration on Endocarditis Prospective Cohort Study</ET><AU>DURANTE-MANGONI (Emanuele); BRADLEY (Suzanne); SELTON-SUTY (Christine); TRIPODI (Marie-Francoise); BARSIC (Bruno); BOUZA (Emilio); CABELL (Christopher H.); DE OLIVEIRA RAMOS (Auristela Isabel); FOWLER (Vance JR); HOEN (Bruno); KONECNY (Pam); MORENO (Asuncion); MURDOCH (David); PAPPAS (Paul); SEXTON (Daniel J.); SPELMAN (Denis); TATTEVIN (Pierre); MIRO (José M.); VAN DER MEER (Jan T. M.); UTILI (Riccardo)</AU><AF>Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II/Naples/Italie (1 aut., 4 aut., 20 aut.); Divisions of Geriatric Medicine and Infectious Diseases, University of Michigan Medical School/Ann Arbor/Etats-Unis (2 aut.); Department of Cardiology, Centre Hôpitalier Universitaire (CHU) Nancy-Brabois/Nancy/France (3 aut.); Intensive Care Unit, University Hospital for Infectious Diseases/Zagreb/Croatie (5 aut.); Department of Medical Microbiology, Hospital General Universitario Gregorio Maranon/Ciberes, Madrid/Espagne (6 aut.); Quintiles Transnational/Durham, North Carolina/Etats-Unis (7 aut.); Instituto Dante Pazzanese de Cardiologia/Sao Paulo/Brésil (8 aut.); Departments of Medicine, Duke University Medical Center/Durham/Etats-Unis (9 aut., 15 aut.); Department of Cardiology, Departments of Infectious Diseases, University Medical Center of Besançon/Besancon/France (10 aut.); St George Hospital/Sydney/Australie (11 aut.); Hospital Clinic-IDIBAPS (Institut d'lnvestigacions Biomèdiques August Pi I Sunyer), University of Barcelona/Barcelona/Espagne (12 aut., 18 aut.); University of Otago/Christchurch/Nouvelle-Zélande (13 aut.); INC Research/Raleigh, North Carolina/Etats-Unis (14 aut.); Department of Infectious Disease, Alfred Hospital/Melbourne/Australie (16 aut.); CHU de Rennes/Rennes/France (17 aut.); University of Amsterdam/Amsterdam/Pays-Bas (19 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Archives of internal medicine : (1960); ISSN 0003-9926; Coden AIMDAP; Etats-Unis; Da. 2008; Vol. 168; No. 19; Pp. 2095-2103; Bibl. 26 ref.</SO><LA>Anglais</LA><EA>Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P<.001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P<.001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.</EA><CC>002B30A03C; 002B01; 002B12A04</CC><FD>Endocardite; Personne âgée; Malade; Résultat; International; Monde; Prospective; Etude cohorte; Santé publique; Médecine</FD><FG>Homme; Pathologie de l'appareil circulatoire; Cardiopathie; Pathologie de l'endocarde</FG><ED>Endocarditis; Elderly; Patient; Result; International; World; Prospective; Cohort study; Public health; Medicine</ED><EG>Human; Cardiovascular disease; Heart disease; Endocardial disease</EG><SD>Endocarditis; Anciano; Enfermo; Resultado; Internacional; Mundo; Prospectiva; Estudio cohorte; Salud pública; Medicina</SD><LO>INIST-2040.354000185729670040</LO><ID>08-0537904</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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