Epidemiology and outcomes of non-HACEK infective endocarditis in the southeast United States

Abstract

Objectives Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE. Materials Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infectionrelated readmission within 90-days of index infection. Results 43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock. Conclusions Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not.

Clinical Features and Outcome of Infective Endocarditis in a University Hospital in Romania

“…Septic shock occurred in 14.1% of patients, higher percentage than that observed in EURO ENDO 9.5% [ 9 ]. Gram negative bacilli etiology IE correlated with septic shock in our patients and this result was also observed in the study performed by Veve et al where 44% of patients with this etiology were in septic shock [ 41 ]. AV (Atrio-ventricular) block was observed in 4.5% in EURO ENDO and a similar value was reported in the present study 6.5% and it was correlated with CoNS IE etiology.…”

Infective Endocarditis by Yersinia Species: A Systematic Review

“…Notably, 15% of patients with IE caused by Yersinia developed heart failure, a proportion similar to that in cases of non-HACEK Gram-negative IE which ranged from 8% to 37% [ 6 , 7 , 8 , 9 ]. Embolic phenomena in Yersinia IE were present in 42% of patients, which is in line with other cases of IE by non-HACEK Gram-negative bacilli, where the rate is from 17% to 65%, while immunologic phenomena were present in 8% of patients, which is lower than the corresponding rate in non-HACEK Gram-negative bacilli IE, where that rate is between 14% and 27% [ 6 , 7 , 8 , 9 , 34 ]. Among patients with IE caused by Yersinia , 8% presented a paravalvular abscess, which is lower than the corresponding rate in IE by non-HACEK Gram-negative bacilli, which was in the range of 13% to 42% [ 6 , 7 , 8 , 9 ].…”

“…Mortality was relatively low, with about 17% of patients dying, all due to IE. This rate was relatively lower than the one in studies of IE by non-HACEK Gram-negative bacilli, where mortality was as high as 44% [ 6 , 7 , 8 , 9 , 34 ].…”

“…The mean age at diagnosis of patients with Yersinia IE was 67 years, which is slightly higher than the age at diagnosis of IE by non-HACEK Gram-negative bacilli in the literature, which is in the range of 40 to 63 years [ 6 , 7 , 8 , 9 , 34 ]. A male predominance among patients with IE by Yersinia species was noted, as in other cases of IE caused by non-HACEK Gram-negative bacilli [ 6 , 7 , 8 , 9 , 34 ].…”

“…The mean age at diagnosis of patients with Yersinia IE was 67 years, which is slightly higher than the age at diagnosis of IE by non-HACEK Gram-negative bacilli in the literature, which is in the range of 40 to 63 years [ 6 , 7 , 8 , 9 , 34 ]. A male predominance among patients with IE by Yersinia species was noted, as in other cases of IE caused by non-HACEK Gram-negative bacilli [ 6 , 7 , 8 , 9 , 34 ]. A prosthetic valve was present in 17% of patients with IE by Yersinia , which is lower than the rate mentioned in other studies of IE by non-HACEK Gram-negative bacilli, which is between 25% and 59% [ 6 , 7 , 8 , 9 , 34 ].…”