@article{3102455,
    title = "Evolution of epidemiological characteristics of infective endocarditis in Greece",
    author = "Giannitsioti, E. and Pefanis, A. and Gogos, C. and Lekkou, A. and Dalekos, G.N. and Gatselis, N. and Georgiadou, S. and Nikou, P. and Vrettou, A. and Rigopoulos, A. and Tryfonopoulos, C. and Tsaganos, T. and Karofilakis, E. and Psarrakis, C. and Argyriou, M. and Gargalianos-Kakolyris, P. and Adamis, G. and Lourida, P. and Kofteridis, D. and Andrianaki, A. and Loupa, C. and Kostis, E. and Sinapidis, D. and Sympardi, S. and Alexiou, N. and Karaiskos, I. and Masgala, A. and Maltezos, E. and Panagopoulos, P. and Sachpekidis, V. and Evdoridis, C. and Sipsas, N.V. and Daikos, G. and Giamarellou, H. and Pontikis, K. and Lioris, I. and Lelekis, M. and Trikkas, A. and Aggouras, D. and Kolias, V. and Rokkas, C. and Nana-Anastasiou, M. and Miyakis, S. and On behalf of the Hellenic Society of Chemotherapy",
    journal = "International Journal of Infectious Diseases",
    year = "2021",
    volume = "106",
    pages = "213-220",
    publisher = "Elsevier B.V.",
    issn = "1201-9712",
    doi = "10.1016/j.ijid.2021.03.009",
    keywords = "antibiotic agent;  antiinfective agent, abscess;  acute kidney failure;  adult;  aged;  antimicrobial therapy;  Article;  bacterial endocarditis;  blood culture;  cardiovascular mortality;  cerebrovascular accident;  clinical outcome;  cohort analysis;  controlled study;  Coxiella burnetii;  data analysis software;  descriptive research;  echocardiography;  Enterococcus;  Enterococcus faecalis;  Enterococcus faecium;  epidemiological data;  female;  Greece;  groups by age;  heart failure;  heart surgery;  hospitalization;  human;  Human immunodeficiency virus infection;  juvenile;  kidney disease;  Legionella;  major clinical study;  male;  methicillin resistant Staphylococcus aureus;  methicillin susceptible Staphylococcus aureus;  middle aged;  polymerase chain reaction;  practice guideline;  prospective study;  prosthetic valve endocarditis;  protocol compliance;  rheumatic fever;  septic shock;  serology;  social status;  Staphylococcus aureus;  Streptococcus group D;  Streptococcus oralis;  survival;  valvular heart disease;  very elderly;  adolescent;  endocarditis;  Greece;  microbiology;  mortality;  virology, Adolescent;  Adult;  Aged;  Anti-Bacterial Agents;  Cohort Studies;  Endocarditis;  Greece;  Humans;  Male;  Middle Aged;  Prospective Studies",
    abstract = "Objective: The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. Methods: A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. Results: Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159–5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190–8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085–4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165–0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259–0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. Conclusions: A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival. © 2021 The Authors"
}