We postulate that the trends for infective endocarditis (IE) are different for patients
admitted for this condition compared with those admitted for a different reason with
IE as a secondary diagnosis. Using the Myocardial Infarction Data Acquisition System
(MIDAS) database, we analyzed 21,443 records of patients hospitalized with diagnosis
of IE from 1994 to 2015. There were 9,191 patients hospitalized with IE as the primary
diagnosis, and 12,252 patients with IE as a secondary diagnosis. Piecewise linear
models were used to detect changes in trends. A bootstrap method was used to assess
the statistical significance of the slopes and break point of each model. Differences
in co-morbidities and microbiological patterns were analyzed. Trend analysis showed
a significant decrease in IE as the primary diagnosis starting in the year 2004 (p
<0.01). Hospitalizations with IE as a secondary diagnosis showed a linear increase
in incidence (p <0.001), without any change points. In primary diagnosis IE, the proportion
of streptococci as a causative microorganism was higher compared with staphylococci
(p <0.001). On the contrary, in secondary diagnosis IE, the proportion of staphylococci
was higher than streptococci (p <0.001). The proportion of gram-negative and other
organism IE was similar in both groups. In conclusion, this study showed 2 divergent
temporal trends in hospitalizations for IE as a primary or secondary diagnosis starting
in 2004. The profile of the microorganisms reveals a steady higher proportion of staphylococcal
infection in secondary diagnosis IE compared with streptococcal infection. Different
strategies are needed for the prevention of IE.
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Article Info
Publication History
Published online: May 09, 2019
Received in revised form:
April 15,
2019
Received:
February 13,
2019
Footnotes
Relationship with industry: No relevant relationship with industry exists. Partially funded by the Robert Wood Johnson Foundation, Princeton NJ .
Identification
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© 2019 Elsevier Inc. All rights reserved.
