Epidemiology, risk factors, and microbiology of infective endocarditis
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Vivian H Chu, MD, MHS
Vivian H Chu, MD, MHS
- Associate Professor of Medicine
- Duke University Medical Center
The epidemiology, risk factors, and microbiology of infective endocarditis (IE) will be reviewed here. Issues related to treatment of IE are discussed separately. (See "Antimicrobial therapy of native valve endocarditis" and "Antimicrobial therapy of prosthetic valve endocarditis".)
Between 2000 and 2011, the incidence of infective endocarditis (IE) in the United States increased from 11 per 100,000 population to 15 per 100,000 population [1,2]. The precise incidence of IE is difficult to ascertain because case definitions have varied over time between authors and between clinical centers . In addition, the incidence of predisposing conditions such as rheumatic heart disease or injection drug use is variable over time and between regions and in low- and high-income countries .
For example, the incidence of IE among patients admitted to Philadelphia-area hospitals from 1988 to 1990 was approximately 11.6 cases per 100,000 person-years . In contrast, the incidence of IE in a Minnesota county between 1970 and 2006 was 5.0 to 7.9 cases per 100,000 person-years [6,7]. During this time span, the incidence of IE in men remained stable (8.6 to 12.7 cases/100,000 person-years) while the incidence of IE in women increased (from 1.4 to 6.7 cases/100,000 person-years). Other studies have reported incidence rates for IE ranging from 0.6 to 6.0 cases per 100,000 person-years [3,8-11].
A population-based observational study in France noted the annual incidence of IE was 33.8 cases per million. The incidence was highest in men aged 75 to 79 years and the majority of patients had no known prior heart disease. Healthcare-associated IE accounted for 27 percent all cases .
Some observations of changes in the incidence of IE have been associated with changes to guidelines regarding antimicrobial prophylaxis for prevention of IE published in 2007; this issue is discussed further separately. (See "Antimicrobial prophylaxis for bacterial endocarditis".)
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- RISK FACTORS
- Patient factors
- - Age >60 years
- - Male sex
- - Injection drug use
- - Poor dentition or dental infection
- Comorbid conditions
- - Structural heart disease
- Valvular disease
- Congenital heart disease
- - Prosthetic heart valve(s)
- - History of infective endocarditis
- - Presence of intravascular device
- - Chronic hemodialysis
- - HIV infection
- INFORMATION FOR PATIENTS