Repeat endocarditis: Analysis of risk factors based on the International Collaboration on Endocarditis - Prospective Cohort Study

Laura Alagna, L Park, BP Nicholson, AJ Keiger, Jacob Strahilevitz, Arthur Morris, Dannah Wray, David Gordon, Francois Delahaye, J Edathodu, Jose Miro, Nuria Fernandez-Hidalgo, Francisco Nacinovich, R Shahid, Christopher Woods, MJ Joyce, Daniel Sexton, Vivian Chu

    Research output: Contribution to journalArticlepeer-review

    41 Citations (Scopus)

    Abstract

    Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. We considered 1874 patients enrolled in the International Collaboration on Endocarditis - Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single-episode IE and 91 (4.8%) had repeat IE: 74/91 (81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p 0.002), HIV (p 0.009), injection drug use (IDU) (p < 0.001), Staphylococcus aureus IE (p 0.003), healthcare acquisition (p 0.006) and previous IE before ICE enrolment (p 0.001). On adjusted analysis, independent risk factors were haemodialysis (OR, 2.5; 95% CI, 1.2-5.3), IDU (OR, 2.9; 95% CI, 1.6-5.4), previous IE (OR, 2.8; 95% CI, 1.5-5.1) and living in the North American region (OR, 1.9; 95% CI, 1.1-3.4). Patients with repeat IE had higher 1-year mortality than those with single-episode IE (p 0.003). Repeat IE is associated with IDU, previous IE and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk of repeat IE.

    Original languageEnglish
    Pages (from-to)566-575
    Number of pages10
    JournalCLINICAL MICROBIOLOGY AND INFECTION
    Volume20
    Issue number6
    DOIs
    Publication statusPublished - Jun 2014

    Keywords

    • Complication of endocarditis
    • Recurrence of endocarditis
    • Relapse of endocarditis
    • Repeat endocarditis
    • Risk factors for endocarditis

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