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Inicio Medicina Clínica (English Edition) Left endocarditis, changes in the new millennium
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Vol. 153. Issue 2.
Pages 63-66 (July 2019)
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Vol. 153. Issue 2.
Pages 63-66 (July 2019)
Brief report
DOI: 10.1016/j.medcle.2018.04.014
Left endocarditis, changes in the new millennium
Endocarditis infecciosas izquierdas, cambios con el nuevo milenio
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Mariam Noureddine-Lópeza,
Corresponding author
mariamnoureddine@hotmail.com

Corresponding author.
, Javier de la Torre-Limaa, Josefa Ruiz-Moralesb, Juan Gálvez-Acebalc, Carmen Hidalgo-Tenoriod, César Arístides de Alarcón Gonzáleze, by the Group for the Study of Cardiovascular Infections of the Andalusian Society of Infectious Diseases (SAEI)
a Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
b Sección de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
c Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain
d Sección de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Granada, Spain
e Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Tables (3)
Table 1. Groups’ demographic and clinical characteristics for each period.
Table 2. Serious complications and mortality from infective endocarditis.
Table 3. Microbial aetiology of the 1604 endocarditis cases.
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Abstract
Introduction

A description of infective left endocarditis at the turn of the millennium.

Method

A multicentre prospective study into the left endocarditis using data collected from the Andalusian cohort for the study of cardiovascular infections during 1984–2014.

Results

Of the 1604 endocarditis cases collected, 382 belonged to G1 (group-1, period 1983–1999) and 1222 to G2 (group-2, 2000–2014). Patients in the new millennium have a significantly higher mean age, have more comorbidity and concomitant diseases, and nosocomial and health-related endocarditis are more frequent, as well as complications. An increase in methicillin-resistant Staphylococcus aureus, Enterococcus sp., Gram-negative bacilli and Streptococcus bovis was noted. Regarding treatment, there is an increase in the use of cephalosporins and a decrease in penicillins; there is more surgery when admitted to hospital and less delay. Mortality stands at around 30% in both millennia. In the multivariate analysis, mortality was associated with: previous millennium (G1), age, Charlson index, renal failure and septic shock, and aetiologically with S. aureus.

Conclusions

Mortality remains stable, despite diagnostic and therapeutic improvements, because patients are older, have greater comorbidity, a closer relationship with the health care system (nosocomial) and microorganisms are more aggressive.

Keywords:
Infective endocarditis
Epidemiology
Mortality
Nosocomial
Resumen
Introducción

Descripción de las características de las endocarditis infecciosas izquierdas con el cambio del milenio.

Método

Estudio multicéntrico prospectivo de endocarditis izquierdas recogidas en la cohorte andaluza para el estudio de las infecciones cardiovasculares entre 1984-2014.

Resultados

De 1.604 endocarditis recogidas 382 pertenecen al grupo 1 (período 1983-1999) y 1.222 al grupo 2 (2000-2014). Los pacientes del grupo 2 presentan mayor edad media, comorbilidad y enfermedades concomitantes, más nosocomialidad, endocarditis asociadas a la atención sanitaria y endocarditis complicadas. Se aprecia un aumento de los Staphylococcus aureus meticilín-resistentes, Enterococcus sp., bacilos gramnegativos y Streptococcus bovis. En el tratamiento aumenta el uso de cefalosporinas y desciende el de penicilina; hay más cirugía al ingreso y menos diferida. La mortalidad se sitúa alrededor del 30% en ambos milenios. En el análisis multivariante la mortalidad se asoció con: milenio anterior (grupo 1), edad, índice de Charlson, fracaso renal y shock séptico y, etiológicamente, Staphylococcus aureus.

Conclusiones

La mortalidad se mantiene estable, pese a mejoras diagnósticas y terapéuticas, debido a que los pacientes son mayores, con mayor comorbilidad, endocarditis relacionadas con la atención sanitaria/nosocomialidad y gérmenes más agresivos.

Palabras clave:
Endocarditis infecciosa
Epidemiología
Mortalidad
Nosocomial

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