Introduction

Over the past 100 years the incidence of infective endocarditis has not changed significantly. This may seem surprising as the detection of bacteremia has improved significantly during this time period and the introduction of two-dimensional (2-D) echocardiography has revolutionized the diagnosis of bacterial endocarditis. Epidemiological studies demonstrate that infective endocarditis accounts for about 1 case per 1,000 hospital admissions (range 0.16 to 5.4 cases per 1,000 admissions) [1]. The incidence of endocarditis depends on the criteria used to identify cases and on referrals to tertiary medical centres and publication bias. When strict criteria were applied to identify all definite, probable and possible cases of endocarditis in residents of Olmsted County, Minnesota, U.S.A from 1950 through 1981, the mean annual age- and sex-adjusted incidence rates per 100,000 person-years were 3.8 for total cases and 3.2 for definite and probable cases only. Total rates were 4.3 for 1950 through 1959, 3.3 for 1960 through 1969 and 3.9 for 1970 through 1981 [2]. A follow-up publication from the same region for the years 1970-2000 demonstrated that age- and sex-adjusted incidence of infective endocarditis ranged from 5.0 to 7.0 cases per 100,000 person-years during the study period and did not change significantly over time (p = 0.42 for trend). Nonetheless, an increasing temporal trend was observed in the proportions of prosthetic valve infective endocarditis cases (P = 0.09). Among individuals with underlying heart disease, there was also an increasing temporal trend in endocarditis complicating mitral valve prolapse (P = 0.04) and a decreasing trend in endocarditis complicating rheumatic heart disease (P = 0.08). However, the absolute numbers were small [3].

This rather stable incidence of endocarditis occurs despite the fact that the epidemiological, microbiological and clinical features of the disease have changed substantially. In particular, the age distribution of patients has increased from a mean of 30 years in the pre-antibiotic era to about age 50 years to date [1]. In addition, new populations at risk have been added, such as injection drug users and immunocompromized patients. These include human immunodeficiency virus (HIV) patients, cancer patients receiving chemotherapy and a growing population of patients receiving particularly aggressive chemotherapy such as bone marrow transplant recipients and patients with solid organ transplants. This chapter is devoted to the changes in the epidemiology and to new insights gained into the clinical presentation, treatment options and outcomes of these special populations that occurred during the past decade.

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