epidemiology of s. aureus endocarditismedia.univ-lyon1.fr/2018/endocardite/com18/kaasch.pdf ·...

Épidémiologie des endocardites infectieuses à Staphylococcus aureus

(Epidemiology of S. aureusendocarditis)Lyon, 30 Novembre 2018

Univ.-Prof. Dr. med. Achim J. Kaasch

Institut für Medizinische Mikrobiologie und Krankenhaushygiene

Heinrich-Heine-Universität Düsseldorf

No conflicts of interest in the past three years

Endocarditis is exceptionally frequent with staphylococcal sepsis. Among23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditiswere found. Otten found 14 cases of endocarditis in 55 patients. The most frequent affections were on the mitral valve, second is the aorticvalve, and third the tricuspid valve.

… Staphylococcal sepsis is usually fatal.

Figure 1: Flowchart of the selection process

Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, et al. (2013) Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review. PLOS ONE 8(12): e82665. https://doi.org/10.1371/journal.pone.0082665

From 1960 to 2011

Incidence – population based studies


Incidence – population based studies

Incidence /100.000 population All endocarditis S. aureus IE

All studies 3.3 0.8

Recent studies 4.7 1.2

New Caledonia 16.1 3.7


Figure 2. Epidemiology of Infective Endocarditis.

Age Male Prosthetic


Figure 4. Microbiology of Infective Endocarditis.


Culture negatives

Coxiella burnettii 13-48%

Bartonella sp. 10-28%

Staphylococcus and Streptococcus spp. 6-17%

Figure 5. Regional Differences for Staphylococcus aureus and Intravenous Drug Abuse.


S. aureus

iv drug use

Figure 6. In-Hospital Mortality of Infectious Endocarditis.

Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, et al. (2013) Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review. PLOS ONE 8(12): e82665. https://doi.org/10.1371/journal.pone.0082665http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082665

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082665

S. aureus endocarditisRisk factors S. aureus Non-S. aureus

Health-care associated 38% 17%

Hemodialysis 14% 6%

Diabetes 20% 15%

Congenital heart defect 8% 13%

Dental procedures 3% 10%

Injection drug use 21% 4%

Mitral valve 46% 47%

Aortic valve 29% 49%

Tricuspid 26% 8%

Pulmonic 1% 1%

Septic pulmonary infarcts 20% 4%

Stroke 21% 14%

Other systemic emboli 27% 19%

In hospital mortality 22% 14%

Fowler VG et al JAMA 2005 Jun 22;293(24):3012-21.

Endocarditis is exceptionally frequent with staphylococcal sepsis. Among23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditiswere found. Otten found 14 cases of endocarditis in 55 patients. The most frequent affections were on the mitral valve, second is the aorticvalve, and third the tricuspid valve.


Transcatheter aortic valve replacement

Endocarditis• Incidence: 1.1% per person-year• Median time: 5.3 months• S. aureus: 23% (enterococci 25%)• 2y-mortality: 67%

Regueiro A et al JAMA 2016 Sep 13;316(10):1083-92.

Webb JG and Wood DA J Am Coll Cardiol 2012 Aug 7;60(6):483-92.

Change of perspective:S. aureus bloodstream infection

Dominant Infective Focus

n=3395 Kaasch J Infect 2014 2014 Mar;68(3):242-51.

Central venous catheter

19%

Peripheral venous catheter

9%

Skin/soft tissue infection

15%Osteoarticular

infection13%

Endocarditis8%

Other focus17%

Focus not identified

19%

Dominant Infective Focus

Central venous catheter

19%

Peripheral venous catheter

9%

Skin/soft tissue infection

15%Osteoarticular

infection13%

Endocarditis8%

Other focus17%

Focus not identified

19%

More than one focus: 15%

n=3395 Kaasch A et al J Infect 2014 Mar;68(3):242-51.

Imaging

A Vertrebral osteomyelitis

Endocarditis

short-term venous catheter

b$focus1_clin

clinical signs

microbiologically proven

imaging proven

-2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12

weeks

VertebralOsteomyelitis(n=74)

Short-termvenous catheter(n=175)

Endocarditis(n=104)

INSTINCT cohortN=1056, unpublished

Dissemination in IE

INSTINCT cohortunpublished

Infective FocusCVC, PVC, SST, osteoart.

Unknown, pneumonia

Endocarditis

n=3395 Kaasch A et al J Infect 2014 Mar;68(3):242-51.

Endocarditis is exceptionally frequent with staphylococcal sepsis. Among23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditiswere found. Otten found 14 cases of endocarditis in 55 cases. The mostfrequent affections were on the mitral valve, second is the aortic valve, and third the tricuspid valve.


Summary

• Incidence– >1/100.000 inhabitants

• Risk factors for S. aureus IE– Healthcare-associated– Hemodialysis– Injection drug use

• Manifestation– Prosthetic devices– Embolic events

• Mortality– in-hospital: 20%– 90-days: 40%

Thank you

epidemiology of s. aureus endocarditismedia.univ-lyon1.fr/2018/endocardite/com18/kaasch.pdf ·...

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