New trends in the epidemiological and clinical features of infective endocarditis: Results of a multicenter prospective study

Enrico Cecchi, Davide Forno, Massimo Imazio, Alessandro Migliardi, Roberto Gnavi, Ivano Dal Conte, Rita Trinchero, M. Patrone, E. Ricchiardi, V. De Ambrogio, N. Aloi, G. Madama, G. Ugliengo, G. Leonardi, U. Sturlese, L. Perotti, L. Riva, M. Subrizi, G. Tassani, M. DalmassoA. Ravera, A. D'Arrigo, I. Parrini, M. Giacosa, A. Gioria, M. Petronio, P. Angelino, M. R. Conte, L. Avonto, F. Pecchio, G. Baralis, M. Tidu, A. Chinaglia, F. Pomari, B. Demichelis, D. DeMarie, A. Ghisio, M. Moratti, L. Coda, G. Di Perri, A. M. Lucchini, F. Lipani, V. Veglio, C. Preziosi, M. L. Soranzo, F. Biancochinto, L. Mangiardi, M. Morello, M. Calachanis, C. Bernasconi, L. Checco, G. Emanuelli, P. Peano, G. F. Pagano, P. Schinco, G. Bonino, M. Di Summa, P. G. Forsennati, G. Actisdato, M. Pasquino, M. Santoro, P. Cavallo Perin, C. Crosazzo, A. Bonzano, A. Chiesa, R. Cavaliere, A. Capra, M. Anselmino, G. Quattrocchio, F. Scaroina, P. Moiraghi

Research output: Contribution to journalArticle

Abstract

Background. The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE. Methods. From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants). Results. A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8% of cases, with prosthetic valve involvement in 27 (18%). The incidence of injection drug use was 10%. Twenty-two cases (15%) were related to invasive procedures. Causative microorganisms included: streptococci 37.4% (oral streptococci 17.7%, group D streptococci 9.5%, pyogenic streptococci 3.4%, enterococci 6.8%), staphylococci 34%, other pathogens 28.5%. Blood cultures were negative in 25% of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p <0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 ± 7.4 days after admission). Valve surgery was performed in 31% of patients. The in-hospital mortality was 14% and that at 3 months 18%. Conclusions. In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.

Original languageEnglish
Pages (from-to)249-256
Number of pages8
JournalItalian Heart Journal
Volume5
Issue number4
Publication statusPublished - Apr 2004

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Endocarditis
Multicenter Studies
Prospective Studies
Streptococcus
Incidence
Epidemiology
Enterococcus faecalis
Delayed Diagnosis
Enterococcus
Hospital Mortality
Staphylococcus
Italy
Staphylococcus aureus
Heart Diseases
Pathology
Injections

Keywords

  • Clinical course
  • Diagnosis
  • Endocarditis
  • Epidemiology
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cecchi, E., Forno, D., Imazio, M., Migliardi, A., Gnavi, R., Dal Conte, I., ... Moiraghi, P. (2004). New trends in the epidemiological and clinical features of infective endocarditis: Results of a multicenter prospective study. Italian Heart Journal, 5(4), 249-256.

New trends in the epidemiological and clinical features of infective endocarditis : Results of a multicenter prospective study. / Cecchi, Enrico; Forno, Davide; Imazio, Massimo; Migliardi, Alessandro; Gnavi, Roberto; Dal Conte, Ivano; Trinchero, Rita; Patrone, M.; Ricchiardi, E.; De Ambrogio, V.; Aloi, N.; Madama, G.; Ugliengo, G.; Leonardi, G.; Sturlese, U.; Perotti, L.; Riva, L.; Subrizi, M.; Tassani, G.; Dalmasso, M.; Ravera, A.; D'Arrigo, A.; Parrini, I.; Giacosa, M.; Gioria, A.; Petronio, M.; Angelino, P.; Conte, M. R.; Avonto, L.; Pecchio, F.; Baralis, G.; Tidu, M.; Chinaglia, A.; Pomari, F.; Demichelis, B.; DeMarie, D.; Ghisio, A.; Moratti, M.; Coda, L.; Di Perri, G.; Lucchini, A. M.; Lipani, F.; Veglio, V.; Preziosi, C.; Soranzo, M. L.; Biancochinto, F.; Mangiardi, L.; Morello, M.; Calachanis, M.; Bernasconi, C.; Checco, L.; Emanuelli, G.; Peano, P.; Pagano, G. F.; Schinco, P.; Bonino, G.; Di Summa, M.; Forsennati, P. G.; Actisdato, G.; Pasquino, M.; Santoro, M.; Cavallo Perin, P.; Crosazzo, C.; Bonzano, A.; Chiesa, A.; Cavaliere, R.; Capra, A.; Anselmino, M.; Quattrocchio, G.; Scaroina, F.; Moiraghi, P.

In: Italian Heart Journal, Vol. 5, No. 4, 04.2004, p. 249-256.

Research output: Contribution to journalArticle

Cecchi, E, Forno, D, Imazio, M, Migliardi, A, Gnavi, R, Dal Conte, I, Trinchero, R, Patrone, M, Ricchiardi, E, De Ambrogio, V, Aloi, N, Madama, G, Ugliengo, G, Leonardi, G, Sturlese, U, Perotti, L, Riva, L, Subrizi, M, Tassani, G, Dalmasso, M, Ravera, A, D'Arrigo, A, Parrini, I, Giacosa, M, Gioria, A, Petronio, M, Angelino, P, Conte, MR, Avonto, L, Pecchio, F, Baralis, G, Tidu, M, Chinaglia, A, Pomari, F, Demichelis, B, DeMarie, D, Ghisio, A, Moratti, M, Coda, L, Di Perri, G, Lucchini, AM, Lipani, F, Veglio, V, Preziosi, C, Soranzo, ML, Biancochinto, F, Mangiardi, L, Morello, M, Calachanis, M, Bernasconi, C, Checco, L, Emanuelli, G, Peano, P, Pagano, GF, Schinco, P, Bonino, G, Di Summa, M, Forsennati, PG, Actisdato, G, Pasquino, M, Santoro, M, Cavallo Perin, P, Crosazzo, C, Bonzano, A, Chiesa, A, Cavaliere, R, Capra, A, Anselmino, M, Quattrocchio, G, Scaroina, F & Moiraghi, P 2004, 'New trends in the epidemiological and clinical features of infective endocarditis: Results of a multicenter prospective study', Italian Heart Journal, vol. 5, no. 4, pp. 249-256.
Cecchi, Enrico ; Forno, Davide ; Imazio, Massimo ; Migliardi, Alessandro ; Gnavi, Roberto ; Dal Conte, Ivano ; Trinchero, Rita ; Patrone, M. ; Ricchiardi, E. ; De Ambrogio, V. ; Aloi, N. ; Madama, G. ; Ugliengo, G. ; Leonardi, G. ; Sturlese, U. ; Perotti, L. ; Riva, L. ; Subrizi, M. ; Tassani, G. ; Dalmasso, M. ; Ravera, A. ; D'Arrigo, A. ; Parrini, I. ; Giacosa, M. ; Gioria, A. ; Petronio, M. ; Angelino, P. ; Conte, M. R. ; Avonto, L. ; Pecchio, F. ; Baralis, G. ; Tidu, M. ; Chinaglia, A. ; Pomari, F. ; Demichelis, B. ; DeMarie, D. ; Ghisio, A. ; Moratti, M. ; Coda, L. ; Di Perri, G. ; Lucchini, A. M. ; Lipani, F. ; Veglio, V. ; Preziosi, C. ; Soranzo, M. L. ; Biancochinto, F. ; Mangiardi, L. ; Morello, M. ; Calachanis, M. ; Bernasconi, C. ; Checco, L. ; Emanuelli, G. ; Peano, P. ; Pagano, G. F. ; Schinco, P. ; Bonino, G. ; Di Summa, M. ; Forsennati, P. G. ; Actisdato, G. ; Pasquino, M. ; Santoro, M. ; Cavallo Perin, P. ; Crosazzo, C. ; Bonzano, A. ; Chiesa, A. ; Cavaliere, R. ; Capra, A. ; Anselmino, M. ; Quattrocchio, G. ; Scaroina, F. ; Moiraghi, P. / New trends in the epidemiological and clinical features of infective endocarditis : Results of a multicenter prospective study. In: Italian Heart Journal. 2004 ; Vol. 5, No. 4. pp. 249-256.
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title = "New trends in the epidemiological and clinical features of infective endocarditis: Results of a multicenter prospective study",
abstract = "Background. The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE. Methods. From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants). Results. A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8{\%} of cases, with prosthetic valve involvement in 27 (18{\%}). The incidence of injection drug use was 10{\%}. Twenty-two cases (15{\%}) were related to invasive procedures. Causative microorganisms included: streptococci 37.4{\%} (oral streptococci 17.7{\%}, group D streptococci 9.5{\%}, pyogenic streptococci 3.4{\%}, enterococci 6.8{\%}), staphylococci 34{\%}, other pathogens 28.5{\%}. Blood cultures were negative in 25{\%} of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p <0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 ± 7.4 days after admission). Valve surgery was performed in 31{\%} of patients. The in-hospital mortality was 14{\%} and that at 3 months 18{\%}. Conclusions. In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.",
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author = "Enrico Cecchi and Davide Forno and Massimo Imazio and Alessandro Migliardi and Roberto Gnavi and {Dal Conte}, Ivano and Rita Trinchero and M. Patrone and E. Ricchiardi and {De Ambrogio}, V. and N. Aloi and G. Madama and G. Ugliengo and G. Leonardi and U. Sturlese and L. Perotti and L. Riva and M. Subrizi and G. Tassani and M. Dalmasso and A. Ravera and A. D'Arrigo and I. Parrini and M. Giacosa and A. Gioria and M. Petronio and P. Angelino and Conte, {M. R.} and L. Avonto and F. Pecchio and G. Baralis and M. Tidu and A. Chinaglia and F. Pomari and B. Demichelis and D. DeMarie and A. Ghisio and M. Moratti and L. Coda and {Di Perri}, G. and Lucchini, {A. M.} and F. Lipani and V. Veglio and C. Preziosi and Soranzo, {M. L.} and F. Biancochinto and L. Mangiardi and M. Morello and M. Calachanis and C. Bernasconi and L. Checco and G. Emanuelli and P. Peano and Pagano, {G. F.} and P. Schinco and G. Bonino and {Di Summa}, M. and Forsennati, {P. G.} and G. Actisdato and M. Pasquino and M. Santoro and {Cavallo Perin}, P. and C. Crosazzo and A. Bonzano and A. Chiesa and R. Cavaliere and A. Capra and M. Anselmino and G. Quattrocchio and F. Scaroina and P. Moiraghi",
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month = "4",
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TY - JOUR

T1 - New trends in the epidemiological and clinical features of infective endocarditis

T2 - Results of a multicenter prospective study

AU - Cecchi, Enrico

AU - Forno, Davide

AU - Imazio, Massimo

AU - Migliardi, Alessandro

AU - Gnavi, Roberto

AU - Dal Conte, Ivano

AU - Trinchero, Rita

AU - Patrone, M.

AU - Ricchiardi, E.

AU - De Ambrogio, V.

AU - Aloi, N.

AU - Madama, G.

AU - Ugliengo, G.

AU - Leonardi, G.

AU - Sturlese, U.

AU - Perotti, L.

AU - Riva, L.

AU - Subrizi, M.

AU - Tassani, G.

AU - Dalmasso, M.

AU - Ravera, A.

AU - D'Arrigo, A.

AU - Parrini, I.

AU - Giacosa, M.

AU - Gioria, A.

AU - Petronio, M.

AU - Angelino, P.

AU - Conte, M. R.

AU - Avonto, L.

AU - Pecchio, F.

AU - Baralis, G.

AU - Tidu, M.

AU - Chinaglia, A.

AU - Pomari, F.

AU - Demichelis, B.

AU - DeMarie, D.

AU - Ghisio, A.

AU - Moratti, M.

AU - Coda, L.

AU - Di Perri, G.

AU - Lucchini, A. M.

AU - Lipani, F.

AU - Veglio, V.

AU - Preziosi, C.

AU - Soranzo, M. L.

AU - Biancochinto, F.

AU - Mangiardi, L.

AU - Morello, M.

AU - Calachanis, M.

AU - Bernasconi, C.

AU - Checco, L.

AU - Emanuelli, G.

AU - Peano, P.

AU - Pagano, G. F.

AU - Schinco, P.

AU - Bonino, G.

AU - Di Summa, M.

AU - Forsennati, P. G.

AU - Actisdato, G.

AU - Pasquino, M.

AU - Santoro, M.

AU - Cavallo Perin, P.

AU - Crosazzo, C.

AU - Bonzano, A.

AU - Chiesa, A.

AU - Cavaliere, R.

AU - Capra, A.

AU - Anselmino, M.

AU - Quattrocchio, G.

AU - Scaroina, F.

AU - Moiraghi, P.

PY - 2004/4

Y1 - 2004/4

N2 - Background. The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE. Methods. From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants). Results. A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8% of cases, with prosthetic valve involvement in 27 (18%). The incidence of injection drug use was 10%. Twenty-two cases (15%) were related to invasive procedures. Causative microorganisms included: streptococci 37.4% (oral streptococci 17.7%, group D streptococci 9.5%, pyogenic streptococci 3.4%, enterococci 6.8%), staphylococci 34%, other pathogens 28.5%. Blood cultures were negative in 25% of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p <0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 ± 7.4 days after admission). Valve surgery was performed in 31% of patients. The in-hospital mortality was 14% and that at 3 months 18%. Conclusions. In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.

AB - Background. The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE. Methods. From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants). Results. A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8% of cases, with prosthetic valve involvement in 27 (18%). The incidence of injection drug use was 10%. Twenty-two cases (15%) were related to invasive procedures. Causative microorganisms included: streptococci 37.4% (oral streptococci 17.7%, group D streptococci 9.5%, pyogenic streptococci 3.4%, enterococci 6.8%), staphylococci 34%, other pathogens 28.5%. Blood cultures were negative in 25% of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p <0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 ± 7.4 days after admission). Valve surgery was performed in 31% of patients. The in-hospital mortality was 14% and that at 3 months 18%. Conclusions. In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.

KW - Clinical course

KW - Diagnosis

KW - Endocarditis

KW - Epidemiology

KW - Prognosis

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