Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Mar 27;62(4):e02208-17.
doi: 10.1128/AAC.02208-17. Print 2018 Apr.

Risk Factors and Outcomes of Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Data from the Prospective Multicenter Italian Endocarditis Study Cohort

Marco Falcone  1 , Giusy Tiseo  2 , Emanuele Durante-Mangoni  3 , Veronica Ravasio  4 , Francesco Barbaro  5 , Maria Paola Ursi  6 , Maria Bruna Pasticci  7 , Matteo Bassetti  8 , Paolo Grossi  9 , Mario Venditti  10 , Marco Rizzi  4
Affiliations
Multicenter Study

Risk Factors and Outcomes of Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Data from the Prospective Multicenter Italian Endocarditis Study Cohort

Marco Falcone et al. Antimicrob Agents Chemother. .

Abstract

The objective of this study was to investigate predisposing factors and outcomes of infective endocarditis (IE) caused by non-HACEK Gram-negative bacilli (GNB) in a contemporary multicenter cohort. Patients with IE due to GNB, prospectively observed in 26 Italian centers from 2004 to 2011, were analyzed. Using a case-control design, each case was compared to three age- and sex-matched controls with IE due to other etiologies. Logistic regression was performed to identify risk factors for IE due to GNB. Factors associated with early and late mortality were assessed by Cox regression analysis. The study group comprised 58 patients with IE due to GNB. We found that Escherichia coli was the most common pathogen, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae The genitourinary tract as a source of infection (odds ratio [OR], 13.59; 95% confidence interval [CI], 4.63 to 39.93; P < 0.001), immunosuppression (OR, 5.16; 95% CI, 1.60 to 16.24; P = 0.006), and the presence of a cardiac implantable electronic device (CIED) (OR, 3.57; 95% CI, 1.55 to 8.20; P = 0.003) were factors independently associated with IE due to GNB. In-hospital mortality was 13.8%, and mortality rose to 30.6% at 1 year. A multidrug-resistant (MDR) etiology was associated with in-hospital mortality (hazard ratio [HR], 21.849; 95% CI, 2.672 to 178.683; P = 0.004) and 1-year mortality (HR, 4.408; 95% CI, 1.581 to 12.287; P = 0.005). We conclude that the presence of a genitourinary focus, immunosuppressive therapy, and an indwelling CIED are factors associated with IE due to GNB. MDR etiology is the major determinant of in-hospital and long-term mortality.

Keywords: Gram-negative bacteria; infective endocarditis; multidrug resistance.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Flow diagram of the study.
FIG 2
FIG 2
Kaplan-Meier plots showing in-hospital (A) and 1-year (B) survival of patients with IE caused by GNB according to multidrug-resistant etiology.
See this image and copyright information in PMC

References

    1. Morpeth S, Murdoch D, Cabell CH, Karchmer AW, Pappas P, Levine D, Nacinovich F, Tattevin P, Fernández-Hidalgo N, Dickerman S, Bouza E, del Río A, Lejko-Zupanc T, de Oliveira Ramos A, Iarussi D, Klein J, Chirouze C, Bedimo R, Corey GR, Fowler VG Jr; International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators. 2007. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med 147:829–835. doi: 10.7326/0003-4819-147-12-200712180-00002. - DOI - PubMed
    1. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. 2009. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 169:463–473. doi: 10.1001/archinternmed.2008.603. - DOI - PMC - PubMed
    1. Falcone M, Russo A, Iacovelli A, Restuccia G, Ceccarelli G, Giordano A, Farcomeni A, Morelli A, Venditti M. 2016. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 22:444–450. doi: 10.1016/j.cmi.2016.01.016. - DOI - PubMed
    1. Reyes MP, Reyes KC. 2008. Gram-negative endocarditis. Curr Infect Dis Rep 10:267–274. doi: 10.1007/s11908-008-0044-5. - DOI - PubMed
    1. Prendergast BD. 2006. The changing face of infective endocarditis. Heart 92:879–885. doi: 10.1136/hrt.2005.067256. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources