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

Durante-Mangoni, Emanuele, Bradley, Suzanne, Selton-Suty, Christine, Tripodi, Marie-Francoise, Barsic, Bruno, Bouza, Emilio, Cabell, Christopher H, Ramos, Auristela I D O, Fowler, Vance, Hoen, Bruno, Koneçny, Pam, Moreno, Asuncion, Murdoch, David, Pappas, Paul, Sexton, Daniel J, Spelman, Denis, Tattevin, Pierre, Miró, Jose M, van der Meer, Jan T M, Utili, Riccardo and International Collaboration on Endocarditis Prospective Cohort Study Group, 2008, Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study., Archives of internal medicine, vol. 168, no. 19, pp. 2095-2103, doi: 10.1001/archinte.168.19.2095.

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Title Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.
Author(s) Durante-Mangoni, Emanuele
Bradley, Suzanne
Selton-Suty, Christine
Tripodi, Marie-Francoise
Barsic, Bruno
Bouza, Emilio
Cabell, Christopher H
Ramos, Auristela I D O
Fowler, Vance
Hoen, Bruno
Koneçny, Pam
Moreno, Asuncion
Murdoch, David
Pappas, Paul
Sexton, Daniel J
Spelman, Denis
Tattevin, Pierre
Miró, Jose M
van der Meer, Jan T M
Utili, Riccardo
International Collaboration on Endocarditis Prospective Cohort Study Group,
Journal name Archives of internal medicine
Volume number 168
Issue number 19
Start page 2095
End page 2103
Total pages 9
Publisher American Medical Association
Place of publication Chicago, IL.
Publication date 2008-10-27
ISSN 1538-3679
Keyword(s) International Collaboration on Endocarditis Prospective Cohort Study Group
Summary 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.
Language eng
DOI 10.1001/archinte.168.19.2095
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2008, American Medical Association
Persistent URL http://hdl.handle.net/10536/DRO/DU:30086798

Document type: Journal Article
Collection: School of Medicine
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