Healthcare-associated infective endocarditis: an undesirable effect of healthcare universalization

• Published in: Clinical microbiology and infection Vol. 16; no. 11; pp. 1683 - 1690
• Main Authors: Lomas, J.M., Martínez-Marcos, F.J., Plata, A., Ivanova, R., Gálvez, J., Ruiz, J., Reguera, J.M., Noureddine, M., de la Torre, J., de Alarcón, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-11-2010; Blackwell Publishing Ltd; Wiley-Blackwell; Elsevier Limited
• Subjects: Adult; Aged; Bacteremia - epidemiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Cardiology. Vascular system; Catheterization, Peripheral - adverse effects; Coagulase-negative Staphylococcus bacteraemia; Community-Acquired Infections - complications; Cross Infection - complications; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Endocardial and cardiac valvular diseases; Endocarditis, Bacterial - complications; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - microbiology; Endocarditis, Bacterial - mortality; Female; healthcare-associated; Heart; Hospital Mortality; Human bacterial diseases; Humans; Incidence; Infectious diseases; infective endocarditis; Male; Medical sciences; Middle Aged; Prospective Studies; Risk Factors; Spain - epidemiology; Staphylococcal Infections - complications; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus - classification; Staphylococcus - isolation & purification; Staphylococcus - pathogenicity; Staphylococcus aureus bacteraemia; vascular catheter-related bacteraemia; Vascular Surgical Procedures - adverse effects; Spain; vascular catheter-related bacteraemia; infective endocarditis; healthcare-associated; Coagulase-negative Staphylococcus bacteraemia; Staphylococcus aureus bacteraemia; Catheter; Cardiovascular disease; Bacteremia; Infection; Heart disease; Blood vessel; Endocardial disease; Endocarditis; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection; Staphylococcus aureus
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2010.03043.x

Invasive medical technology has led to an increase in the incidence of healthcare-associated infective endocarditis (HAIE). A prospective multicentre cohort study was conducted at seven hospitals in Andalusia, Spain, to establish the characteristics of HAIE and to compare them with those of community-acquired infective endocarditis (CAIE). HAIE was defined as either infective endocarditis (IE) manifesting >48 h after admission to hospital, or IE associated with a significant invasive procedure performed in the 6 months before diagnosis. Seven hundred and ninety-three cases of IE were investigated, and HAIE accounted for 127 (16%). As compared with patients with CAIE, patients with HAIE were older (60.1 ± 14.4 years vs. 53.6 ± 17.5 years) and had more comorbidities (Charlson index 3.3 ± 2.3 vs. 1.8 ± 2.3) and staphylococcal infections (58.3% vs. 24.8%). Vascular manipulation was the main cause of bacteraemia responsible for HAIE (63%). Peripheral vein catheter-associated bacteraemia accounted for 32.8% of the catheter-related bacteraemias. In-hospital mortality (44.9% vs. 24.2%) was higher in the HAIE group. Septic shock (OR 2.2, 95% CI 2.9–30.2) and surgery not performed because of high surgical risk (OR 1.6, 95% CI 1.2–20) were independent predictors of mortality in HAIE. The present study demonstrates that HAIE is a growing health problem associated with high mortality. Careful management of vascular devices is essential to minimize the risk of bacteraemias leading to HAIE.