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The International Collaboration on Endocarditis–Prospective Cohort Study

David R. Murdoch, MD, MSc; G. Ralph Corey, MD; Bruno Hoen, MD; José M. Miró, MD, PhD; Vance G. Fowler Jr, MD, MHS; Arnold S. Bayer, MD; Adolf W. Karchmer, MD; Lars Olaison, MD, PhD; Paul A. Pappas, MS; Philippe Moreillon, MD, PhD; Stephen T. Chambers, MD, MSc; Vivian H. Chu, MD, MHS; Vicenç Falcó, MD; David J. Holland, MB, ChB, PhD; Philip Jones, MD; John L. Klein, MD; Nigel J. Raymond, MB, ChB; Kerry M. Read, MB, ChB; Marie Francoise Tripodi, MD; Riccardo Utili, MD; Andrew Wang, MD; Christopher W. Woods, MD, MPH; Christopher H. Cabell, MD, MHS; for the International Collaboration on Endocarditis–Prospective Cohort Study (ICE-PCS) Investigators

Arch Intern Med. 2009;169(5):463-473.

Background  We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.

Methods  Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005.

Results  The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk.

Conclusions  In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Author Affiliations: Department of Pathology, University of Otago, Christchurch, New Zealand (Drs Murdoch and Chambers); Departments of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Corey, Fowler, Karchmer, Chu, Wang, Woods, and Cabell), Centre Hospitalier Universitaire, University of Lausanne, Lausanne, Switzerland (Dr Moreillon), Middlemore Hospital (Dr Holland) and North Shore Hospital (Dr Read), Auckland, New Zealand, and Wellington Hospital, Wellington, New Zealand (Dr Raymond); Duke Clinical Research Institute (Drs Corey, Fowler, and Cabell and Mr Pappas), Durham; Departments of Infectious Diseases, Hôpital Saint-Jacques, Besançon, France (Dr Hoen), Sahlgrenska University Hospital, Göteborg, Sweden (Dr Olaison), Hospital Universitari Vall D’Hebron, Barcelona, Spain (Dr Falcó), and University of New South Wales, Sydney, Australia (Dr Jones); Hospital Clinic–Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona (Dr Miró); Divisions of Infectious Diseases, University of California, Los Angeles, Harbor Medical Center, Torrance (Dr Bayer), and Beth Israel-Deaconess Medical Center, Boston, Massachusetts (Dr Karchmer); Department of Infection, St Thomas' Hospital, London, England (Dr Klein); and Department of Cardiothoracic and Respiratory Services, Second University of Naples, Naples, Italy (Drs Tripodi and Utili).

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