Health Care - Associated Infective Endocarditis. An Undesirable Effect of Health Care Universalization

Abstract

Invasive medical technology has led to an increase in the incidence of healthcare-associated infective endocarditis (HAIE). A prospective multicentre cohort study was conducted at seven hospitals in Andalusia, Spain, to establish the characteristics of HAIE and to compare them with those of community-acquired infective endocarditis (CAIE). HAIE was defined as either infective endocarditis (IE) manifesting >48 h after admission to hospital, or IE associated with a significant invasive procedure performed in the 6 months before diagnosis. Seven hundred and ninety-three cases of IE were investigated, and HAIE accounted for 127 (16%). As compared with patients with CAIE, patients with HAIE were older (60.1 ± 14.4 years vs. 53.6 ± 17.5 years) and had more comorbidities (Charlson index 3.3 ± 2.3 vs. 1.8 ± 2.3) and staphylococcal infections (58.3% vs. 24.8%). Vascular manipulation was the main cause of bacteraemia responsible for HAIE (63%). Peripheral vein catheter-associated bacteraemia accounted for 32.8% of the catheter-related bacteraemias. In-hospital mortality (44.9% vs. 24.2%) was higher in the HAIE group. Septic shock (OR 2.2, 95% CI 2.9-30.2) and surgery not performed because of high surgical risk (OR 1.6, 95% CI 1.2-20) were independent predictors of mortality in HAIE. The present study demonstrates that HAIE is a growing health problem associated with high mortality. Careful management of vascular devices is essential to minimize the risk of bacteraemias leading to HAIE.

Healthcare-Associated Infective Endocarditis: Case Series in Referral Hospital from 2006 to 2011

“…The incidence of 11% of patients on hemodialysis (HD) and 17% of patients with diabetes is in accordance with the literature, where it is 11.9%-19.3% for HD and 19-30.9% for diabetes 4 , 5 , 20 , 21 . It has been reported in a study on intravenous catheters from INC that devices used for HD, especially femoral catheters, are a particular risk for bacteremia and endocarditis, thus being an important issue not only for patients with prosthetic valves but also for those with native valves 25 , 26 .…”

“…The mean age of patients was 47.2 years, lower when compared with the mean age of HCA-IE in the literature, which varies between 60.1 and 69 years 4 , 6 , 10 , 20 , 21 . However, in Terpenning et al 11 and Lamas et al 2 , the mean age was comparable to that in our series, 47.8 and 53.8 years, respectively.…”

“…These are not exactly comparable data, but can be used to extrapolate some information on HCA-IE in Brazil. The proportion of prosthetic valves affected varies from 11.8% to 45.5% in published HCA-IE series and is 43% in ours 4 , 5 , 11 , 17 , 20 - 23 . Despite the number of prosthetic valves involved, the rate of early PVE in our institution is within the one described by the literature 24 .…”

“…The incidence of HCA-IE has been growing in the last decades representing 10-34% of all IE cases 2 , 4 - 8 . The incidence of our HCA-IE cases (35%) was in the upper limit described in reported series from the international literature, probably because the hospital where the study was done is a cardiac referral center, with daily insertion of cardiac prosthesis and intracardiac devices, as well as occasional heart transplantation.…”

“…HCA-IE is an important public health problem and represents 10-34% of all cases of IE 4 - 8 . It is a severe complication of hospitalization and is associated with higher morbidity and mortality when compared to community acquired IE.…”