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Observational Study
. 2019 Apr 25;23(1):143.
doi: 10.1186/s13054-019-2387-8.

Epidemiology of infective endocarditis in French intensive care units over the 1997-2014 period-from CUB-Réa Network

Jérémie Joffre  1   2 , Guillaume Dumas  1 , Philippe Aegerter  3 , Vincent Dubée  4 , Naike Bigé  1 , Gabriel Preda  1 , Jean-Luc Baudel  1 , Eric Maury  1 , Bertrand Guidet  1   2   3   4   5 , Hafid Ait-Oufella  6   7   8 ; CUB-Réa Network
Collaborators, Affiliations
Observational Study

Epidemiology of infective endocarditis in French intensive care units over the 1997-2014 period-from CUB-Réa Network

Jérémie Joffre et al. Crit Care. .

Abstract

Background: Few studies focus only on severe forms of infective endocarditis, for which organ failure requires admission to an intensive care unit (ICU). This study aimed to describe demographical, comorbidities, organ failure, and pathogen-related characteristics in a population of critically ill patients admitted to ICU for infective endocarditis and to identify risk factors of in-ICU mortality.

Methods: Retrospective observational multicenter (N = 34) study of the CUB-Rea register, based on ICD-10 coding rules, between 1997 and 2014 in France including ICU patients managed for infective endocarditis. In-ICU mortality associated factors were assessed by multivariate logistic regression including an interrupted time analysis of three periods (1997-2003, 2004-2009, and 2010-2014).

Results: Four thousand four hundred five patients admitted in ICU for infective endocarditis were included. We observed an increase in endocarditis prevalence, as well as an increase in organ failure severity over the three periods. In addition, valve surgery was more frequently performed (27%, 31%, and 42%, P < 0.0001) while in-ICU mortality significantly decreased (28%, 29%, and 23%, P < 0.001). Since 2010, a significant increase in the trends' slope of incidence for Streptococcus sp. and Staphylococcus sp. was observed with no change concerning intracellular bacteria, Enterococcus sp. or Candida sp. slope trends. In multivariate analysis, age, SAPS2, organ failure, stroke, and Staphylococcus sp. were associated with ICU mortality. Conversely, surgery, intracardiac devices, male gender, and Streptococcus sp.-related infective endocarditis were associated with a better outcome.

Conclusions: Our study reveals a shifting landscape of infective endocarditis epidemiology in French ICUs, characterized by reduced in-ICU mortality despite higher severity, more surgery, and substantial changes in microbial epidemiology.

Keywords: Critical care; Epidemiology; Infective endocarditis; Outcome; Surgery.

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Conflict of interest statement

Ethics approval and consent to participate

According to French regulation, the CUB-Réa project was approved by the Comité National de l’Informatique et des Libertés. CUB-Réa was initially funded by Assistance Publique-Hôpitaux de Paris. CUB-Réa has a steering committee composed of nine medical doctors and a database administrator (P.A.). The steering committee is charged with defining the minimum dataset, item definitions, participation requirements, coding rules, annual activity report, and data audit. Standard information, both administrative and medical in nature, is collected locally. Data are gathered prospectively for all patients hospitalized in the ICUs and are transmitted anonymously to the administrative center to be recorded in a relational database.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of infective endocarditis according to gender and age
Fig. 2
Fig. 2
Crude (a) and relative (b) observed annual incidence of infective endocarditis in ICU over the 1997–2014 period. The shaded regions indicate 95% confidence intervals
Fig. 3
Fig. 3
Multivariate analysis of risks factors for in-ICU mortality (logistic regression). Abbreviations: SAPS for Simplified Acute Physiology Score, RTT for renal replacement therapy, IV for intravenous. The dots represent the odds ratio; dot size is proportional to the odds ratio. The line through each dot corresponds to the 95% confidence interval. Variables with P < 0.10 entered in the maximal model for multivariate analysis. Goodness of fit (le Cessie-van Houwelingen statistic): P value = 0.13, calibration (AUC-ROC) 0.85.
Fig. 4
Fig. 4
Culprit pathogens’ distribution over the time (expressed as percentage of infective endocarditis case) and interrupted time series analysis. Intracellular germs include Coxiella Burnetii, Bartonella spp., Brucella spp., Chlamydia spp., Mycoplasma pneumoniae, Legionella pneumophila, Rickettsiae sp., Mycobacterium tuberculosis, and other Mycobacterium species, Francisella tularensis, Listeria monocytogenes, Nocardia spp.
See this image and copyright information in PMC

References

    1. Prendergast BD. The changing face of infective endocarditis. Heart. 2006;7:879–885. doi: 10.1136/hrt.2005.067256. - DOI - PMC - PubMed
    1. Delahaye F, Goulet V, Lacassin F, Ecochard R, Selton-Suty C, Hoen B, Etienne J, et al. Characteristics of infective endocarditis in France in 1991. A 1-year survey. Eur Heart J. 1995;3:394–401. doi: 10.1093/oxfordjournals.eurheartj.a060923. - DOI - PubMed
    1. Duval X, Delahaye F, Alla F, Tattevin P, Obadia JF, Le Moing V, Doco-Lecompte T, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol. 2012;22:1968–1976. doi: 10.1016/j.jacc.2012.02.029. - DOI - PubMed
    1. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;19:2070–2076. doi: 10.1016/j.jacc.2015.03.518. - DOI - PubMed
    1. Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis. Lancet. 2015;9974:1219–1228. doi: 10.1016/S0140-6736(14)62007-9. - DOI - PMC - PubMed

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