Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. - Archive ouverte HAL Access content directly
Journal Articles Archives of Internal Medicine Year : 2008

Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.

Emanuele Durante-Mangoni
  • Function : Author
Suzanne Bradley
  • Function : Author
Christine Selton-Suty
  • Function : Author
Marie-Françoise Tripodi
  • Function : Author
Bruno Barsic
  • Function : Author
Emilio Bouza
  • Function : Author
Christopher H Cabell
  • Function : Author
Vance Fowler
  • Function : Author
Pam Koneçny
  • Function : Author
Asuncion Moreno
  • Function : Author
David Murdoch
  • Function : Author
Paul Pappas
  • Function : Author
Daniel J Sexton
  • Function : Author
Denis Spelman
  • Function : Author
José M Miró
  • Function : Author
Jan T M van Der Meer
  • Function : Author
Riccardo Utili
  • Function : Author
Non Renseigné
  • Function : Author

Abstract

BACKGROUND: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. METHODS: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. RESULTS: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality. CONCLUSIONS: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.

Dates and versions

hal-00465390 , version 1 (19-03-2010)

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Emanuele Durante-Mangoni, Suzanne Bradley, Christine Selton-Suty, Marie-Françoise Tripodi, Bruno Barsic, et al.. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.. Archives of Internal Medicine, 2008, 168 (19), pp.2095-103. ⟨10.1001/archinte.168.19.2095⟩. ⟨hal-00465390⟩
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