Epidemiology of infective endocarditis: novel aspects in the twenty-first century

ABSTRACT

Introduction

The epidemiology of infective endocarditis (IE) in this millennium has changed with emergence of new risk factors and reemergence of others. This, coupled with modifications in national guidelines in the setting of a pandemic, prompted an address of the topic.

Areas covered

Our goal is to provide a contemporary review of IE epidemiology considering changing incidence of rheumatic heart disease (RHD), cardiac device implantation, and injection drug use (IDU), with SARS-CoV-2 pandemic as the backdrop.

Methods

PubMed and Google Scholar were used to identify studies of interest.

Expert opinion

Our experience over the past two decades verifies the notion that there is not one ‘textbook’ profile of IE. Multiple factors have dramatically impacted IE epidemiology, and these factors differ, based, in part on geography. RHD has declined in many areas of the world, whereas implanted cardiovascular devices-related IE has grown exponentially. Perhaps the most influential, at least in areas of the United States, is injection drug use complicating the opioid epidemic. Healthy younger individuals contracting a potentially life-threatening infection has been tragic. In the past year, epidemiological changes due to the COVID-19 pandemic have also occurred. No doubt, changes will characterize IE in the future and serial review of the topic is warranted.

KEYWORDS:

• Epidemiology
• infective endocarditis
• injection drug use
• prosthetic valves
• incidence
• cardiac device

Article highlights

• Rheumatic heart disease (RHD), a leading predisposition of infective endocarditis (IE) in the past, has declined globally with a shift in clinical features.

• An ever-increasing array of cardiovascular devices have forever changed the landscape of IE epidemiology.

• A multinational outbreak of Mycobacterium chimera-related IE emerged in 2013 and was linked to heater-cooler systems in patients who underwent heart surgery.

• Injection drug use (IDU) complicating the ongoing opioid epidemic has changed IE incidence and epidemiology in the United States.

• Although still early in the pandemic, the full story of SARS-CoV-2ʹs impact on the cardiovascular system remains to be told; a decline in IE cases seen over the past year suggests that it may represent an epiphenomenon.

Acknowledgments

The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, an ongoing focus of investigation at Mayo Clinic for over 60 years.

Declaration of Interest

LM Baddour reports consulting duties at Botanix Pharmaceuticals, Roivant Sciences Inc., and Boston Scientific; and royalty payments (authorship) from UpToDate.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.