Hospital-acquired infective endocarditis: should the definition be broadened?
Hospital-acquired infective endocarditis (IE) is a growing health-care problem. Hospital-acquired IE, according to the commonly used definition, is IE manifesting > or =72 h after admission to the hospital or within several weeks after a hospital-based invasive procedure. To assess the validity of this definition, we evaluated 87 episodes of IE, with special attention to recent hospitalizations. The incidence rate of IE in the 6-month period after discharge from the hospital was 27 cases per 100,000 person-years, compared with 1.1 cases per 100,000 person-years in a population with no recent hospitalizations. Furthermore, episodes of IE manifesting during this 6-month period were notable for a high proportion of typically hospital-acquired pathogens (26% vs. 0%; P=.001) and a low proportion of viridans streptococci (0% vs. 36%; P<.001), compared with community-acquired episodes that did not involve recent hospitalization. We conclude that characteristics of hospital-acquired IE extend to episodes arising within 6 months after discharge from the hospital and suggest that the definition of hospital-acquired IE be broadened to include these episodes.
Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel. rbenami1@zahav.net.il
Ronen
R
Ben-Ami
Michael
M
Giladi
Yehuda
Y
Carmeli
Ruth
R
Orni-Wasserlauf
Yardena
Y
Siegman-Igra
D000368:Aged; D003428:Cross Infection / Q000382:microbiology* / Q000503:physiopathology; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge; D013203:Staphylococcal Infections