Health care-associated native valve endocarditis: importance of non-nosocomial acquisition.

BACKGROUND The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined. OBJECTIVE To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis. DESIGN Prospective cohort 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 ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005. MEASUREMENTS Clinical and echocardiographic findings, microbiology, complications, and mortality. RESULTS Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]). LIMITATIONS Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use. CONCLUSION More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection. PRIMARY FUNDING SOURCE None.

[1]  L. B. Guze,et al.  Hospital-acquired bacterial endocarditis. , 1963, Archives of internal medicine.

[2]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[3]  J M Hughes,et al.  CDC definitions for nosocomial infections, 1988. , 1988, American journal of infection control.

[4]  M. Terpenning,et al.  Hospital-acquired infective endocarditis. , 1988, Archives of internal medicine.

[5]  J. Alpert,et al.  Increasing frequency of staphylococcal infective endocarditis. Experience at a university hospital, 1981 through 1988. , 1990, Archives of internal medicine.

[6]  D. Graham,et al.  Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. , 1991, The American journal of medicine.

[7]  T. Sorrell,et al.  A comparison of hospital and community-acquired infective endocarditis. , 1992, The American journal of cardiology.

[8]  D. Durack,et al.  New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. , 1994, The American journal of medicine.

[9]  M. Fernández-Guerrero,et al.  Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  L. Fenelon,et al.  Increasing incidence of coagulase negative staphylococcal endocarditis , 1998 .

[11]  S. Eykyn,et al.  Hospital acquired native valve endocarditis: analysis of 22 cases presenting over 11 years , 1998, Heart.

[12]  L. Fenelon,et al.  Infective endocarditis: Evaluation of the duke criteria and transoesophageal echocardiography for the diagnosis of endocarditis , 1998 .

[13]  D. McClish,et al.  Nosocomial bloodstream infections in United States hospitals: a three-year analysis. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  V. Fowler,et al.  Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  L. Fenelon,et al.  Nosocomial infective endocarditis. , 2000, The Journal of hospital infection.

[16]  E. Mylonakis,et al.  Infective endocarditis in adults. , 2001, The New England journal of medicine.

[17]  R. Wenzel,et al.  The impact of hospital-acquired bloodstream infections. , 2001, Emerging infectious diseases.

[18]  L. Leibovici,et al.  Long-term outcome of infective endocarditis: the impact of early surgical intervention. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  J. Hadler,et al.  Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. , 2001, The Journal of infectious diseases.

[20]  M. A. Fernández,et al.  Infective Endocarditis—A Prospective Study at the End of the Twentieth Century: New Predisposing Conditions, New Etiologic Agents, and Still a High Mortality , 2001, Medicine.

[21]  Daniel J Sexton,et al.  Health CareAssociated Bloodstream Infections in Adults: A Reason To Change the Accepted Definition of Community-Acquired Infections , 2002, Annals of Internal Medicine.

[22]  Vance G Fowler,et al.  Changing patient characteristics and the effect on mortality in endocarditis. , 2002, Archives of internal medicine.

[23]  C. Cabell,et al.  Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation. , 2002, Infectious disease clinics of North America.

[24]  D. Schwartz,et al.  Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  F. Alla,et al.  Changing profile of infective endocarditis: results of a 1-year survey in France. , 2002, JAMA.

[26]  H. Giamarellou.  Nosocomial cardiac infections. , 2002, The Journal of hospital infection.

[27]  J. Miro,et al.  Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. , 2002, Infectious disease clinics of North America.

[28]  Joan Buenconsejo,et al.  Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. , 2003, JAMA.

[29]  Susan K. Johnson,et al.  Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. , 2003, JAMA.

[30]  Fred C Tenover,et al.  Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. , 2003, The New England journal of medicine.

[31]  Y. Carmeli,et al.  Hospital-acquired infective endocarditis: should the definition be broadened? , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  J. Timsit,et al.  Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients , 2004, Intensive Care Medicine.

[33]  E. Tacconelli,et al.  Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains. , 2004, The Journal of antimicrobial chemotherapy.

[34]  S. McAllister,et al.  Vancomycin-Resistant Staphylococcus aureus Isolate from a Patient in Pennsylvania , 2004, Antimicrobial Agents and Chemotherapy.

[35]  J. Jernigan,et al.  Vancomycin-resistant Staphylococcus aureus in the absence of vancomycin exposure. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[36]  S. Hopkins,et al.  Healthcare-Associated Staphylococcus aureus Bacteremia and the Risk for Methicillin Resistance: Is the Centers for Disease Control and Prevention Definition for Community-Acquired Bacteremia Still Appropriate? , 2005, Infection Control &#x0026; Hospital Epidemiology.

[37]  P. Martín-Dávila,et al.  Nosocomial endocarditis in a tertiary hospital: an increasing trend in native valve cases. , 2005, Chest.

[38]  Bruno Hoen,et al.  Staphylococcus aureus endocarditis: a consequence of medical progress. , 2005, JAMA.

[39]  J. Mandrekar,et al.  Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. , 2005, Journal of the American Medical Association (JAMA).

[40]  J. Casabé,et al.  Epidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: a national survey. The Endocarditis Infecciosa en la República Argentina-2 (EIRA-2) Study. , 2006, American heart journal.

[41]  Y. Tabak,et al.  Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database* , 2006, Critical care medicine.

[42]  D. Sexton,et al.  Influence of diabetes mellitus on the clinical manifestations and prognosis of infective endocarditis: A report from the International Collaboration on Endocarditis – Merged Database , 2006, Scandinavian journal of infectious diseases.

[43]  H. Ghomrawi,et al.  The Impact of Valve Surgery on 6-Month Mortality in Left-Sided Infective Endocarditis , 2007, Circulation.

[44]  Stamatios Lerakis,et al.  The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). , 2007, American heart journal.

[45]  杜昕,et al.  Infective endocarditis , 2007 .

[46]  Pierre Tattevin,et al.  Non-HACEK Gram-Negative Bacillus Endocarditis , 2007, Annals of Internal Medicine.

[47]  M. F. Fernández Guerrero,et al.  Enterococcal Endocarditis on Native and Prosthetic Valves: A Review of Clinical and Prognostic Factors With Emphasis on Hospital-Acquired Infections as a Major Determinant of Outcome , 2007, Medicine.

[48]  Andrew Wang,et al.  Early surgery in patients with infective endocarditis: a propensity score analysis. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[49]  Patricia Muñoz,et al.  Contemporary clinical profile and outcome of prosthetic valve endocarditis. , 2007, JAMA.

[50]  Piet Claus,et al.  Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. , 2006, European heart journal.

[51]  P. Tornos,et al.  Contemporary epidemiology and prognosis of health care-associated infective endocarditis. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[52]  E. Lautenbach,et al.  Prevention and treatment of health care-acquired infections. , 2008, The Medical clinics of North America.

[53]  Bruno Hoen,et al.  Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[54]  E. Calbo,et al.  Bloodstream infections in adults: importance of healthcare-associated infections. , 2008, The Journal of infection.