OR DECADES, INFECTIVE ENDOCARditis (IE) caused by Staphylococcus aureus has been viewed primarily as a community-acquired disease, especially associated with injection drug use. [1][2][3][4][5][6][7] In contrast, patients with nosocomial or intravascular catheterassociated S aureus bacteremia were considered to be at low risk for IE. 5,6,[8][9][10][11] S aureus IE is relatively infrequent at any individual institution, and observations of its characteristics were based primarily upon relatively small samples, 1,3,6,9,[12][13][14] single-center experiences, 5,6,8,9,[13][14][15][16] or retrospectively identified patients. 2,7,8,15,16 Patient characteristics, treatment practices, and outcomes in these single-center studiesoftendifferedconsiderably.Moreover, because no large, prospectively col-See also pp 3022 and 3061.
In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.
CoNS have emerged as an important cause of NVE in both community and health care settings. Despite high rates of surgical therapy, NVE caused by CoNS is associated with poor outcomes.
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