Nosocomial Vs. Community-Acquired Infective Endocarditis in Spain: Location, Trends, Clinical Presentation, Etiology, and Survival in the 21st Century

Major changes have occurred in the epidemiology and etiology of infective endocarditis (IE). Nevertheless, the differences between nosocomial infective endocarditis (NIE) and community-acquired infective endocarditis (CIE) have not been addressed in a population-based study. We conducted a retrospective, nationwide, temporal trend study from 1997 to 2014 analyzing the epidemiology, clinical, geographical, meteorological characteristics of patients diagnosed with IE in Spain, to distinguish NIE from CIE. Among 25,952 patients with IE (62.2 ± 18·6 years; 65.9% men), 45.9% had NIE. The incidence of IE increased from 2.83 to 3.73 due to the NIE incidence increment with a decline in CIE. Patients with NIE were older (63.8 years vs. 60.8 years, p < 0·001), presented a higher Charlson index (1.22 vs. 1.03, p < 0.001), a greater history of implanted cardiac devices (8.7% vs. 4.6%, p < 0.001), and higher mortality (31.5% vs. 21.7%, p < 0.001). The most frequent microorganism for both NIE and CIE was Staphylococcus (p < 0.001), and the North reported a higher incidence (p < 0.001). Risk factors of mortality for NIE were age, Charlson index, hemodialysis, shock, heart failure, and stroke. Risk factors for CIE included female sex, renal disease, and cardiac-device carriers. The etiology of IE shifted from community origins to mostly nosocomial-associated infections. Higher morbidity, mortality, and poorer outcomes are associated with NIE.

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The Association between Substance Use Disorders and Long-Term Outcome of Stroke: Results from a Population-Based Study of Stroke among 450,229 Urban Citizens

Neuroepidemiology ◽

10.1159/000514401 ◽

2021 ◽

pp. 1-9

Author(s):

Mohammad Sobhan Sheikh Andalibi ◽

Amir Rezaei Ardani ◽

Amin Amiri ◽

Negar Morovatdar ◽

Amirhossein Talebi ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

Population Based ◽

Functional Dependency ◽

Stroke Mortality ◽

Vascular Risk ◽

Population Based Study ◽

Stroke Outcomes ◽

History Of

Introduction: Little is known regarding long-term stroke outcomes in patients with substance use disorder (SUD). Based on anecdotal data, some individuals use illicit drugs, particularly opioids, in an attempt to reduce stroke mortality, disability, or recurrence. This study is aimed to assess the effect of SUD on stroke outcomes. Methods: Patients were recruited from the Mashhad Stroke Incidence Study, a population-based study of stroke in Iran. For a period of 1 year, all patients with first-ever stroke (FES) were recruited and then followed up for the next 5 years. Disability and functional dependency were defined using modified Rankin Scale (>2) and Barthel Index (<60), respectively. We compared the cumulative rates of mortality in follow-up points using the log-rank test. We used multivariable logistic, Cox regression and competing risk models to assess adjusted hazard ratio (aHR) with 95% confidence interval (CI) of stroke disability, functional dependency, mortality, and recurrence among those with a history of SUD. Results: 595 FES patients (mean age of 64.6 ± 14.8 years) were recruited in this study. Eighty-one (13.6%) were current substance users, including opium (n = 68), naswar (n = 5, 6.1%), hashish (n = 1), heroin (n = 1), and (n = 7) others. The frequency of vascular risk factors was similar between the SUD and non-SUD groups, except for a higher rate of cigarette smoking in the SUD group (p < 0.001). After adjusting for various sociodemographic variables, vascular risk factors, and the severity of stroke at admission, SUD increased the 3-month (aHR: 1.60, CI: 1.01–2.49), 1-year (aHR: 1.73, CI: 1.20–2.65), and 5-year (aHR: 1.72, CI: 1.23–2.35) poststroke mortality risk. We did not observe a significant change in the risk of stroke recurrence, disability, and functional dependency in those with a history of SUD. Conclusion: SUD increased the hazard ratio of stroke mortality with no effect on the disability rate. The public should be advised about the potential harm of substance abuse.

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Comparison of metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients: a retrospective study

10.21203/rs.3.rs-551090/v1 ◽

2021 ◽

Author(s):

Xiaolin Huang ◽

Jiaojiao Zhou ◽

Hong Zhang ◽

Pei Gao ◽

Long Wang ◽

...

Keyword(s):

Risk Factors ◽

Recurrent Stroke ◽

Population Based ◽

Metabolic Status ◽

Stroke Patients ◽

Population Based Study ◽

Metabolic Phenotypes ◽

History Of ◽

Integrated Discrimination Improvement ◽

Conventional Risk Factors

Abstract Background Metabolic status and body mass index (BMI) are known as apparent risk factors of recurrent stroke, but which one is more likely related to recurrent stroke remains uncertain. This study aimed to compare the metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. Methods In this retrospective population-based study, 856 hospitalized stroke patients from the Third Affiliated Hospital of Soochow University were enrolled. Recurrent stroke was defined as newly-onset stroke patients with a history of previous stroke. Metabolic phenotypes were based on Adult Treatment Panel III criteria. BMI ≥ 25kg/m2 was defined as obesity. Results Among the hospitalized stroke patients, the prevalence of recurrent stroke was 21.9%. Metabolic phenotypes rather than BMI were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy ones had 72% (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.01–2.68) increased recurrent stroke, regardless of BMI and other confounding factors. Whereas, no statistical association between BMI and recurrent stroke were found. Metabolic status improved risk prediction of recurrent stroke when adding to conventional risk factors (net reclassification index 17.6%, P = 0.0047; integrated discrimination improvement 0.7%, P = 0.014), while BMI did not. Conclusions Recurrent stroke was likely associated with poor metabolic status rather than with BMI, suggesting that controlling metabolic abnormalities could be an important method for recurrent stroke prevention.

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Prevalence and Relationship Between Diabetic Retinopathy and Nephropathy, and its Risk Factors in the North-East of Spain, a Population-Based Study

Ophthalmic Epidemiology ◽

10.3109/09286586.2010.498661 ◽

2010 ◽

Vol 17 (4) ◽

pp. 251-265 ◽

Cited By ~ 47

Author(s):

Romero-Aroca Pedro ◽

Sagarra-Alamo Ramon ◽

Baget-Bernaldiz Marc ◽

Fernández-Ballart Juan ◽

Méndez-Marin Isabel

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Population Based ◽

Population Based Study ◽

North East ◽

The North

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712. Risk of Infective Endocarditis after Transcatheter Aortic Valve Replacement in Patients with Bloodstream Infection: A Population-Based Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.904 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S407-S407

Author(s):

Khawaja M Talha ◽

Jack McHugh ◽

Daniel DeSimone ◽

Larry M Baddour ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Population Based ◽

Population Based Study ◽

Surgical Risk ◽

Factors Associated ◽

Transcatheter Aortic Valve

Abstract Background Transcatheter aortic valve replacement (TAVR) was initially approved as an alternative to surgery for patients at high surgical risk. However, it is now being considered for patients with intermediate and low surgical risk. This will result in the expansion of patient pool for TAVR; hence it is of interest to ascertain risk of blood stream infection (BSI) and infective endocarditis (IE) following TAVR. We aim to study the incidence, epidemiology and risk factors associated with IE in patients who underwent TAVR and subsequently developed a BSI. Methods A population-based study was conducted in 7 counties in southeastern Minnesota using the expanded Rochester Epidemiology Project (E-REP) for all adult (≥18 years) patients who underwent TAVR from January 1st, 2010 to December 31st, 2018. Transcatheter procedures that included replacement of either the aortic or mitral valve were included. Medical records were screened for development of BSI from time of TAVR until May 15th, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. ‘Early’ IE was defined as that occurring < 12 months following TAVR, with subsequent cases defined as ‘late’ IE. Results A total of 247 patients underwent TAVR during the study period. There were 24 patients with of BSI and 10 (42%) developed IE with an annual incidence of 5 per 1000 persons-years. Median age for patients who developed IE was 85.4 years. Male gender was affected predominantly (70%). Six developed IE at outset of BSI, while four developed IE subsequent to IE. The median time to development of IE was 791 days following TAVR. There was an equal number of early and late IE cases (n=5). The most common pathogen causing IE was viridians group streptococci (n=4) followed by enterococci and coagulase-negative staphylococci with 2 patients each. Mean Charlson comorbidity index was 6.6. Two patients with IE died before resolution of infection (20%). Conclusion The incidence of BSI and subsequent IE in patients with TAVR was low in our population. Due to the small number of BSI and IE cases, statistical analysis was not feasible. An analysis of all cases seen at Mayo Clinic is planned since the number of cases would be much higher to investigate potential risk factors associated with BSI and IE. Disclosures Larry M. Baddour, MD, Boston Scientific (Consultant) M. Rizwan Sohail, MD, Aziyo Biologics (Consultant)Medtronic Inc (Consultant, Research Grant or Support)

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