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dc.contributor.authorBor, David Harkavy
dc.contributor.authorWoolhandler, Steffie
dc.contributor.authorNardin, Rachel Austen
dc.contributor.authorBrusch, John L.
dc.contributor.authorHimmelstein, David Urius
dc.date.accessioned2013-05-13T19:15:45Z
dc.date.issued2013
dc.identifier.citationBor, David Harkavy, Steffie Woolhandler, Rachel Austen Nardin, John L. Brusch, and David Urius Himmelstein. 2013. Infective endocarditis in the U.S., 1998–2009: A nationwide study. PLoS ONE 8(3): e60033.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10622936
dc.description.abstractBackground: Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates. Methods and findings: Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness. Conclusions: Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0060033en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603929/pdf/en_US
dash.licenseLAA
dc.subjectMedicineen_US
dc.subjectCardiovascularen_US
dc.subjectCardiomyopathiesen_US
dc.subjectEpidemiologyen_US
dc.subjectCardiovascular Disease Epidemiologyen_US
dc.subjectInfectious Diseasesen_US
dc.subjectBacterial Diseasesen_US
dc.subjectBacteremiaen_US
dc.subjectStaph Infectionsen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Care Policyen_US
dc.subjectHealth Risk Analysisen_US
dc.titleInfective Endocarditis in the U.S., 1998–2009: A Nationwide Studyen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorBor, David Harkavy
dc.date.available2013-05-13T19:15:45Z
dc.identifier.doi10.1371/journal.pone.0060033*
dash.contributor.affiliatedBrusch, John
dash.contributor.affiliatedNardin, Rachel
dash.contributor.affiliatedHimmelstein, David
dash.contributor.affiliatedBor, David


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