PURPOSE: 50% of all infective endocarditis (IE) cases occur in patients over the age of 50. The majority of IE studies are looking primarily at this age population. We sought to provide a picture of the epidemiology and outcomes of IE in young adults.
METHODS: We reviewed 116 adults of less than 50 years of age admitted for definite and possible IE, as defined by the modified Dukes criteria. Patients were divided into medical (MED, n=76) and surgical (SURG, n=40) treatment group. Each group was compared using t test and chi square test.
RESULTS: The mean age of the cohort was 35 (19-50) years. All patients had native valve IE, 64,7% definite and 36.3% possible. There was very high prevalence of intravenous drug use (IVDU, 37%), HIV (6.9%) and congenital heart disease (16.4%). Dyspnea was the most common presenting symptom (36.2%). The most common complication was embolic event (45.7%). S. aureus was the most common pathogen (48.3%), MRSA (66%). The MED had higher prevalence of IVDU (47.4% vs. 17.5%, p=0.002), hepatitis C (40.8% vs. 22.5%, p=0.04), positive blood cultures (77.6% vs. 50%, p<0.05) and predisposing factors (67.1% vs. 30%, p<0.01) while SURG had higher rate of heart failure (50% vs. 9.2%, p<0.01) and valve perforation (47.5% vs. 1.3%, p<0.01). Both in-hospital mortality (17.1% vs. 7.5%, p<0.01) and overall mortality during the five year follow up (38.9% vs. 30.7%, p=0.04) were significantly higher in MED compared with SURG (Hazard Ratio 0.49, 95% CI 0.24-0.98, p=0.04).
CONCLUSIONS: Young adults with IE have significantly higher prevalence of IVDU and congenital heart disease compared to the general IE patient population. Despite better surgical candidacy of younger adults, surgical treatment is less common in this age group and appears to be associated with better outcomes compared to the general IE patient population. Surgical group had better in-hospital and 5-year mortality than medical group.
CLINICAL IMPLICATIONS: Surgical intervention for infectious endocarditis is mainstay of treatment after initiation of antibiotics and should be offered early for improved outcomes.
DISCLOSURE: The following authors have nothing to disclose: Athanasios Smyrlis, Jeong Yun, Young Chae, Jonathan Sarik, Aman Amanullah, Benjamin Youdelman
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