Changing patient characteristics and the effect on mortality in endocarditis

Christopher H. Cabell, James G. Jollis, Gail E. Peterson, G. Ralph Corey, Deverick J. Anderson, Daniel J. Sexton, Christopher W. Woods, L. Barth Relier, Thomas Ryan, Vance G. Fowler

Research output: Contribution to journalArticle

363 Citations (Scopus)

Abstract

Background: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Methods: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling. Results: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P = .04, P = .008, and P<.001, respectively), while rates of infection due to viridans group streptococci decreased (P = .007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P = .04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3). Conclusions: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.

Original languageEnglish (US)
Pages (from-to)90-94
Number of pages5
JournalArchives of Internal Medicine
Volume162
Issue number1
StatePublished - Jan 14 2002

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Endocarditis
Mortality
Demography
Renal Dialysis
Staphylococcus aureus
Infection
Confidence Intervals
Viridans Streptococci
Survival
Immunosuppression
Logistic Models
Odds Ratio
Regression Analysis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Cabell, C. H., Jollis, J. G., Peterson, G. E., Ralph Corey, G., Anderson, D. J., Sexton, D. J., ... Fowler, V. G. (2002). Changing patient characteristics and the effect on mortality in endocarditis. Archives of Internal Medicine, 162(1), 90-94.

Changing patient characteristics and the effect on mortality in endocarditis. / Cabell, Christopher H.; Jollis, James G.; Peterson, Gail E.; Ralph Corey, G.; Anderson, Deverick J.; Sexton, Daniel J.; Woods, Christopher W.; Barth Relier, L.; Ryan, Thomas; Fowler, Vance G.

In: Archives of Internal Medicine, Vol. 162, No. 1, 14.01.2002, p. 90-94.

Research output: Contribution to journalArticle

Cabell, CH, Jollis, JG, Peterson, GE, Ralph Corey, G, Anderson, DJ, Sexton, DJ, Woods, CW, Barth Relier, L, Ryan, T & Fowler, VG 2002, 'Changing patient characteristics and the effect on mortality in endocarditis', Archives of Internal Medicine, vol. 162, no. 1, pp. 90-94.
Cabell CH, Jollis JG, Peterson GE, Ralph Corey G, Anderson DJ, Sexton DJ et al. Changing patient characteristics and the effect on mortality in endocarditis. Archives of Internal Medicine. 2002 Jan 14;162(1):90-94.
Cabell, Christopher H. ; Jollis, James G. ; Peterson, Gail E. ; Ralph Corey, G. ; Anderson, Deverick J. ; Sexton, Daniel J. ; Woods, Christopher W. ; Barth Relier, L. ; Ryan, Thomas ; Fowler, Vance G. / Changing patient characteristics and the effect on mortality in endocarditis. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 1. pp. 90-94.
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AU - Sexton, Daniel J.

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N2 - Background: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Methods: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling. Results: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P = .04, P = .008, and P<.001, respectively), while rates of infection due to viridans group streptococci decreased (P = .007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P = .04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3). Conclusions: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.

AB - Background: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Methods: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling. Results: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P = .04, P = .008, and P<.001, respectively), while rates of infection due to viridans group streptococci decreased (P = .007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P = .04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3). Conclusions: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.

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