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Original research article
Infective endocarditis in octogenarians
  1. Léopold Oliver1,2,
  2. Cécile Lavoute2,
  3. Roch Giorgi3,4,
  4. Erwan Salaun1,5,
  5. Sandrine Hubert2,5,
  6. Jean-Paul Casalta5,
  7. Frédérique Gouriet5,
  8. Sebastien Renard2,
  9. Ludivine Saby2,
  10. Jean-Francois Avierinos2,
  11. Laurie-Anne Maysou2,
  12. Alberto Riberi2,5,
  13. Dominique Grisoli2,5,
  14. Anne-Claire Casalta2,
  15. Frédéric Collart2,
  16. Didier Raoult5,
  17. Gilbert Habib1,2,5
  1. 1 Aix-Marseille Université, Marseille, France
  2. 2 Department of Cardiology, APHM, La Timone Hospital, Marseille, France
  3. 3 Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
  4. 4 APHM, La Timone Hospital, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
  5. 5 URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095 IHU - Méditerranée Infection, Marseille, France
  1. Correspondence to Dr Gilbert Habib, Cardiology Department, Hôpital La Timonep, Boulevard Jean Moulin, 13005 Marseille, France; gilbert.habib{at}free.fr

Abstract

Objective To describe the characteristics of infective endocarditis (IE) in octogenarians and assess their prognosis.

Methods Patients with definite IE hospitalised at a referral centre between July 2008 and July 2013 were prospectively included. A total of 454 patients were divided into three groups: 230 patients under 65 years old, 173 patients between 65 and 80 years old, and 51 patients over 80 years old. The main end point was 1-year mortality.

Results One-year mortality was higher in the ≥80 years old group (37.3%) than in the <65 years old group (13%; p<0.001) and the 65–80 years old group (19.7%; p=0.009). Enterococci and Streptococcus gallolyticus were the more frequent micro-organisms. Embolism under antibiotic therapy (n=11 (21.6%), p=0.03) and renal failure (n=23 (51%), p=0.004) were more frequent in the ≥80 years old group. Among the ≥80 years old group, 38 patients had theoretical indication for surgery. Mortality was low (6.3%) in the 16 operated patients, but very high (72.7%) in the 22 patients not operated. Even if octogenarians were less often operated, their survival after surgery was excellent like younger patients (93.7%, 89.9% and 90.4%, respectively), whereas the absence of surgery was associated with very poor prognosis.

Conclusions IE in octogenarians is a different disease, with Enterococci as the most frequent micro-organisms and with higher mortality than younger patients. ESC recommendations for surgery are less implemented than in younger patients, yielding dramatic mortality in patients not operated despite a theoretical indication for surgery, while operated patients have an excellent prognosis. These results suggest that surgery is underused in octogenarians.

  • octogenarians
  • infective endocarditis
  • elderly
  • surgery
  • guidelines

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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