Here are some interesting tidbits recently published from the largest prospective cohort of infective endocarditis ever collected (abstract). Causative organisms were Gram positive in 81-88% of cases (3-4% Gram negative, 1-2% fungi or yeast, and 8-13% other / culture negative). MSSA accounted for almost 1/3 of cases, and MRSA accounted for 36% of cases in those >65 years old, and 21% of cases in those 18-65 years old. Compared to patients 18-65 years old, those >65 years old were more likely to have a +blood culture (92% vs 86%) but less likely to have vegetations (84% vs 88%) peripheral embolic events (15% vs 26%) or stroke (15% vs 18%). However, they were twice a likely to die (25% vs 13%). Take home messages here are to remember atypical presentations (lack of blood culture or vegetations; hence the need for the modified Duke criteria for diagnosis (Duke criteria)), and the overwhelmingly high rates of MRSA and death in the elderly.
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