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Arch Intern Med. 2009 Mar 9;169(5):463-73. doi: 10.1001/archinternmed.2008.603.

Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

Collaborators (262)

Gordon D, Devi U, Spelman D, van der Meer JT, Kauffman C, Bradley S, Armstrong W, Giannitsioti E, Giamarellou H, Lerakis S, del Rio A, Moreno A, Mestres CA, Ninot CA, Pare C, de la Maria CG, Armero Y, de Lazzari E, Marco F, Gatell JM, Almela M, Azqueta M, Sitges M, Claramonte X, Jiménez-Expósito MJ, de Benito N, Ramirez J, Perez N, Miro JM, Almirante B, Fernandez-Hidalgo N, de Vera PR, Tornos P, Falco V, Claramonte X, Sidani N, Kanj-Sharara S, Kanafani Z, Raglio A, Goglio A, Gnecchi F, Suter F, Valsecchi G, Rizzi M, Ravasio V, Hoen B, Chirouze C, Giannitsioti E, Leroy J, Plesiat P, Bernard Y, Casey A, Lambert P, Watkin R, Elliott T, Patel M, Dismukes W, Pan A, Caros G, Mathiron AB, Tribouilloy C, Goissen T, Delahaye A, Delahaye F, Vandenesch F, Vizzotti C, Nacinovich FM, Marin M, Trivi M, Lombardero M, Cortes C, Casabé JH, Altclas J, Kogan S, Clara L, Sanchez M, Commerford A, Hansa C, Deetlefs E, Ntsekhe M, Commerford P, Wray D, Steed LL, Church P, Cantey R, Morris A, Holland DJ, Murdoch DR, Chambers ST, Read KM, Raymond NJ, Lang S, Kotsanas D, Korman TM, Peterson G, Purcell J, Southern PM Jr, Shah M, Bedimo R, Reddy A, Levine D, Dhar G, Hanlon-Feeney A, Hannan M, Kelly S, Wang A, Cabell CH, Woods CW, Sexton DJ, Benjamin DJ Jr, McDonald JR, Federspiel J, Engemann JJ, Reller B, Drew L, Caram LB, Stryjewski M, Morpeth S, Lalani T, Fowler VG Jr, Chu VH, Mazaheri B, Neuerburg C, Naber C, Athan E, Henry M, Harris O, Alestig E, Olaison L, Wikstrom L, Snygg-Martin U, Francis J, Venugopal K, Nair L, Thomas V, Chaiworramukkun J, Pachirat O, Chetchotisakd P, Suwanich T, Kamarulzaman A, Tamin SS, Premru MM, Logar M, Lejko-Zupanc T, Orezzi C, Klein JL, Bouz E, Rodríguez-Créixems M, Marín M, Fernández M, Muñoz P, Fernández R, Ramallo V, Raoult D, Thuny F, Habib G, Casalta JP, Fournier PE, Chipigina N, Kirill O, Vinogradova T, Kulichenko VP, Butkevich OM, Lion C, Selton-Suty C, Coyard H, Doco-Lecompte T, Iarussi D, Durante-Mangoni E, Ragone E, Dialetto G, Tripodi MF, Utili R, Casillo R, Kumar AS, Sharma G, Dickerman SA, Street A, Eisen DP, McBryde ES, Grigg L, Abrutyn E, Michelet C, Tattevin P, Donnio PY, Fortes CQ, Edathodu J, Al-Hegelan M, Font B, Anguera I, Guma JR, Cereceda M, Oyonarte MJ, Mella RM, Garcia P, Jones SB, Ramos AI, Paiva MG, Tranchesi RA, Woon LL, Lum LN, Tan RS, Rees D, Kornecny P, Lawrence R, Dever R, Post J, Jones P, Ryan S, Harkness J, Feneley M, Rubinstein E, Strahilewitz J, Ionac A, Mornos C, Dragulescu S, Forno D, Cecchi E, De Rosa F, Imazio M, Trinchero R, Wiesbauer F, Gattringer R, Rubinstein E, Deans G, Andrasevic AT, Barsic B, Klinar I, Vincelj J, Bukovski S, Krajinovic V, Cabell CH, Stafford J, Baloch K, Pappas PA, Redick T, Harding T, Karchmer AW, Bayer AS, Hoen B, Cabell CH, Corey R, Miro JM, Moreillon P, Fowler VG Jr, Olaison L, Sexton DJ, Durack DT, Abrutyn E, Rubinstein E, Eykyn S, Murdoch DR, Bayer AS, Hoen B, Cabell CH, Fowler VG Jr, Chu VH, Miro JM, Corey R, Pappas PA, Abrutyn E, Athan E.

Author information

  • 1Department of Pathology, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand. david.murdoch@cdhb.govt.nz



We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.


Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005.


The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk.


In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

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