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

Benito, Natividad, Miró, Jose M, de Lazzari, Elisa, Cabell, Christopher H, del Río, Ana, Altclas, Javier, Commerford, Patrick, Delahaye, Francois, Dragulescu, Stefan, Giamarellou, Helen, Habib, Gilbert, Kamarulzaman, Adeeba, Kumar, A Sampath, Nacinovich, Francisco M, Suter, Fredy, Tribouilloy, Christophe, Venugopal, Krishnan, Moreno, Asuncion, Fowler, Vance G, ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators, and Athan, Eugene 2009, Health care-associated native valve endocarditis: importance of non-nosocomial acquisition, Annals of internal medicine, vol. 150, no. 9, pp. 586-594, doi: 10.7326/0003-4819-150-9-200905050-00004.

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Title Health care-associated native valve endocarditis: importance of non-nosocomial acquisition
Author(s) Benito, Natividad
Miró, Jose M
de Lazzari, Elisa
Cabell, Christopher H
del Río, Ana
Altclas, Javier
Commerford, Patrick
Delahaye, Francois
Dragulescu, Stefan
Giamarellou, Helen
Habib, Gilbert
Kamarulzaman, Adeeba
Kumar, A Sampath
Nacinovich, Francisco M
Suter, Fredy
Tribouilloy, Christophe
Venugopal, Krishnan
Moreno, Asuncion
Fowler, Vance G
ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators,
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Journal name Annals of internal medicine
Volume number 150
Issue number 9
Start page 586
End page 594
Total pages 9
Publisher American College of Physicians
Place of publication Philadelphia, Pa.
Publication date 2009-05-05
ISSN 1539-3704
Keyword(s) ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators
Summary 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.
Language eng
DOI 10.7326/0003-4819-150-9-200905050-00004
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2009, American College of Physicians
Persistent URL http://hdl.handle.net/10536/DRO/DU:30086781

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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