engleski

RISKS FOR INFECTIVE ENDOCARDITIS (IE) IN THE ELDERLY. LESSONS FROM THE INTERNATIONAL COLLABORATION ON ENDOCARDITIS PROSPECTIVE COHORT STUDY (ICE-PCS).

Background. It is assumed that IE is more common in older adults, however no data regarding risk factors for IE are available from large prospective studies. Methods To delineate risk factors for IE in aged individuals we analyzed data from 1779 consecutive IE cases prospectively enrolled in the ICE-PCS. Patients >64 (n=689) were compared with patients <65. Data were analyzed by Wilcoxon or chi-square tests. Results Compared to younger patients, older IE patients were more often female (p<.002) and European (p<0001). IE in older patients were more likely to be of nosocomial origin and to be associated with invasive procedures (p<.0001). Risk factors such as gastrointestinal and genitourinary neoplasm, diabetes, steroid use, presence of intra-cardiac prosthetic devices were more frequent in patients >64 p<0.001 for all comparisons). Moderate to severe non-rheumatogenic mitral regurgitation and aortic stenosis was also more common in older patients (p<.0001). Bacteremia due to coagulase-negative staphylococci, enterococci and Streptococcus bovis, were more frequent in older patients. Gastrointestinal and genitourinary sources were presumed to be the most common causes of infection ; Enterococci were also commonly isolated from sources other than blood, such as the urine. A higher mortality was observed in older patients (26 vs 12, respectively ; p<-0001). Conclusion Risk factors for IE in elderly patients include diabetes, neoplasms of the gastrointestinal and genitourinary tracts, intracardiac devices and invasive procedures. Further studies are needed to determine if selected use of prophylatic antibiotics prior to invasive procedures could reduce the incidence of IE in elderly patients.

endocarditis; elderly;

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