The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark.
Department of Cardiology Bispebjerg-Frederiksberg Hospital University of Copenhagen Copenhagen Denmark.
J Am Heart Assoc. 2022 Aug 16;11(16):e025801. doi: 10.1161/JAHA.122.025801. Epub 2022 Aug 10.
Background Monitoring of microbiological cause of infective endocarditis (IE) remains key in the understanding of IE; however, data from large, unselected cohorts are sparse. We aimed to examine temporal changes, patient characteristics, and in-hospital and long-term mortality, according to microbiological cause in patients with IE from 2010 to 2017. Methods and Results Linking Danish nationwide registries, we identified all patients with first-time IE. In-hospital and long-term mortality rates were assessed according to microbiological cause and compared using multivariable adjusted logistic regression analysis and Cox proportional hazard analysis, respectively. A total of 4123 patients were included. was the most frequent cause (28.1%), followed by species (26.0%), species (15.5%), coagulase-negative staphylococci (6.2%), and "other microbiological causes" (5.3%). Blood culture-negative IE was registered in 18.9%. The proportion of blood culture-negative IE declined during the study period, whereas no significant changes were seen for any microbiological cause. Patients with species were older and more often had a prosthetic heart valve compared with other causes. For species IE, in-hospital and long-term mortality (median follow-up, 2.3 years) were 11.1% and 58.5%, respectively. Compared with species IE, the following causes were associated with a higher in-hospital mortality: IE (odds ratio [OR], 3.48 [95% CI, 2.74-4.42]), species IE (OR, 1.48 [95% CI, 1.11-1.97]), coagulase-negative staphylococci IE (OR, 1.79 [95% CI, 1.21-2.65]), "other microbiological cause" (OR, 1.47 [95% CI, 0.95-2.27]), and blood culture-negative IE (OR, 1.99 [95% CI, 1.52-2.61]); and the following causes were associated with higher mortality following discharge (median follow-up, 2.9 years): IE (hazard ratio [HR], 1.39 [95% CI, 1.19-1.62]), species IE (HR, 1.31 [95% CI, 1.11-1.54]), coagulase-negative staphylococci IE (HR, 1.07 [95% CI, 0.85-1.36]), "other microbiological cause" (HR, 1.45 [95% CI, 1.13-1.85]), and blood culture-negative IE (HR, 1.05 [95% CI, 0.89-1.25]). Conclusions This nationwide study showed that was the most frequent microbiological cause of IE, followed by species and species. Patients with IE had the highest in-hospital mortality
背景监测感染性心内膜炎（IE）的微生物病因仍然是了解 IE 的关键；然而，来自大型、未选择队列的数据仍然很少。我们旨在根据 2010 年至 2017 年 IE 患者的微生物病因，研究时间变化、患者特征以及住院和长期死亡率。
方法和结果通过链接丹麦全国性登记处，我们确定了所有首次 IE 的患者。根据微生物病因评估住院和长期死亡率，并分别使用多变量调整的逻辑回归分析和 Cox 比例风险分析进行比较。共纳入 4123 例患者。最常见的病因是 （28.1%），其次是 物种（26.0%）、 物种（15.5%）、凝固酶阴性葡萄球菌（6.2%）和“其他微生物病因”（5.3%）。血培养阴性 IE 占 18.9%。研究期间，血培养阴性 IE 的比例下降，而任何微生物病因均未见明显变化。与其他病因相比， 物种 IE 患者年龄较大，且更常患有人工心脏瓣膜。对于 物种 IE，住院和长期死亡率（中位随访 2.3 年）分别为 11.1%和 58.5%。与 物种 IE 相比，以下病因与更高的住院死亡率相关：IE（比值比 [OR]，3.48 [95%CI，2.74-4.42]）、 物种 IE（OR，1.48 [95%CI，1.11-1.97]）、凝固酶阴性葡萄球菌 IE（OR，1.79 [95%CI，1.21-2.65]）、“其他微生物病因”（OR，1.47 [95%CI，0.95-2.27]）和血培养阴性 IE（OR，1.99 [95%CI，1.52-2.61]）；与出院后死亡率更高相关的病因包括：IE（风险比 [HR]，1.39 [95%CI，1.19-1.62]）、 物种 IE（HR，1.31 [95%CI，1.11-1.54]）、凝固酶阴性葡萄球菌 IE（HR，1.07 [95%CI，0.85-1.36]）、“其他微生物病因”（HR，1.45 [95%CI，1.13-1.85]）和血培养阴性 IE（HR，1.05 [95%CI，0.89-1.25]）。
结论这项全国性研究表明， 是 IE 最常见的微生物病因，其次是 物种和 物种。IE 患者的住院死亡率最高。
