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

Abstract

BackgroundHealthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature.ObjectiveTo evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE.MethodsObservational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro.ResultsFifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%).ConclusionIn Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

Demographic Characteristics, Clinical Presentation, Underlying Conditions, and Outcome of Infective Endocarditis

“…Our study found that IE was more common in men. This finding is in agreement with the studies by 7%); however, the prevalence in our study was higher than the rates of the disease noted in the studies by Parvisi et al (35%) and Francischetto et al (49%) (6)(7)(8)(9)(10)(11). The high prevalence rate might be attributed to intravenous drug users who were more common in men.…”

“…In this study, 76% of the patients had fever, which is similar to the findings obtained by Reyahin et al (79.7%), but lower than those reported by Besharat et al (91%), Behzadnia et al (95%), and Francischetto et al (92%). It is possible that the patients had undergone antibiotic treatment before admission to our center (7,9,12).…”

Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN

“…The relatively low surgical intervention rate was somewhat unanticipated because non-population based, tertiary care referral studies have reported surgical rates close to 50% 18, 29, 30 . Over the study period in our investigation, there were 444 non-Olmsted County patients treated at Mayo Clinic Rochester, a large tertiary care referral center.…”

Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis

“…60 Our findings are in consonance with the results of a recent study showing that prior use of antibiotics is the main factor for the presence of infectious health care-associated endocarditis. 85 It can therefore be inferred that the current state of antibiotic therapy has reached a critical point because indiscriminate usage is leading to both compromised immunity and increased resistance.…”