USC di Malattie Infettive, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Infection. 2012 Oct;40(5):527-35. doi: 10.1007/s15010-012-0285-y. Epub 2012 Jun 19.
The characteristics of patients with infective endocarditis (IE) vary significantly by region of the world. The aim of this study was to evaluate the contemporary epidemiology, characteristics, and outcome of IE in a large, nationwide cohort of Italian patients.
We conducted a prospective, observational study at 24 medical centers in Italy, including all the consecutive patients with a definite or possible diagnosis of IE (modified Duke criteria) admitted from January 2004 through December 2009. A number of clinical variables were collected through an electronic case report form and analyzed to comprehensively delineate the features of IE. We report the data on patients with definite IE.
A total of 1,082 patients with definite IE were included. Of these, 753 (69.6%) patients had infection on a native valve, 277 (25.6%) on a prosthetic valve, and 52 (4.8%) on an implantable electronic device. Overall, community-acquired (69.2%) was more common than nosocomial (6.2%) or non-nosocomial (24.6%) health care-associated IE. Staphylococcus aureus was the most common pathogen (22.0%). In-hospital mortality was 15.1%. From the multivariate analysis, congestive heart failure (CHF), stroke, prosthetic valve infection, S. aureus, and health care-associated acquisition were independently associated with increased in-hospital mortality, while surgery was associated with decreased mortality.
The current mortality of IE remains high, and is mainly due to its complications, such as CHF and stroke.
世界各地感染性心内膜炎（IE）患者的特征存在显著差异。本研究旨在评估意大利一个大型全国性患者队列中IE 的当代流行病学、特征和结局。
我们在意大利的 24 家医疗中心进行了一项前瞻性、观察性研究，纳入了 2004 年 1 月至 2009 年 12 月期间所有确诊或疑似 IE（改良的 Duke 标准）的连续患者。通过电子病例报告表收集了许多临床变量，并进行了分析，以全面描绘 IE 的特征。我们报告了确诊 IE 患者的数据。
共纳入 1082 例确诊 IE 患者。其中，753 例（69.6%）患者为原生瓣膜感染，277 例（25.6%）为人工瓣膜感染，52 例（4.8%）为植入式电子设备感染。总体而言，社区获得性（69.2%）IE 比医院获得性（6.2%）或非医院获得性（24.6%）医疗保健相关 IE 更常见。金黄色葡萄球菌是最常见的病原体（22.0%）。院内死亡率为 15.1%。多变量分析显示，充血性心力衰竭（CHF）、中风、人工瓣膜感染、金黄色葡萄球菌和医疗保健相关感染与院内死亡率增加独立相关，而手术与死亡率降低相关。
IE 的当前死亡率仍然很高，主要是由于其并发症，如充血性心力衰竭和中风。
