Background Infective endocarditis (IE) is associated with significant mortality and morbidity. This study aims to update the epidemiology of IE and to identify predictors of adverse outcome in the Chinese population in Hong Kong.

Methods This was a single-centre retrospective study of patients diagnosed with IE in Princess Margaret Hospital in Hong Kong during 2002-2016. Primary outcome was defined as in-hospital mortality. Secondary outcomes included 1-year mortality, valvular surgical intervention, heart failure, stroke and systemic embolization.

Results In total, 196 patients with definite or possible IE were included in the study. The incidence of IE was 2.26 per 100,000 person-years and had remained stable. Health care-associated IE (HCAIE) accounted for 32% of cases, with an increasing trend. Staphylococcus aureus was the most frequently isolated organism in the overall study population (37.8%) and among intravenous drug users (85.2%). In-hospital mortality remained high (29.1%) and was independently associated with higher Charlson Comorbidity Index (OR 1.24, p=0.001), heart failure (OR 5.65, p

Discussion This study showed that the incidence of IE remained stable during 2002-2016. There was an increasing proportion of HCAIE and Staphylococcus aureus has become the most common causative organism. IE was associated with high mortality and morbidity. Independent predictors for in-hospital mortality were patient’s medical comorbidity, large vegetation size and heart failure, while infection by viridans group streptococci was associated with reduced risk.