Abstract 15138: Systematic Review&Meta-Analysis of Infective Endocarditis Microbiology Over 5 Decades
CONTEXT: Data are conflicting regarding changes in the microbiology of infective endocarditis (IE) over time.
METHODS: We searched, without language restrictions, PubMed, MEDLINE and EMBASE from 1960 until 2011. Search was supplemented with references from reviewed articles and correspondence with other researchers. We included studies reporting IE microbiology, time-frame, population, and IE definition. We excluded studies limited to specific sub-groups. Also included were data from our Institution from 2000 to 2010. Quality of papers was assessed as recommended by Khan and Stroup. RESULTS: 161 studies and 27,354 patients were included. In hospital-based studies (n=143; 23,877 patients), Staphyloccocal IE increased over time, with significant increases in 1) coagulase-negative Staphyloccocus over 5 decades (2% to 10%; p<0.001) and 2) S. Aureus (SA) in the last decade (Fig 1A, 21% to 30%; p<0.05). Streptoccocus viridans (SV) decreased over the same time period (Fig 1B, 32% to 17%; p<0.001). Enterococcal IE increased in the last decade (8% to 10%; p<0.01). Prosthetic, IV drug abuse (IVDA) and culture negative (CN) IE did not significantly change over time. Patient age and male predominance increased over time. In subgroup analysis, SA increased due to increasing North American incidence, without significant changes in Europe. This may be secondary to an increase in IVDA IE in North America (Spearman R2=0.54 p=0.003). No significant changes in IE microbiology over time were found in population-based studies (n=18; 3,477 patients). CONCLUSION: We present the largest meta-analysis of IE over the last five decades and the only one of hospital-based studies. Significant changes in IE microbiology have occurred, especially in the last decade and in North America. Staphylococcal species increased while SV and CN IE decreased. Moreover, mean age at diagnosis increased together with male to female ratio.
- © 2012 by American Heart Association, Inc.