Cresti Alberto, Chiavarelli Mario, Scalese Marco, Nencioni Cesira, Valentini Silvia, Guerrini Francesco, D'Aiello Incoronata, Picchi Andrea, De Sensi Francesco, Habib Gilbert
Cardiological Department, Misericordia Hospital, Grosseto, Italy.
Division of Cardiothoracic Surgery, Department of Surgery, Le Scotte Hospital, Siena University, Siena, Italy.
Cardiovasc Diagn Ther. 2017 Feb;7(1):27-35. doi: 10.21037/cdt.2016.08.09.
The population at risk, the clinical and microbiological features of infective endocarditis (IE) have changed. Aim of our study was to evaluate the contemporary epidemiological trends, over a 17-year period in a definite region of Tuscany, Italy, to analyze the clinical outcomes and associated prognostic factors.
From 1 January 1998 to 31 December 2014, all patients with a definite diagnosis of IE were prospectively entered in a data-base. The Health-Care system data-base was interrogated to capture patients who could have been missed. The final dataset derived by the merging of the two data-bases.
Incidence rate of IE was 4.6/100,000/y with a significant linear incidence increase. In hospitalized patients the incidence was 1.27/1,000 admissions. Over age 65 incidence rate was 11.7/100,000/y. Male/female ratio was 1.54:1. A temporal trend towards an increase in the mean population age was found (P=0.033). There was an increase in the incidence of Health-care associated IE, P=0.016. The most common microorganisms were staphylococcus aureus (25%) and coagulase-negative staphylococci (22%). In-hospital mortality was 24%. A trend towards an increase in mortality rate was found (P=0.055). Independent predictors of mortality were older age, S. aureus infection, heart failure, septic shock and persistent bacteremia.
Our study confirms an increasing mortality trend in IE, although with a borderline significance. Elderly forms are associated with poor prognosis and higher than 1-year mortality rate even in the multivariate analysis. Ageing population, increase in healthcare-associated and staphylococcal infections, may explain the rise of IE incidence and of the mortality trend.
感染性心内膜炎（IE）的高危人群、临床及微生物学特征已发生变化。我们研究的目的是评估意大利托斯卡纳特定地区17年间当代的流行病学趋势，分析临床结局及相关预后因素。
从1998年1月1日至2014年12月31日，所有确诊为IE的患者均被前瞻性纳入数据库。查询医疗保健系统数据库以获取可能遗漏的患者。最终数据集由两个数据库合并而成。
IE的发病率为4.6/100,000/年，发病率呈显著线性上升。住院患者的发病率为1.27/1000次入院。65岁以上人群的发病率为11.7/100,000/年。男女比例为1.54:1。发现平均人群年龄有上升趋势（P = 0.033）。医疗保健相关IE的发病率有所增加，P = 0.016。最常见的微生物是金黄色葡萄球菌（25%）和凝固酶阴性葡萄球菌（22%）。住院死亡率为24%。发现死亡率有上升趋势（P = 0.055）。死亡率的独立预测因素为高龄、金黄色葡萄球菌感染、心力衰竭、感染性休克和持续性菌血症。
我们的研究证实了IE死亡率呈上升趋势，尽管具有临界显著性。即使在多变量分析中，老年型IE的预后也较差，死亡率高于1年。人口老龄化、医疗保健相关感染和葡萄球菌感染的增加，可能解释了IE发病率和死亡率上升的原因。
