title: Hospital practices influence the pattern of infective endocarditis.
abstract: OBJECTIVE
  To identify factors contributing to infective endocarditis at a major teaching hospital.
  
  
  METHODS
  Retrospective review of clinical records of patients diagnosed with endocarditis by standard case definitions with respect to causative organisms, clinical features and outcome.
  
  
  RESULTS
  One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed. In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci. Nosocomial acquisition and/or inter-hospital transfer accounted for 83 episodes; 48 (58%) S. aureus (P < 0.001) and nine (11%) viridans streptococci (P < 0.001). In cases from the local community, viridans streptococci were more common than S. aureus (37% versus 25%); these included 18 episodes (14 S. aureus) in intravenous drug users.
  
  
  CONCLUSIONS
  We conclude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly by the prevalence of nosocomial endocarditis and the need for interhospital transfer of complicated cases.
authors.affiliation: Centre for Infectious Diseases and Microbiology, University of Sydney, ICPMR, Westmead Hospital, NSW.
authors.forename: D E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: S C
authors.initials: SC
authors.lastname: Chen
authors.forename: E J
authors.initials: EJ
authors.lastname: Wright
authors.forename: D
authors.initials: D
authors.lastname: Crimmins
authors.forename: P J
authors.initials: PJ
authors.lastname: Collignon
authors.forename: T C
authors.initials: TC
authors.lastname: Sorrell
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000209:etiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D016459:Prosthesis-Related Infections; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000209:etiology*; D013295:Streptococcus mutans; D013298:Streptococcus sanguis; D015819:Substance Abuse, Intravenous / Q000150:complications