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. 2023 Aug 9;10(8):ofad393.
doi: 10.1093/ofid/ofad393. eCollection 2023 Aug.

Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008-2021)

David Alonso-Menchén  1 , Emilio Bouza  1   2   3 , Maricela Valerio  1   2 , Arístides de Alarcón  4   5 , Encarnación Gutiérrez-Carretero  6   7 , José M Miró  5   8 , Miguel Ángel Goenaga-Sánchez  9 , Antonio Plata-Ciézar  10 , Claudia González-Rico  5   11 , Luis Eduardo López-Cortés  5   12 , María Ángeles Rodríguez Esteban  13 , Francisco Javier Martínez-Marcos  14 , Patricia Muñoz  1   2   3 ; Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Investigators
Collaborators, Affiliations

Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008-2021)

David Alonso-Menchén et al. Open Forum Infect Dis. .

Erratum in

Abstract

Background: Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity.

Methods: This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data.

Results: IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40).

Conclusions: Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.

Keywords: healthcare-related infections; infective endocarditis; nosocomial infections.

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Conflict of interest statement

Potential conflicts of interest. D. A. received support from Angelini and Shionogi to attend meetings. M. V. reports honoraria for lectures and support to attend meetings from Pfizer, MSD, and ViiV/GSK. M. A. G. received payment for expert testimony for ViiV and support for travel from Angelini. P. M. reports consulting fees, honoraria for lectures, and payment for expert testimony from Gilead, Mundipharma, and Pfizer and support for attending meetings from Pfizer. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Survival curve of patients with healthcare-associated infective endocarditis according to hemodialysis treatment.
See this image and copyright information in PMC

Comment in

References

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