Evolution of epidemiological characteristics of infective endocarditis in Greece

Int J Infect Dis. 2021 Mar 9:S1201-9712(21)00226-5. doi: 10.1016/j.ijid.2021.03.009. Online ahead of print.


OBJECTIVE: Clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues.

METHODS: A nationwide prospective study evaluated IE at the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and cox-regression models.

RESULTS: Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; MRSA 33.8%) predominated in the young without impact on mortality (p = 0.593) whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (CI95%:1.159-5.029), p = 0.019], stroke [OR 3.206 (CI95%:1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283(CI95%:1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (CI95%:0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487(CI95%:0.259-0.916),p = 0.026]. Compared to a previous country cohort, history of rheumatic fever and native valve predisposition had declined whilst underlying renal disease and right-sided IE increased (p < 0.0001). Moreover, HIV infection has emerged (p = 0.002). No difference in rates of surgery and outcome was assessed.

CONCLUSIONS: Country survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.

PMID:33711517 | DOI:10.1016/j.ijid.2021.03.009