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The causative agents in infective endocarditis: a systematic review comprising 33,214 cases

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Abstract

Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term “infective endocarditis”. All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3 % of studies (N = 57) (and in 55.4 % of studies using Duke’s criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and diagnostic strategies.

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Acknowledgments

The authors are thankful to Drs F. Chirillo, M.M. Mokhles, M. Pazdernik and K. Yamane for providing original data or full texts related to their publications.

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    Authors and Affiliations

    1. Society of Junior Doctors, Athens, Greece

      Christiana T. Vogkou, Nikolaos I. Vlachogiannis, Leonidas Palaiodimos & Antonis A. Kousoulis

    2. School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

      Christiana T. Vogkou & Nikolaos I. Vlachogiannis

    3. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

      Leonidas Palaiodimos

    4. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

      Antonis A. Kousoulis

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    Correspondence to Leonidas Palaiodimos.

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    Christiana T. Vogkou and Nikolaos I. Vlachogiannis contributed equally to this work.

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    Appendix

    Appendix

    All studies included in this review can be found in Table 3.

    Table 3 Included studies.ᅟ
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    Vogkou, C.T., Vlachogiannis, N.I., Palaiodimos, L. et al. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases. Eur J Clin Microbiol Infect Dis 35, 1227–1245 (2016). https://doi.org/10.1007/s10096-016-2660-6

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