Épidémiologie des endocardites infectieuses à Staphylococcus aureus (Epidemiology of S. aureus endocarditis)

Transcription

1 Épidémiologie des endocardites infectieuses à Staphylococcus aureus (Epidemiology of S. aureus endocarditis) Lyon, 30 Novembre 2018 Univ.-Prof. Dr. med. Achim J. Kaasch Institut für Medizinische Mikrobiologie und Krankenhaushygiene Heinrich-Heine-Universität Düsseldorf

2 No conflicts of interest in the past three years

3 Endocarditis is exceptionally frequent with staphylococcal sepsis. Among 23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditis were found. Otten found 14 cases of endocarditis in 55 patients. The most frequent affections were on the mitral valve, second is the aortic valve, and third the tricuspid valve. Staphylococcal sepsis is usually fatal.

4 Figure 1: Flowchart of the selection process From 1960 to 2011 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): e

5 Incidence population based studies 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): e

6 Incidence population based studies Incidence / population All endocarditis S. aureus IE All studies Recent studies New Caledonia 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): e

7 Figure 2. Epidemiology of Infective Endocarditis. Age Male Prosthetic 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): e

8 Figure 4. Microbiology of Infective 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): e

9 Culture negatives Coxiella burnettii 13-48% Bartonella sp % Staphylococcus and Streptococcus spp. 6-17% <5% each: Tropheryma whippeli, HACEK group, Brucella sp., Chlamydophila sp., 2015 Tattevin et al Med Mal Infect Jan-Feb;45(1-2):1-8.

10 Figure 5. Regional Differences for Staphylococcus aureus and Intravenous Drug Abuse. S. aureus iv drug use 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): e

11 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): e

12 S. aureus endocarditis Risk 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):

13 Endocarditis is exceptionally frequent with staphylococcal sepsis. Among 23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditis were found. Otten found 14 cases of endocarditis in 55 patients. The most frequent affections were on the mitral valve, second is the aortic valve, and third the tricuspid valve. Staphylococcal sepsis is usually fatal.

14 Transcatheter aortic valve replacement Webb JG and Wood DA J Am Coll Cardiol 2012 Aug 7;60(6): 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):

15 Change of perspective: S. aureus bloodstream infection

16 Dominant Infective Focus Focus not identified 19% Central venous catheter 19% Peripheral venous catheter 9% Other focus 17% Endocarditis 8% Osteoarticular infection 13% Skin/soft tissue infection 15% n=3395 Kaasch J Infect Mar;68(3):

17 Dominant Infective Focus Focus not identified 19% Central venous catheter 19% Other focus 17% More than one focus: 15% Peripheral venous catheter 9% Endocarditis 8% Osteoarticular infection 13% Skin/soft tissue infection 15% n=3395 Kaasch A et al J Infect 2014 Mar;68(3):

18 Imaging Short-term venous catheter (n=175) short-term venous catheter clinical signs microbiologically proven imaging proven Endocarditis (n=104) Endocarditis Vertebral Osteomyelitis (n=74) A Vertrebral osteomyelitis weeks INSTINCT cohort N=1056, unpublished

19 Dissemination in IE INSTINCT cohort unpublished

20 n=3395 Kaasch A et al J Infect 2014 Mar;68(3): Infective Focus CVC, PVC, SST, osteoart. Endocarditis Unknown, pneumonia

21 Endocarditis is exceptionally frequent with staphylococcal sepsis. Among 23 cases of staphylococcal sepsis, 9 cases with ulcerative endocarditis were found. Otten found 14 cases of endocarditis in 55 cases. The most frequent affections were on the mitral valve, second is the aortic valve, and third the tricuspid valve. Staphylococcal sepsis is usually fatal.

22 Summary Incidence >1/ 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%

23 Thank you