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The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century

  • Cardiovascular Infections (B Hoen, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Infective endocarditis (IE) is a relatively infrequent infectious disease. It does, however, causes serious morbidity, and its mortality rate has remained unchanged at approximately 25%. Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very scarce. Moreover, prophylaxis guidelines have recently changed and the impact on IE incidence is still unknown.

Recent Findings

In high-income countries, the proportion of IE related to prior rheumatic disease has decreased significantly and has been replaced proportionally by cases related to degenerative valvulopathies, prosthetic valves, and cardiovascular implantable electronic devices. Nosocomial and non-nosocomial-acquired cases have risen, as has the proportion caused by staphylococci, and the median age of patients. In low-income countries, in contrast, rheumatic disease remains the main risk factor, and streptococci the most frequent causative agents. Studies performed to evaluate impact of guidelines changes’ have shown contradictory results.

Summary

The increased complexity of cases in high-income countries has led to the creation of IE teams, involving several specialties. New imaging and microbiological techniques may increase sensitivity for diagnosis and detection of IE cases. In low-income countries, IE remained related to classic risk factors. The consequences of prophylaxis guidelines changes are still undetermined.

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Author notes

  1. J Ambrosioni, M Hernandez-Meneses and A Téllez have equal contributions.

Authors and Affiliations

  1. Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    J Ambrosioni, M Hernandez-Meneses, A Téllez, J Pericàs, A. Moreno & José M. Miro

  2. Cardiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain

    C. Falces, JM Tolosana & B. Vidal

  3. Microbiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain

    M. Almela

  4. Cardiovascular Service, Hospital Clinic, University of Barcelona, Barcelona, Spain

    E. Quintana

  5. Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain

    J. Llopis

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  7. B. Vidal
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  8. M. Almela
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  12. José M. Miro
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Consortia

the Hospital Clinic Infective Endocarditis Investigators

Corresponding author

Correspondence to José M. Miro.

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Conflicts of Interest

Drs Ambrosioni, Hernandez-Meneses, Téllez, Pericàs, Falces, Tolosana, Vidal, Almela, Quintana, Llopis and Moreno declare no conflict of interests.

Dr. Miró has received consulting honoraria and/or research grants from AbbVie, Bristol-Myers Squibb, Cubist, Medtronic, Novartis, Gilead Sciences, and ViiV Healthcare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding

The Spanish Network for Research in Infectious Diseases provided funding to Jose M. Miró under grant number REIPI RD06/0008. While the manuscript was being drafted, Juan Ambrosioni developed this work in the frame of a “Juan de la Cierva 2012” post-doctoral program, Ministerio de Competitividad, Spain. Juan M Pericàs received a “Rio Hortega” Research Grant (CM14/00135; 2015-16) from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad, Madrid (Spain). Jose M. Miró received a personal intensification research grant #INT15/00168 during 2016 from Instituto de Salud Carlos III, Madrid, Spain. The European Regional Development Fund (ERDF) “A way to build Europe” also provided funding.

Additional information

This article is part of the Topical Collection on Cardiovascular Infections

The following are Researchers of the Hospital Clínic Infective Endocarditis Study Group: Jose M. Miró, Juan Ambrosioni, Adrian Téllez, Marta Hernandez-Meneses, Juan M. Pericàs, Christian Manzardo, and Asunción Moreno (Infectious Diseases Service); Cristina Garcia de la Mària, Javier Garcia-Gonzalez (Experimental Endocarditis Laboratory); Francesc Marco, Manel Almela, Jordi Vila (Microbiology Service); Eduard Quintana, Elena Sandoval, Juan C. Paré, Carlos Falces, Daniel Pereda, Ramon Cartañá, Salvador Ninot, Manel Azqueta, Marta Sitges, Barbara Vidal, José L. Pomar, Manuel Castella, José M. Tolosana, José Ortiz (Cardiovascular Institute); Guillermina Fita, Irene Rovira (Anaesthesiology Department); David Fuster, Ulises Granados (Nuclear Medicine Service); Jose Ramírez, (Pathology Department); Mercè Brunet (Toxicology Service); Dolors Soy (Pharmacy Service); Pedro Castro (Intensive Care Unit), and Jaume Llopis (Department of Statistics, Faculty of Biology, University of Barcelona).

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Ambrosioni, J., Hernandez-Meneses, M., Téllez, A. et al. The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century. Curr Infect Dis Rep 19, 21 (2017). https://doi.org/10.1007/s11908-017-0574-9

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  • DOI: https://doi.org/10.1007/s11908-017-0574-9

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