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
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", section on 'Trends in endocarditis incidence'.)
- Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015; 65:2070.
- Toyoda N, Chikwe J, Itagaki S, et al. Trends in Infective Endocarditis in California and New York State, 1998-2013. JAMA 2017; 317:1652.
- Tleyjeh IM, Abdel-Latif A, Rahbi H, et al. A systematic review of population-based studies of infective endocarditis. Chest 2007; 132:1025.
- Ambrosioni J, Hernandez-Meneses M, Téllez A, et al. The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century. Curr Infect Dis Rep 2017; 19:21.
- Berlin JA, Abrutyn E, Strom BL, et al. Incidence of infective endocarditis in the Delaware Valley, 1988-1990. Am J Cardiol 1995; 76:933.
- Griffin MR, Wilson WR, Edwards WD, et al. Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981. JAMA 1985; 254:1199.
- Correa de Sa DD, Tleyjeh IM, Anavekar NS, et al. Epidemiological trends of infective endocarditis: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 2010; 85:422.
- Smith RH, Radford DJ, Clark RA, Julian DG. Infective endocarditis: a survey of cases in the South-East region of Scotland, 1969-72. Thorax 1976; 31:373.
- Hickey AJ, MacMahon SW, Wilcken DE. Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J 1985; 109:431.
- Williams RC, Kunkel HG. Rheumatoid factors and their disappearance following therapy in patients with subacute bacterial endocarditis. Arthritis Rheum 1962; 5:126.
- Hill EE, Herijgers P, Claus P, et al. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J 2007; 28:196.
- Selton-Suty C, Célard M, Le Moing V, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis 2012; 54:1230.
- Cantrell M, Yoshikawa TT. Infective endocarditis in the aging patient. Gerontology 1984; 30:316.
- Durante-Mangoni E, Bradley S, Selton-Suty C, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med 2008; 168:2095.
- Castillo FJ, Anguita M, Castillo JC, et al. Changes in Clinical Profile, Epidemiology and Prognosis of Left-sided Native-valve Infective Endocarditis Without Predisposing Heart Conditions. Rev Esp Cardiol (Engl Ed) 2015; 68:445.
- Lerner PI, Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med 1966; 274:199.
- Watanakunakorn C. Changing epidemiology and newer aspects of infective endocarditis. Adv Intern Med 1977; 22:21.
- Lockhart PB, Brennan MT, Thornhill M, et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc 2009; 140:1238.
- Chen SJ, Liu CJ, Chao TF, et al. Dental scaling and risk reduction in infective endocarditis: a nationwide population-based case-control study. Can J Cardiol 2013; 29:429.
- Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736.
- Gould FK, Elliott TS, Foweraker J, et al. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57:1035.
- Strom BL, Abrutyn E, Berlin JA, et al. Risk factors for infective endocarditis: oral hygiene and nondental exposures. Circulation 2000; 102:2842.
- Duval X, Millot S, Chirouze C, et al. Oral Streptococcal Endocarditis, Oral Hygiene Habits, and Recent Dental Procedures: A Case-Control Study. Clin Infect Dis 2017; 64:1678.
- McKinsey DS, Ratts TE, Bisno AL. Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum. Am J Med 1987; 82:681.
- Cherubin CE, Neu HC. Infective endocarditis at the Presbyterian Hospital in New York City from 1938-1967. Am J Med 1971; 51:83.
- Weinberger I, Rotenberg Z, Zacharovitch D, et al. Native valve infective endocarditis in the 1970s versus the 1980s: underlying cardiac lesions and infecting organisms. Clin Cardiol 1990; 13:94.
- Clemens JD, Horwitz RI, Jaffe CC, et al. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. N Engl J Med 1982; 307:776.
- Beton DC, Brear SG, Edwards JD, Leonard JC. Mitral valve prolapse: an assessment of clinical features, associated conditions and prognosis. Q J Med 1983; 52:150.
- DeSimone DC, DeSimone CV, Tleyjeh IM, et al. Association of Mitral Valve Prolapse With Infective Endocarditis Due to Viridans Group Streptococci. Clin Infect Dis 2015; 61:623.
- Michel PL, Acar J. Native cardiac disease predisposing to infective endocarditis. Eur Heart J 1995; 16 Suppl B:2.
- Dodo H, Perloff JK, Child JS, et al. Are high-velocity tricuspid and pulmonary regurgitation endocarditis risk substrates? Am Heart J 1998; 136:109.
- Gersony WM, Hayes CJ, Driscoll DJ, et al. Bacterial endocarditis in patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation 1993; 87:I121.
- Horstkotte D. Prosthetic valve endocarditis. In: Infective Endocarditis, Horstkotte D, Bodnar E (Eds), IRC Publishers, London 1991. p.229.
- Tornos MP, Permanyer-Miralda G, Olona M, et al. Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study. Ann Intern Med 1992; 117:567.
- Carrel T, Schaffner A, Vogt P, et al. Endocarditis in intravenous drug addicts and HIV infected patients: possibilities and limitations of surgical treatment. J Heart Valve Dis 1993; 2:140.
- Martín-Dávila P, Fortún J, Navas E, et al. Nosocomial endocarditis in a tertiary hospital: an increasing trend in native valve cases. Chest 2005; 128:772.
- Finkelstein R, Sobel JD, Nagler A, Merzbach D. Staphylococcus aureus bacteremia and endocarditis: comparison of nosocomial and community-acquired infection. J Med 1984; 15:193.
- Martino P, Micozzi A, Venditti M, et al. Catheter-related right-sided endocarditis in bone marrow transplant recipients. Rev Infect Dis 1990; 12:250.
- Morpeth S, Murdoch D, Cabell CH, et al. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med 2007; 147:829.
- Fernández-Hidalgo N, Almirante B, Tornos P, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis 2008; 47:1287.
- Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293:3012.
- Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009; 169:463.
- Valla D, Pariente EA, Degott C, et al. Right-sided endocarditis complicating peritoneovenous shunting for ascites. Arch Intern Med 1983; 143:1801.
- Daly JS, Worthington MG, Brenner DJ, et al. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. J Clin Microbiol 1993; 31:872.
- Sax H, Bloemberg G, Hasse B, et al. Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery. Clin Infect Dis 2015; 61:67.
- Nucifora G, Badano LP, Viale P, et al. Infective endocarditis in chronic haemodialysis patients: an increasing clinical challenge. Eur Heart J 2007; 28:2307.
- Robinson DL, Fowler VG, Sexton DJ, et al. Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis 1997; 30:521.
- Abbott KC, Agodoa LY. Hospitalizations for bacterial endocarditis after initiation of chronic dialysis in the United States. Nephron 2002; 91:203.
- Horstkotte D, Piper C, Niehues R, et al. Late prosthetic valve endocarditis. Eur Heart J 1995; 16 Suppl B:39.
- Bestetti RB, Figueiredo JF, Da Costa JC. Salmonella tricuspid endocarditis in an intravenous drug abuser with human immunodeficiency virus infection. Int J Cardiol 1991; 30:361.
- Riancho JA, Echevarría S, Napal J, et al. Endocarditis due to Listeria monocytogenes and human immunodeficiency virus infection. Am J Med 1988; 85:737.
- Nahass RG, Weinstein MP, Bartels J, Gocke DJ. Infective endocarditis in intravenous drug users: a comparison of human immunodeficiency virus type 1-negative and -positive patients. J Infect Dis 1990; 162:967.
- Gould K, Ramirez-Ronda CH, Holmes RK, Sanford JP. Adherence of bacteria to heart valves in vitro. J Clin Invest 1975; 56:1364.
- Erbay AR, Erbay A, Canga A, et al. Risk factors for in-hospital mortality in infective endocarditis: five years' experience at a tertiary care hospital in Turkey. J Heart Valve Dis 2010; 19:216.
- Klein RS, Recco RA, Catalano MT, et al. Association of Streptococcus bovis with carcinoma of the colon. N Engl J Med 1977; 297:800.
- Kreuzpaintner G, Horstkotte D, Heyll A, et al. Increased risk of bacterial endocarditis in inflammatory bowel disease. Am J Med 1992; 92:391.
- Bayer AS. Infective endocarditis. Clin Infect Dis 1993; 17:313.
- 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