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The article presents a study which aims to provide a presentation, etiology, and outcome of the infective endocarditis (IE) in the 21st century. The prospective cohort study employed 2,781 adults with IE who were confined to 58 hospitals in 25 countries from 2000-2005. Results showed that the most common infective agent was the Staphylococcus aureus which usually infected the mitral and aortic valve. It adds that the most common complications were stroke, embolization, heart failure, and intracardiac abscess, while surgical therapy was common and mortality remained high. It concludes that IE is an acute disease in the 21st century which is characterized by high rate of Staphylococcus infection and mortality.

Background: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Methods: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling. Results: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P=.04, P=.008, and P<.001, respectively), while rates of infection due to viridans group streptococci de- creased (P=.007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P=.04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3). Conclusions: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis. [ABSTRACT FROM AUTHOR]

Investigates the incidence of Staphylococcus aureus bacteremia among elderly versus younger adult patients. Demographic characteristics of patients with Staphylococcus aureus bacteremia; Odds ratio for older group compared with younger group for selected pain characteristics and outcome of Staphylococcus aureus bacteremia.

A letter to the editor is presented which discusses a study about the rates of endocarditis with Staphylococcus aureus in the U.S.