Changing spectrum of infective endocarditis: review of 194 episodes over 20 years

Circ J. 2003 Jan;67(1):3-7. doi: 10.1253/circj.67.3.


A review of admission records identified 194 episodes of infective endocarditis (IE) from January 1980 to December 1999 at a community hospital in Tokyo. The cases were divided into decades, and the clinical picture and short-term outcomes were compared and analyzed. The mean age of patients in the 1990s was older (45.5 +/-13.2 vs 55.1+/-12.6 years, p<0.001), and prosthetic valve endocarditis was significantly more frequently seen (14.4% vs 31.8%, p=0.004). None had a history of intravenous drug abuse (IVDA). Patients on chronic hemodialysis comprised 5.8% of IE cases in the 90s. Overall, dental procedure or caries still remained the main presumed source of infection. Staphylococcal IE showed a tendency to increase, and methicillin-resistant staphylococcal IE was significantly prominent in the 90s (0% vs 10.4%, p=0.0006). The overall in-hospital mortality was similar between the 2 groups (13.6% vs 18.8%, NS). Multivariate analysis found neurological abnormality, renal insufficiency and staphylococcal IE as predictors of in-hospital mortality. The characteristics of IE in Japan have changed, even among non-IVDA patients, and it appears to occur in a more high-risk patient population, which may warrant a more aggressive therapeutic approach to its management and treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Echocardiography
  • Endocarditis, Bacterial / etiology
  • Endocarditis, Bacterial / microbiology*
  • Endocarditis, Bacterial / mortality
  • Endocarditis, Bacterial / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Staphylococcal Infections