Repeat endocarditis: Analysis of Risk Factors based on the International Collaboration on Endocarditis - Prospective Cohort Study (ICE-PCS).
Clin Microbiol Infect. 2013 Sep 18;
Authors: Alagna L, Park LP, Nicholson B, Keiger A, Strahilevitz J, Morris A, Wray D, Gordon D, Delahaye F, Jameela E, Miró JM, Fernández-Hidalgo N, Nacinovich FM, Shahid R, Woods CW, Joyce MJ, Sexton DJ, Chu VH
BACKGROUND: Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE.
METHODS: 1874 patients enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality.
RESULTS: Of 1874 patients, 1783 (95.2%) had single episode IE and 91 (4.8%) had repeat IE: 74/91(81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p=0.002), HIV (p=0.009), injection drug use (IDU) (p<0.001), Staphylococcus aureus IE (p=0.003), health-care acquisition (p=0.006) and previous IE before ICE enrolment (p=0.001). On adjusted analysis, independent risk factors were haemodialysis (OR 2.5, 95% CI, 1.2-5.3), IDU (OR 2.9, 95% CI 1.6- 5.4), previous IE (OR 2.8, 95% CI, 1.5-5.1) and North American region (OR 1.9, 95% CI 1.1- 3.4). Patients with repeat IE had higher 1-year mortality than those with single episode IE (p=0.003).
CONCLUSIONS: Repeat IE is associated with IDU, previous IE, and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk for repeat IE. This article is protected by copyright. All rights reserved.
PMID: 24102907 [PubMed - as supplied by publisher]