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

• Published in: International journal of infectious diseases Vol. 76; pp. 120 - 125
• Main Authors: Ambrosioni, Juan, Martinez-Garcia, Clara, Llopis, Jaume, Garcia-de-la-Maria, Cristina, Hernández-Meneses, Marta, Tellez, Adrián, Falces, Carles, Almela, Manel, Vidal, Bàrbara, Sandoval, Elena, Fuster, David, Quintana, Eduard, Tolosana, José M., Marco, Francesc, Moreno, Asunción, Miró, José M.
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-11-2018; Elsevier
• Subjects: Adult; Aggregatibacter - isolation & purification; Cardiobacterium - isolation & purification; case-control; clinical characteristics; Eikenella corrodens - isolation & purification; Endocarditis; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - microbiology; Endocarditis, Bacterial - mortality; epidemiology; Female; HACEK; Haemophilus - isolation & purification; Humans; Kingella - isolation & purification; Male; Middle Aged; outcome; Retrospective Studies; Viridans group streptococci; epidemiology; Viridans group streptococci; case-control; HACEK; Endocarditis; clinical characteristics; outcome
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2018.08.013

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).
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.
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).
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.