Health Care–Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition

Abstract

Background The clinical profile and outcome of nosocomial and non-nosocomial health care–associated native valve endocarditis are not well defined. Objective To describe the prevalence, clinical characteristics, and outcomes of nosocomial and non-nosocomial health care–associated native valve endocarditis. Design Prospective observational study. Setting 61 hospitals in 28 countries. Patients Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the International Collaboration on Endocarditis–Prospective Cohort Study from June 2000 to August 2005. Measurements Characteristics of nosocomial and non-nosocomial health care–associated native valve endocarditis cases were described and compared with those cases acquired in the community. Results Health care–associated native valve endocarditis was present in 557 (34%) of 1622 patients with native valve endocarditis and no history of injection drug use (nosocomial native valve endocarditis 303 patients [54%]; non-nosocomial health care–associated native valve endocarditis 254 patients [46%]). Staphylococcus aureus was the most common cause of health care-associated native valve endocarditis (nosocomial native valve endocarditis, 47%; non-nosocomial health care–associated native valve endocarditis, 42%; p=0.3), with a notable proportion of methicillin-resistant S. aureus (nosocomial native valve endocarditis, 57%; non-nosocomial health care–associated native valve endocarditis, 41%; p=0.014). Patients with health care–associated native valve endocarditis had lower rates of cardiac surgery (41% health care–associated native valve endocarditis vs 51% community-acquired native valve endocarditis, p<0.001) and higher in-hospital mortality rates than patients with community-acquired native valve endocarditis (25% health care–associated native valve endocarditis vs. 13% community-acquired native valve endocarditis vs., p<0.001). Multivariable analysis confirmed a higher mortality associated with health care–associated native valve endocarditis (incidence risk ratio=1.20 (CI 95%, 1.03–1.61). Limitations This study involves tertiary hospitals with cardiac surgery programs. The results may not be generalized to patient populations receiving care in other types of facility. Conclusions More than one-third of all cases of native valve endocarditis in non-drug users involve contact with health care. S. aureus is the leading cause of health care–associated native valve endocarditis. Non-nosocomial health care–associated native valve endocarditis is common, especially in the US. Patients with health care-associated and community-acquired native valve endocarditis differ in their presentation, microbiology, and outcome. By contrast, patients with nosocomial and non-nosocomial healthcare-associated endocarditis are similar.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)

“…La EI tiene una incidencia de aproximadamente 1,7-6,2 por 100.000 pacientes por año, con un incremento rev Med chile 2012; 140: 1517-1528 endocarditis infecciosa: estudio cooperativo nacional y seguimiento a 10 años -M. oyonarte et al mecanismos de inmunidad, siendo estos pacientes muy susceptibles a contraer infecciones estafilocó-cicas, ya que están más expuestos a procedimientos invasivos, tanto en centros hospitalarios como de la comunidad 5,6,42 .…”

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

“…Despite improvements in diagnostic testing, antimicrobial treatment, and surgical intervention, changes in the epidemiology of IE, including the rise of health care–associated infection and Staphylococcus aureus as a virulent causative organism,2, 3 increase the risk of complications and death in the acute phase of IE. Furthermore, survival after hospital discharge may be reduced by late complications and comorbid conditions 4, 5…”

Superior mesenteric artery aneurysm in a patient with infective endocarditis

“…2 Many types of medical procedures have been associated with causing IE, from any type of vascular access (including peripheral intravenous catheters) to gastrointestinal, cardiac, and genitourinary procedures. 1,3,4 The clinical features of IE are quite variable. Most patients will present with systemic symptoms such as fever (found in 90%), night sweats, weight loss, and anorexia; however, fever is less common in the elderly.…”