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.
We retrospectively screened 1836 men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (1984-2003) for hepatitis C virus (HCV) antibodies. HCV incidence was 0.18/100 person-years (PY) in human immunodeficiency virus (HIV)-positive MSM (8/4408 PY [95% confidence interval {CI}, 0.08-0.36]) but was 0/100 PY in MSM without HIV (0/7807 PY [95% CI, 0.00-0.05]). After 2000, HCV incidence among HIV-positive men increased 10-fold to 0.87/100 PY (5/572 PY [95% CI, 0.28-2.03]). Additional hospital cases (n=34) showed that MSM in Amsterdam who acquired HCV infection after 2000 reported high rates of ulcerative sexually transmitted infections (59%) and rough sexual techniques (56%), denied injection drug use, and were infected mainly with the difficult-to-treat HCV genotypes 1 (56%) and 4 (36%). Phylogenetic analysis showed 3 monophyletic clusters of MSM-specific HCV strains. The emergence of an MSM-specific transmission network suggests that HIV-positive MSM with high-risk sexual behaviors are at risk for sexually acquired HCV. Targeted prevention and routine HCV screening among HIV-positive MSM is needed to deter the spread of HCV.
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