Tleyjeh Imad M, Abdel-Latif Ahmed, Rahbi Hazim, Scott Christopher G, Bailey Kent R, Steckelberg James M, Wilson Walter R, Baddour Larry M
Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Chest. 2007 Sep;132(3):1025-35. doi: 10.1378/chest.06-2048.
We sought to summarize and critically appraise the literature on the epidemiology of infective endocarditis (IE) in the general population.
We retrieved population-based IE surveys by searching MEDLINE and EMBASE. Two reviewers independently extracted relevant data. We performed a metaregression to determine if temporal trends of IE characteristics exist.
Fifteen population-based investigations with 2,371 IE cases from seven countries (Denmark, France, Italy, the Netherlands, Sweden, United Kingdom, and United States) from 1969 to 2000 were eligible. Different case definitions and procedures were used to capture all IE cases, including census of existing diagnoses, record-linkage system, and direct contact survey. In the unadjusted regression, there was a decline in the proportion of IE patients with underlying rheumatic heart disease (RHD; 12%; 95% confidence interval [CI], - 21 to - 3%; p = 0.01) and an increase in the proportion of patients undergoing valve surgery (9%; 95% CI, 3 to 16%) per decade. After adjusting for country, the decline in IE cases with underlying RHD became nonsignificant, but the proportions of IE patients undergoing valve surgery increased 7% per decade (95% CI, - 4 to 14%; p = 0.06), and those with underlying prosthetic valve increased 7% per decade (95% CI, - 1 to 16%; p = 0.07). There were no significant temporal trends in the causative organisms.
Evidence from well-planned, representative IE epidemiologic surveys is scarce in many countries. Available studies suggest a changing distribution of underlying valvular heart disease in patients with IE and an increase in its surgical treatment.
我们试图总结并批判性评价普通人群中感染性心内膜炎（IE）流行病学的相关文献。
通过检索MEDLINE和EMBASE获取基于人群的IE调查。两名研究者独立提取相关数据。我们进行了Meta回归分析以确定IE特征是否存在时间趋势。
1969年至2000年期间，来自七个国家（丹麦、法国、意大利、荷兰、瑞典、英国和美国）的15项基于人群的调查，共纳入2371例IE病例，符合研究要求。采用了不同的病例定义和程序来捕获所有IE病例，包括现有诊断普查、记录链接系统和直接接触调查。在未调整的回归分析中，每十年患有潜在风湿性心脏病（RHD）的IE患者比例下降（12%；95%置信区间[CI]，-21%至-3%；p = 0.01），接受瓣膜手术的患者比例增加（9%；95%CI，3%至16%）。在对国家进行调整后，患有潜在RHD的IE病例的下降变得不显著，但接受瓣膜手术的IE患者比例每十年增加7%（95%CI，-4%至14%；p = 0.06），患有潜在人工瓣膜的患者比例每十年增加7%（95%CI，-1%至16%；p = 0.07）。致病微生物方面没有显著的时间趋势。
许多国家缺乏精心规划的、具有代表性的IE流行病学调查证据。现有研究表明，IE患者潜在瓣膜性心脏病的分布正在发生变化，且手术治疗有所增加。
