학술논문
Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort.
Document Type
Academic Journal
Author
Calderón Parra J; Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.; De Castro-Campos D; Cardiology Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.; Muñoz García P; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain.; Olmedo Samperio M; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain.; Marín Arriaza M; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain.; De Alarcón A; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen del Rocío, Sevilla, Spain.; Gutierrez-Carretero E; Cardiac Surgery Department, Hospital Virgen del Rocío, Sevilla, Spain.; Fariñas Alvarez MC; Infectious Diseases Unit, Hospital Marqués de Valdecilla, Santander, Spain.; Miró Meda JM; Infectious Diseases Department, Hospital Clinic, Barcelona, Spain.; Goneaga Sanchez MÁ; Infectious Diseasses Department, Hospital Donosti, San Sebastían, Spain.; Rodriguez García R; Cardiac Surgery Department, Central Hospital of Asturias, Oviedo, Spain.; Ojeda Burgos G; Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Virgen de la Victoria, Malaga, Spain.; Valcarce-Gonzalez Z; Internal Medicine Department, Hospital of Alava, Alava, Spain.; Ramos-Martinez A; Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Source
Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 9003220 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0828 (Electronic) Linking ISSN: 09536205 NLM ISO Abbreviation: Eur J Intern Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Infective endocarditis (IE) due to non-HACEK bacilli (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella, or Kingella) is uncommon and poorly described. The objectives of this study were to describe non-HACEK Gram-Negative Bacilli (GNB) IE cases and compare characteristic of IE produced by Enterobacterales and non-fermenting (NF) GNB.
Methods: From January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included.
Results: A total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62-78] vs 68 years [IQR: 57-77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4-8] vs 4 [IQR 3-7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00-1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90-5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17-11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09-0.96; p = 0.043).
Conclusion: Non-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.
(Copyright © 2021. Published by Elsevier B.V.)
Methods: From January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included.
Results: A total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62-78] vs 68 years [IQR: 57-77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4-8] vs 4 [IQR 3-7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00-1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90-5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17-11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09-0.96; p = 0.043).
Conclusion: Non-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.
(Copyright © 2021. Published by Elsevier B.V.)