Epidemiology and etiology

Despite IE being a fairly uncommon infection, in the United States, there are about 10,000 to 20,000 new cases annually, and IE accounts for approximately 1 case per 1,000 hospital admissions.1 Although the exact number of cases is often difficult to determine owing to the diagnostic criteria and reporting methods for this disease, it continues to rise. IE is now considered the fourth leading cause of serious infectious disease syndromes following urosepsis, pneumonia, and intra-abdominal sepsis.2 Men are affected more commonly than women at a ratio of 1.7:1. Although IE occurs at any age, more than 50% of cases occur in patients older than 50 years.1 IE in children continues to be uncommon and is mainly associated with underlying structural defects, surgical repair of the defects, or nosocomial catheter-related bacteremia.1 With the increased use of mechanical valves, prosthetic-valve endocarditis (PVE) now accounts for approximately 7% to 25%. Patients who are IVDUs are also at an increased risk for IE, with 150 to 2,000 cases per 100,000 persons per year, most being younger adults. Additionally, other patients at high risk for IE include patients with any congenital or structural cardiac defects, including valvular disease; long-term hemodialysis; diabetes mellitus; poor oral hygiene; major dental treatment; previous endocarditis; hypertrophic cardiomyopathy; and mitral valve prolapse with regurgita-tion4-8

Although almost any type of organism is capable of causing IE, the majority of cases are caused by gram-positive organisms. These consist primarily of streptococci, staphylococci, and enterococci. Consideration of gram-negative, fungal, and other atypical organisms must be taken into account, particularly in certain patient populations. In Table 74-1, approximate percentages are given for each organism based on the type of IE, including native valve (community acquired versus health care-associated), prosthetic valve (grouped by months postsurgery) and IVDUs.

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