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Multicenter Study
. 2009 May 5;150(9):586-94.
doi: 10.7326/0003-4819-150-9-200905050-00004.

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

Natividad Benito  1 , José M Miró, Elisa de Lazzari, Christopher H Cabell, Ana del Río, Javier Altclas, Patrick Commerford, Francois Delahaye, Stefan Dragulescu, Helen Giamarellou, Gilbert Habib, Adeeba Kamarulzaman, A Sampath Kumar, Francisco M Nacinovich, Fredy Suter, Christophe Tribouilloy, Krishnan Venugopal, Asuncion Moreno, Vance G Fowler Jr; ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators
Collaborators, Affiliations
Multicenter Study

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

Natividad Benito et al. Ann Intern Med. .

Erratum in

  • Ann Intern Med. 2010 Apr 6;152(7):480

Abstract

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.

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Conflict of interest statement

Potential conflict of interest: Dr. Fowler has served as a consultant for Biosynexus, Cubist, Inhibitex, Merck, and Johnson & Johnson; received research grant support from Cubist, Inhibitex, Merck, Nabi, and Theravance, and is on speaker’s bureau for Cubist and Pfizer. Dr. José M Miró has received honoraria for speaking or participating in Advisory Boards and/or research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, (BMS) Chiron, Cubist, Novartis, Glaxo Smith Kline (GSK), Gilead Sciences, Oxford Immunotec, Pfizer, Roche and Theravance.

References

    1. Wenzel RP, Edmond MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis. 2001;7:174–7. - PMC - PubMed
    1. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: A three-year analysis. Clin Infect Dis. 1999;29:239–44. - PubMed
    1. Graham DR, Keldermans MM, Klemm LW, Semenza NJ, Shafer ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med. 1991;91:95S–100S. - PubMed
    1. Morin CA, Hadler JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. J Infect Dis. 2001;184:1029–34. - PubMed
    1. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community acquired infections. Ann Intern Med. 2002;137:791–7. - PubMed

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