A comparison of hospital and community-acquired infective endocarditis.
The epidemiology, clinical features, microbiology and outcome of 30 episodes of nosocomial endocarditis occurring over a 13-year period were reviewed and compared with 148 cases of community-acquired endocarditis. Twenty-eight patients (93%) had been in hospital for > 1 week and 10 patients (33%) for > 1 month when they developed endocarditis. Left-sided infection was most frequent; only 3 cases involved the tricuspid valve. Compared with community-acquired infection, patients tended to be older, had a greater incidence of congestive cardiac failure (p = 0.001) or hypotension (p = 0.0008) at presentation and were more likely to have bacteremia after an invasive procedure (83 vs 31%; p < 0.00001). Intravascular devices were the presumed source of bacteremia in 11 cases (37%); the same organism was isolated from both the blood and the suspected source of infection. Staphylococcus aureus was the most frequent causative organism, accounting for 17 episodes (57%), including 4 (13%) due to methicillin-resistant strains. Nosocomial endocarditis had a significantly higher mortality than did community-acquired infection (40 vs 18%; p = 0.02). Eight patients (27%) needed valve replacement. Proper adherence to protocols for management of intravascular devices and appropriate antimicrobial prophylaxis before procedures may have prevented endocarditis in 15 of 30 patients.
Chen
S C
SC
Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, New South Wales, Australia.
Dwyer
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DE
Sorrell
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TC
D000328:Adult; D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000382:microbiology; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D013203:Staphylococcal Infections / Q000453:epidemiology; D015996:Survival Rate