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Results of a 1-Year Survey in France

Bruno Hoen, MD; François Alla, MD; Christine Selton-Suty, MD; Isabelle Béguinot, MD; Anne Bouvet, MD; Serge Briançon, MD; Jean-Paul Casalta, MD; Nicolas Danchin, MD; François Delahaye, MD; Jerome Etienne, MD; Vincent Le Moing, MD; Catherine Leport, MD; Jean-Luc Mainardi, MD; Raymond Ruimy, MD; François Vandenesch, MD; for the Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) Study Group

JAMA. 2002;288:75-81.

Context  Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991.

Objective  To update information gained from the 1991 study on the epidemiology of IE in France.

Design and Setting  Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants).

Patients  Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria.

Main Outcome Measures  Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes.

Results  The annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P = .67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P = .97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P = .08).

Conclusion  Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.

Author Affiliations: Centre Hospitalier Universitaire de Besançon, Besançon (Dr Hoen), Centre Hospitalier Universitaire de Nancy, Nancy (Drs Alla, Selton-Suty, and Briançon), Centre Hospitalier Universitaire de Reims, Reims (Dr Béguinot), Centre National de Référence des Streptocoques, Hôtel Dieu, Université Paris VI (Dr Bouvet), Centre National de Référence des Rickettsies, Marseille (Dr Casalta), Hôpital Européen Georges Pompidou, Paris (Drs Danchin and Mainardi), Hôpital Louis Pradel, Lyon (Drs Delahaye and Vandenesch), Centre National de Référence des Staphylocoques, Lyon (Drs Etienne and Vandenesch), Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris (Drs Le Moing, Leport, and Ruimy), France.

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