Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey

Clin Infect Dis. 2012 May;54(9):1230-9. doi: 10.1093/cid/cis199.


Background: Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE.

Methods: A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death.

Results: The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]).

Conclusions: S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Endocarditis, Bacterial / epidemiology*
  • Endocarditis, Bacterial / microbiology
  • Female
  • France / epidemiology
  • Hospitals
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance*
  • Prognosis
  • Risk Factors
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcus / pathogenicity
  • Staphylococcus aureus / pathogenicity*
  • Young Adult