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. 2021 Oct;8(2):e001846.
doi: 10.1136/openhrt-2021-001846.

Escalating incidence of infective endocarditis in Europe in the 21st century

Khawaja M Talha  1 , Larry M Baddour  2   3 , Martin H Thornhill  4 , Verda Arshad  2 , Wajeeha Tariq  2 , Imad M Tleyjeh  5   6 , Christopher G Scott  7 , Meredith C Hyun  7 , Kent R Bailey  7 , Nandan S Anavekar  3 , Raj Palraj  2 , M Rizwan Sohail  2   8 , Daniel C DeSimone  2   3 , Mark J Dayer  9
Affiliations

Escalating incidence of infective endocarditis in Europe in the 21st century

Khawaja M Talha et al. Open Heart. 2021 Oct.

Abstract

Aim: To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe.

Methods: A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence.

Results: Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%.

Conclusion: Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase.

Trial registeration number: CRD42020191196.

Keywords: endocarditis; epidemiology; systematic reviews as topic.

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Conflict of interest statement

Competing interests: LMB, M.D. reports Boston Scientific, consultant duties; UpToDate, royalty payments (authorship duties); Botanix Pharmaceuticals, consulting duties; Roivant Sciences, consultant duties. MRS, M.D. reports receiving funds from TYRX and Medtronic for prior research unrelated to this study administered according to a sponsored research agreement between Mayo Clinic and study sponsor that prospectively defined the scope of the research effort and corresponding budget; and honoraria/consulting fees from Medtronic, Philips and Aziyo Biologics. Research Grant: Medtronic. MJD, M.B.B.S. reports payments from Biotronik unrelated to this study. IMT, M.D. reports UpToDate, royalty payments (authorship duties). The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Schematic representation of study selection using PRISMA checklist. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Visual representation of European countries included in the systematic review.
Figure 3
Figure 3
Temporal trends of crude incidence of IE across all studies from 2000 to 2020. The y-axis denotes number of cases per 100 000 people while the x-axis denotes years 2000–2020. IE, infective endocarditis.
Figure 4
Figure 4
Individual and pooled incidence rate per 100 000 /year, log scale regression. The y-axis denotes incidence rate per 100 000 (%), while the x-axis denotes years 2000–2018.
See this image and copyright information in PMC

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