Infective endocarditis: mortality was high.

Clinical bottom line (level 2c)

  1. Around a fifth of patients died.
  2. The mitral and aortic valves were most commonly affected in bacterial endocarditis.
  3. The commonest infecting organisms were viridans Streptococci, Staphylococcus and Enterococci.
Van der Meer et al: Archives of Internal Medicine 1992; 152: 1863-1869
Expires July 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: the Netherlands, 1986 to 1988

432 patients (aged ?, ?% male) bacterial endocarditis diagnosed using von Reyn criteria

Excluded if
  • cases denied access to records and the patients




    • 93% followed for until discharge
    Outcomes studied:
  • iv drug use
  • previous endocarditis
  • mortality
  • infected with viridans Streptococci, Staphylococci and Enterococci
  • heart disease involvement: mitral
  • heart disease involvement: aortic valve
  • heart disease involvement: congenital heart disease
  • congential heart disease
  • heart disease involvement: mitral and aortic and mitral
  • heart disease involvement: right sided
  • heart disease involvement: right and left sighted valvular disease
  • no heart disease

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    iv drug use until discharge 32/438 7.3%
    (4.9% to 9.7%)
    previous endocarditis until discharge 50/438 11%
    (8.4% to 14%)
    mortality until discharge 80/406 20%
    (16% to 24%)
    infected with viridans Streptococci, Staphylococci and Enterococci until discharge 388/451 86%
    (24% to 33%)
    heart disease involvement: mitral until discharge 125/ 29%
    (24% to 33%)
    heart disease involvement: aortic valve until discharge 110/ 25%
    (21% to 29%)
    heart disease involvement: congenital heart disease until discharge 38/ 8.7%
    (6.0% to 11%)
    congential heart disease until discharge 38/ 8.7%
    (6.0% to 11%)
    heart disease involvement: mitral and aortic and mitral until discharge 36/ 8.2%
    (5.6% to 11%)
    heart disease involvement: right sided until discharge 21/ 4.8%
    (2.8% to 6.8%)
    heart disease involvement: right and left sighted valvular disease until discharge 12/ 2.7%
    (1.2% to 4.3%)
    no heart disease until discharge 7/ 1.6%
    (0.4% to 2.8%)

    • 349 patients (aged 2 to 89 years; mean 47; 62% male) with native valve endocarditis.
    • 89 patients (aged 22 to 84; mean 62; 52% male) with prosthetic valve endocarditis.
    • Patients with recurrent endocarditis were documented as a separate case. 51 recurrences occurred (at least six months interval between episodes).

    Citation

    1. Van der Meer JTM, et al: Epidemiology of bacterial endocarditis in the Netherlands. 1 Patient characteristics. Archives of Internal Medicine 1992; 152: 1863-1869
    Search Terms: explode 'infective, endocarditis and epidemiology'
    Contributor: Carl Heneghan, Sumit Dhingra and Chris Ball, July 2000
    Reviewer:

    Clinical Question.
    Patient infective endocarditis
    Intervention or Exposure clinical findings
    Outcome prevalence