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Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking.In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed.Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9\% vs 53.5\%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9\% vs 12.8\%; P < .001), and age older than 65 years was an independent predictor of mortality.In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.

Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.

DE ROSA, Francesco Giuseppe;
2008-01-01

Abstract

Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking.In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed.Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9\% vs 53.5\%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9\% vs 12.8\%; P < .001), and age older than 65 years was an independent predictor of mortality.In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.
2008
http://dx.doi.org/10.1001/archinte.168.19.2095
Age Factors, Aged, Endocarditis; Bacterial; epidemiology/etiology/therapy, Female, Humans, International Cooperation, Male, Middle Aged, Prospective Studies, Risk Factors
Durante-Mangoni E, Bradley S, Selton-Suty C, Tripodi MF, Barsic B, Bouza E, Cabell CH, Ramos AI, Fowler V Jr, Hoen B, Koneçny P, Moreno A, Murdoch D, Pappas P, Sexton DJ, Spelman D, Tattevin P, Miró JM, van der Meer JT, Utili R; International Collaboration on Endocarditis Prospective Cohort Study Group. Collaborators: Gordon D, Devi U, Spelman D, van der Meer JT, Kauffman C, Bradley S, Armstrong W, Giannitsioti E, Giamarellou H, Lerakis S, del Rio A, Moreno A, Mestres CA, Paré C, Garcia de la Maria C, De Lazzario E, Marco F, Gatell JM, Miró JM, Almela M, Azqueta M, Jiménez-Expósito MJ, de Benito N, Perez N, Almirante B, Fernandez-Hidalgo N, Rodriguez de Vera P, Tornos P, Falcó V, Claramonte X, Armero Y, Sidani N, Kanj-Sharara S, Kanafani Z, Raglio A, Goglio A, Gnecchi F, Suter F, Valsecchi G, Rizzi M, Ravasio V, Hoen B, Chirouze C, Giannitsioti E, Leroy J, Plesiat P, Bernard Y, Casey A, Lambert P, Watkin R, Elliott T, Patel M, Dismukes W, Pan A, Caros G, Tribouilloy AB, Goissen T, Delahaye A, Delahaye F, Vandenesch F, Vizzotti C, Nacinovich FM, Marin M, Trivi M, Lombardero M, Cortes C, Horacio Casabe J, Altclas J, Kogan S, Clara L, Sanchez M, Commerford A, Hansa C, Deetlefs E, Ntsekhe M, Commerford P, Wray D, Steed LL, Church P, Cantey R, Morris A, Murdoch D, Read K, Raymond N, Lang S, Chambers S, Kotsanas D, Korman TM, Peterson G, Purcell J, Southern PM Jr, Shah M, Bedimo R, Reddy A, Levine D, Dhar G, Hanlon-Feeney A, Hannan M, Kelly S, Wang A, Cabell CH, Woods CW, Sexton DJ, Benjamin D Jr, Corey GR, McDonald JR, Federspiel J, Engemann JJ, Reller LB, Drew L, Caram LB, Stryjewski M, Morpeth S, Lalani T, Fowler V Jr, Chu V, Mazaheri B, Neuerburg C, Naber C, Athan E, Henry M, Harris O, Alestig E, Olaison L, Wikstrom L, Snygg-Martin U, Francis J, Venugopal K, Nair L, Thomas V, Chaiworramukkun J, Pachirat O, Chetchotisakd P, Suwanich T, Kamarulzaman A, Tamin SS, Premru MM, Logar M, Lejko-Zupanc T, Orezzi C, Klein J, Bouza E, Moreno M, Rodríguez-Créixems M, Fernández M, Muñoz P, Fernández R, Ramallo V, Raoult D, Thuny F, Habib G, Casalta JP, Fournier PE, Chipigina N, Kirill O, Vinogradova T, Kulichenko VP, Butkevich OM, Lion C, Alla F, Coyard H, Doco-Lecompte T, Iarussi D, Durante-Mangoni E, Ragone E, Dialetto G, Tripodi MF, Utili R, Casillo R, Kumar AS, Sharma G, Dickerman SA, Street A, Eisen DP, McBryde ES, Grigg L, Abrutyn E, Michelet C, Tattevin P, Donnio PY, Fortes CQ, Edathodu J, Al-Hegelan M, Font B, Anguera I, Raimon Guma J, Cereceda M, Oyonarte MJ, Montagna Mella R, Garcia P, Braun Jones S, de Oliveira Ramos AI, Paiva MG, de Medeiros RA, Woon LL, Lum LN, Tan RS, Rees D, Koneçny P, Lawrence R, Dever R, Post J, Jones P, Ryan S, Harkness J, Feneley M, Rubinstein E, Strahilewitz J, Ionac A, Mornos C, Dragulescu S, Forno D, Cecchi E, De Rosa F, Imazio M, Trinchero R, Wiesbauer F, Gattringer R, Rubinstein E, Deans G, Andrasevic AT, Barsic B, Klinar I, Vincelj J, Bukovski S, Krajinovic V, Cabell C, Stafford J, Baloch K, Pappas P, Redick T, Harding T, Karchmer AW, Bayer A, Hoen B, Cabell CH, Sexton DJ, Durack DT, Abrutyn E, Rubinstein E, Corey R, Miró JM, Moreillon P, Eykynm S, Fowler V Jr, Olaison L, Murdoch D, Athan E, Corey GR, Chu V.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/122594
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