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Open Access Research article

Profile of infective endocarditis observed from 2003 - 2010 in a single center in Italy

Laurenzia Ferraris12*, Laura Milazzo12, Davide Ricaboni12, Cristina Mazzali1, Giovanna Orlando3, Giuliano Rizzardini4, Marco Cicardi15, Ferdinando Raimondi6, Loredana Tocalli7, Alessandro Cialfi8, Paolo Vanelli9, Massimo Galli12, Carlo Antona19 and Spinello Antinori12

Author Affiliations

1 Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università di Milano, “Luigi Sacco” Hospital, via G. B. Grassi, 74, 20157 Milano, Italy

2 Third Division of Infectious Diseases, “Luigi Sacco” Hospital, Milano, Italy

3 Second Division of Infectious Diseases, “Luigi Sacco” Hospital, Milano, Italy

4 First Division of Infectious Diseases, “Luigi Sacco” Hospital, Milano, Italy

5 Division of Internal Medicine, “Luigi Sacco” Hospital, Milano, Italy

6 Intensive Care Unit, “Luigi Sacco” Hospital, Milano, Italy

7 Microbiology Laboratory, “Luigi Sacco”, Milano, Italy

8 Department of Cardiology, “Luigi Sacco” Hospital, Milano, Italy

9 Cardiosurgery Division, “Luigi Sacco” Hospital, Milano, Italy

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BMC Infectious Diseases 2013, 13:545  doi:10.1186/1471-2334-13-545

Published: 15 November 2013

Abstract

Background

This study aimed to provide a contemporary picture of the epidemiologic, clinical, microbiologic characteristics and in-hospital outcome of infective endocarditis (IE) observed in a single center in Italy.

Methods

We performed a retrospective study of patients with definite or probable IE observed at the “L. Sacco” Hospital in Milan, Italy, from January 1, 2003 through December 31, 2010.

Results

189 episodes of IE in 166 patients were included. The mean number of incident IE in the study period was of 1.27 (range 0.59-1.76) cases per 1000 patients admitted. The median age of the cohort was 57 (interquartile range, 43-72) years, 63% were male and 62.5% had native valve IE. Twenty-six percent were active intravenous drug users (IVDU), 29% had a health care-associated IE and 5% chronic rheumatic disease. Twenty-nine percent of the cases occurred in patients affected by chronic liver disease and 19% in HIV positive subjects. Staphylococcus aureus was the most common pathogen (30%), followed by streptococci. The mitral (34%) and aortic (31%) valves were involved most frequently. The following complications were common: stroke (19%), non-stroke embolizations (25%), heart failure (26%) and intracardiac abscess (9%). Surgical treatment was frequently employed (52%) but in hospital mortality remained high (17%). Health care-associated IE and complications were independently associated with an increased risk of in-hospital death, while surgery was associated with decreased mortality.

Conclusion

S. aureus emerged as the leading causative organism of IE in a University hospital in northern Italy. Our study confirmed the high in-hospital mortality of IE, particularly if health care associated, and the protective role of surgery.

Keywords:
Infective endocarditis; Echocardiography; Valvular disease; Prognostic factors; Staphylococcus aureus; Surgery