Repeat endocarditis: Analysis of risk factors based on the International collaboration on endocarditis - Prospective cohort study

L. Alagna*, L. P. Park, B. P. Nicholson, A. J. Keiger, J. Strahilevitz, A. Morris, D. Wray, D. Gordon, F. Delahaye, J. Edathodu, J. M. Miró, N. Fernández-Hidalgo, F. M. Nacinovich, R. Shahid, C. W. Woods, M. J. Joyce, D. J. Sexton, V. H. Chu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. We considered 1874 patients enrolled in the International Collaboration on Endocarditis - Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single-episode IE and 91 (4.8%) had repeat IE: 74/91 (81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p 0.002), HIV (p 0.009), injection drug use (IDU) (p < 0.001), Staphylococcus aureus IE (p 0.003), healthcare acquisition (p 0.006) and previous IE before ICE enrolment (p 0.001). On adjusted analysis, independent risk factors were haemodialysis (OR, 2.5; 95% CI, 1.2-5.3), IDU (OR, 2.9; 95% CI, 1.6-5.4), previous IE (OR, 2.8; 95% CI, 1.5-5.1) and living in the North American region (OR, 1.9; 95% CI, 1.1-3.4). Patients with repeat IE had higher 1-year mortality than those with single-episode IE (p 0.003). Repeat IE is associated with IDU, previous IE and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk of repeat IE.

Original languageAmerican English
Pages (from-to)566-575
Number of pages10
JournalClinical Microbiology and Infection
Issue number6
StatePublished - Jun 2014
Externally publishedYes

Bibliographical note

Funding Information:
We would like to acknowledge the support given to this project from all of the personnel at each site and at the coordinating centre and Dr Scarpellini Paolo MD for mentorship during this project period. This work was supported in part by grants from the American Heart Association 0675027N (VHC) and the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (Madrid, Spain), the Spanish Network for Research in Infectious Diseases (REIPI RD06/0008), Fondo de Investigaciones Sanitarias (FIS) (Madrid, Spain) grants FIS 05/0170 and FIS 080268 and Fundacion Maximo Soriano Jiménez (Barcelona, Spain). J.M.M. held during 2011 an INT10/219 Intensification Research Grant (I3SNS & PRICS programmes) from the Instituto de Salud Carlos III, Madrid (Spain) and the Departament de Salut de la Generalitat de Catalunya, Barcelona (Spain).


  • Complication of endocarditis
  • Recurrence of endocarditis
  • Relapse of endocarditis
  • Repeat endocarditis
  • Risk factors for endocarditis


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