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.

In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

A total of 188 human (n592) and animal (n596) isolates of Clostridium difficile of different PCR ribotypes were screened for susceptibility to 30 antimicrobials using broth microdilution. When comparing the prevalence of antimicrobial resistance, the isolates of animal origin were significantly more often resistant to oxacillin, gentamicin and trimethoprim/sulfamethoxazole (P,0.01). The most significant difference between the animal and human populations (P50.0006) was found in the level of imipenem resistance, with a prevalence of 53.3 % in isolates of human origin and 28.1 % in isolates of animal origin. Overall, the results show similar MICs for the majority of tested antimicrobials for isolates from human and animal sources, which were collected from the same geographical region and in the same time interval. This supports the hypothesis that C. difficile could be transmissible between human and animal hosts. Resistant isolates have been found in all animal species tested, including food and companion animals, and also among non-toxigenic isolates. The isolates of the most prevalent PCR ribotype 014/020 had low resistance rates for moxifloxacin, erythromycin, rifampicin and daptomycin, but a high resistance rate for imipenem. Multiresistant strains were found in animals and humans, belonging to PCR ribotypes 012, 017, 027, 045, 046, 078 and 150, and also to non-toxigenic strains of PCR ribotypes 010 and SLO 080.

Structured abstract BackgroundNearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality. Methods and Results Among 5,591 patients included in the International Collaboration on Endocarditis ProspectiveCohort Study, 1,467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement.Patients who received bioprostheses were older (62 vs 54 years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively.In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60).Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). ConclusionsPatients with IE who receive a biologic valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biologic valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction. There are limited data to support the choice of either type of prosthesis in IE. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT[6] The characteristics of patients receiving biological or mechanical prosthesis and the association between type of valve prosthesis and outcome are not clearly defined. Thus, the objectives of this observational study were to describe the characteristics of patients according to the type of prosthesis and to examine the relationship between prosthesis type and 1-year mortality. METHODS International Collaboration on Endocarditis -Prospective Cohort StudyA C C E P T E D M A N U S C R I P T Medicine. All patients from sites meeting criteria for participation were included in ICE-PCS. ACCEPTED MANUSCRIPTSites had to meet the following criteria: (1) minimum enrolment of 12 cases per year in a centre with access to cardiac surgery; (2) patient identification procedures in place to ensure consecutive enrolment and to minimize ascertainment bias; (3) high-quality data, including query resolution; and (4) institutional review board and/or ethics committee approval or waiver based on local standards. Patient Selection, Data Collection and OutcomesPatients were identified prospectively and consecutively enrolled in ICE-PCS if they met criteria for possible or definite I...