Department of Cardiology, Concord Repatriation General Hospital, Sydney South Western Area Health Service, University of Sydney, 3rd floor West, Hospital Rd, Concord, NSW 2139, Australia.
Eur Heart J. 2010 Aug;31(15):1890-7. doi: 10.1093/eurheartj/ehq110. Epub 2010 May 7.
Institutional-based studies of infective endocarditis (IE) are limited by referral bias. Longitudinal population-based data were used to overcome such bias to provide a contemporary profile of IE and specifically investigate the importance of health care-associated IE and age.
Between 2000 and 2006, 1536 consecutive adult admissions with IE were identified in the Australian state of New South Wales using a state-wide database. The annual incidence was 4.7 per 100 000 (95% CI 4.4-4.9) being highest in patients aged between 80 and 84 years. The most frequent causative organism was Staphylococcus aureus (32%). Surgery was performed in 20% and the 6-month mortality was 18%. During the study period, the median age of patients increased from 61 to 65 years (P = 0.02), but microbiology, surgery, and mortality rates remained stable. Health care-associated IE was identified in 30% and was associated with older age, diabetes, renal impairment, heart failure, and infection with methicillin-resistant Staphylococcus aureus and enterococcus. Even after adjustment for these differences, recent health care exposure was an independent predictor of mortality (hazard ratio 1.62, 95% CI 1.34-1.96).
Contemporary IE contributes to health care-related infection, occurs in an increasingly elderly population, and remains a condition with unacceptably high mortality.
感染性心内膜炎（IE）的机构基础研究受到转诊偏倚的限制。本研究使用纵向人群数据来克服这种偏倚，提供 IE 的当代特征，并特别研究医疗保健相关性 IE 和年龄的重要性。
2000 年至 2006 年，使用新南威尔士州的全州数据库，在澳大利亚新南威尔士州确定了 1536 例连续成年 IE 住院患者。发病率为每 100000 人 4.7 例（95%CI 4.4-4.9），年龄在 80-84 岁之间的患者发病率最高。最常见的病原体是金黄色葡萄球菌（32%）。20%的患者接受了手术，6 个月死亡率为 18%。在研究期间，患者的中位年龄从 61 岁增加到 65 岁（P = 0.02），但微生物学、手术和死亡率保持稳定。确定了 30%的医疗保健相关性 IE，其与年龄较大、糖尿病、肾功能不全、心力衰竭以及耐甲氧西林金黄色葡萄球菌和肠球菌感染有关。即使在调整了这些差异后，近期医疗保健接触仍然是死亡率的独立预测因素（危险比 1.62，95%CI 1.34-1.96）。
当代 IE 导致了与医疗保健相关的感染，发生在越来越多的老年人群中，而且仍然是死亡率高得无法接受的疾病。
