Journal Article

Contemporary Epidemiology and Prognosis of Health Care–Associated Infective Endocarditis

Nuria Fernández-Hidalgo, Benito Almirante, Pilar Tornos, Carles Pigrau, Antonia Sambola, Albert Igual and Albert Pahissa

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 10, pages 1287-1297
Published in print November 2008 | ISSN: 1058-4838
Published online November 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/592576
Contemporary Epidemiology and Prognosis of Health Care–Associated Infective Endocarditis

More Like This

Show all results sharing these subjects:

  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
  • Microbiology

GO

Show Summary Details

Preview

Background. The aim of this study was to describe the characteristics of health care-associated infective endocarditis (HAIE) and to establish the risk factors for mortality.

Methods. We conducted a prospective, observational cohort study. HAIE was defined according to the following conditions: (1) symptom onset >48 h after hospitalization or within 6 months after hospital discharge; or (2) ambulatory manipulations causing endocarditis.

Results. Eighty-three episodes of HAIE (accounting for 28.4% of all cases of endocarditis) were diagnosed. Compared with patients with community-acquired endocarditis, patients with HAIE were older (median age ± standard deviation, 65.3±16.4 years vs. 57.8±17.0 years; P=.001), were in poorer health before disease onset (Charlson index, 2.5±2.3 vs. 1.7±2.1; P=.006), had more staphylococcal (55.4% vs. 28.3% of cases) and enterococcal infections (22.9% vs. 7.7% of cases; P<.005), underwent fewer surgeries (22.9% vs. 45.9% of cases; P<.005), and experienced a higher rate of in-hospital (45.8% vs. 22.0%) and 1-year mortality (59.5% vs. 29.6%; P<.005). In the HAIE cohort, independent predictors of in-hospital death were stroke (odds ratio [OR], 8.95; 95% confidence interval [CI], 2.04–39.31; P=.004), congestive heart failure (OR, 5.48; 95% CI, 1.77–17.03; P=.003), surgery indicated but not performed (OR, 3.74; 95% CI, 1.22–11.45; P=.021), and enterococcal infection (OR, 0.18; 95% CI, 0.04–0.78; P=.022). Independent predictors of 1-year mortality were surgery indicated but not performed (OR, 7.81; 95% CI, 2.06–29.67; P=.003), acute renal failure (OR, 7.18; 95% CI, 1.32–39.18; P=.023), and enterococcal infection (OR, 0.18; 95% CI, 0.04–0.81; P=.026). For the series overall (292 episodes), HAIE was an independent predictor of in-hospital (OR, 2.83; 95% CI, 1.34–5.98; P=.007) and 1-year mortality (OR, 2.59; 95% CI, 1.25–5.39; P=.011).

Conclusions. HAIE is an important health problem associated with considerable mortality. New strategies to prevent HAIE should be assessed.

Journal Article.  3985 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.