Evolution of epidemiological characteristics of infective endocarditis in Greece.
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Giannitsioti Efthymia, Pefanis Angelos, Gogos Charalampos, Lekkou Alexandra, Dalekos Georgios N, Gatselis Nikolaos, Georgiadou Sara, Nikou Paraskevas, Vrettou Agathi, Rigopoulos Angelos, Tryfonopoulos Christos, Tsaganos Thomas, Karofilakis Emmanouil, Psarrakis Christos, Argyriou Michail, Gargalianos-Kakolyris Panagiotis, Adamis Georgios, Lourida Panagiota, Kofteridis Diamantis, Andrianaki Aggeliki, Loupa Chariclia, Kostis Evangelos, Sinapidis Dimitris, Sympardi Styliani, Alexiou Nikolaos, Karaiskos Ilias, Masgala Aikaterini, Maltezos Efstratios, Panagopoulos Periklis, Sachpekidis Vasileios, Evdoridis Constantinos, Sipsas Nikolaos V, Daikos Georgios, Giamarellou Helen, Hellenic Society of Chemotherapy
Аннотация
METHODS: A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models.
RESULTS: Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed.
CONCLUSIONS: A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.