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. 2018 Nov:76:120-125.
doi: 10.1016/j.ijid.2018.08.013. Epub 2018 Aug 25.

HACEK infective endocarditis: Epidemiology, clinical features, and outcome: A case-control study

Juan Ambrosioni  1 , Clara Martinez-Garcia  2 , Jaume Llopis  3 , Cristina Garcia-de-la-Maria  1 , Marta Hernández-Meneses  1 , Adrián Tellez  1 , Carles Falces  4 , Manel Almela  5 , Bàrbara Vidal  4 , Elena Sandoval  6 , David Fuster  7 , Eduard Quintana  6 , José M Tolosana  4 , Francesc Marco  5 , Asunción Moreno  1 , José M Miró  8 ; Hospital Clinic Infective Endocarditis Investigators
Affiliations
Free article

HACEK infective endocarditis: Epidemiology, clinical features, and outcome: A case-control study

Juan Ambrosioni et al. Int J Infect Dis. 2018 Nov.
Free article

Abstract

Objectives: The study aimed to describe the epidemiological, microbiological, and clinical features of a population sample of 17 patients with HACEK infective endocarditis (HACEK-IE) and to compare them with matched control patients with IE caused by viridans group streptococci (VGS-IE).

Methods: Cases of definite (n=14, 82.2%) and possible (n=3, 17.6%) HACEK-IE included in the Infective Endocarditis Hospital Clinic of Barcelona (IE-HCB) database between 1979 and 2016 were identified and described. Furthermore, a retrospective case-control analysis was performed, matching each case to three control subjects with VGS-IE registered in the same database during the same time period.

Results: Seventeen out of 1209 IE cases (1.3%, 95% confidence interval 0.69-1.91%) were due to HACEK group organisms. The most frequently isolated HACEK species were Aggregatibacter spp (n=11, 64.7%). Intracardiac vegetations were present in 70.6% of cases. Left heart failure (LHF) was present in 29.4% of cases. Ten patients (58.8%) required in-hospital surgery and none died during hospitalization. In the case-control analysis, there was a trend towards larger vegetations in the HACEK-IE group (median (interquartile range) size 11.5 (10.0-20.0) mm vs. 9.0 (7.0-13.0) mm; p=0.068). Clinical manifestations, echocardiographic findings, LHF rate, systemic emboli, and other complications were all comparable (p>0.05). In-hospital surgery and mortality were similar in the two groups. One-year mortality was lower for HACEK-IE (1/17 vs. to 6/48; p=0.006).

Conclusions: HACEK-IE represented 1.3% of all IE cases. Clinical features and outcomes were comparable to those of the VGS-IE control group. Despite the trend towards a larger vegetation size, the embolic event rate was not higher and the 1-year mortality was significantly lower for HACEK-IE.

Keywords: Endocarditis; HACEK; Viridans group streptococci; case-control; clinical characteristics; epidemiology; outcome.

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