Abstract

FERREIROS, Ernesto R. et al. S. aureus Infective Endocarditis in Argentina: A Comparative Analysis after 10 Years of EIRA-1 and EIRA-2 Surveys. Rev. argent. cardiol. [online]. 2006, vol.74, n.1, pp.35-42. ISSN 1850-3748.

Work Objective To analyze the evolution and profile of infective endocarditis (IE) in Argentina during the last 10 years through the comparison of EIRA-1 and EIRA-2 surveys. To determine the epidemiological and clinical characteristics, and in-hospital evolution of S. aureus IE (SAIE) in Argentina. Research Design and Methods The EIRA-2 survey was a prospective, multicentric study performed in 82 hospitals belonging to 16 of the 24 Argentinean provinces. Patients with definitive diagnosis of IE (Duke criteria) were followed-up during an 18-month period. Results Three hundred and ninety episodes of definitive IE were reported (108 SAIE and 282 non-SAIE); mean age was 58.5±17.3 years, male sex 70%. No statistically significant differences were observed between SAIE and non-SAIE regarding mean age, sex, prosthetic valve IE, degenerative valve IE, prevalence of heart failure and surgical treatment. The comparison of the EIRA-2 and EIRA-1 surveys showed that IE profile has changed in the last decade in Argentina. Currently, patients are older (58 vs. 51 years), and have a higher prevalence of underlying heart disease (67% vs. 55%) particularly prosthetic valve (19.2% vs. 8.5%), degenerative valve disease (12.4% vs. 4.8%), and congenital heart disease (9.5% vs. 4.2%); infections were more frequently caused by S. aureus (30% vs. 26%) and less by S. viridans (30.8% vs. 26.8%) with a decreased time until final diagnosis (21.5 vs. 33 days). No significant changes were observed in the overall mortality rate. Patients with SAIE showed a significantly (p< 0.01) higher prevalence of underlying heart disease (58.3% vs. 67.4% [OR 0.7; 95%CI: 0.4-0.99]); and a lower incidence of rheumatic valve disease [0.9% vs. 7.1% (OR 0.1; 95%CI: 0.01-0.9)] and congenital heart disease [3.7% vs. 11.7% (OR 0.29; 95%CI: 0.08-0.9)]. Prior invasive procedures (33.3% vs. 22% [OR 1.8; 95%CI: 1.1-3.0]) and hemodialysis (21.3% vs. 10.6% [OR 2.2; 95%CI: 1.2-4.3]) were significantly more frequent in SAIE; as well as a higher incidence of stroke (17.6% vs. 11.3% [OR 1.7; 95%CI: 1.0-3,2]), embolism (8.3% vs. 2.8% [OR 3.1; 95%CI: 1.06-9.2]) and in-hospital mortality (34.3% vs. 20.9% [OR 2.0; 95%CI: 1.2-3.3]). Conclusion Patients with SAIE have a higher risk profile and a worse prognosis, showing a higher incidence of stroke, embolism and in-hospital mortality. The comparison of the overall results of the EIRA-2 and EIRA-1 surveys showed that the clinical profile of IE has changed in Argentina; the different risk profile is the most likely explanation for the unchanged in-hospital mortality of IE. More aggressive measures are needed in order to improve the prognosis of IE.

Keywords : Endocarditis; Epidemiology; S. aureus; Hospital mortality.

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