Non-HACEK gram-negative bacillus endocarditis.
BACKGROUND
Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users.


OBJECTIVE
To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients.


METHODS
Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database.


METHODS
61 hospitals in 28 countries.


METHODS
Hospitalized patients with definite endocarditis.


METHODS
Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens.


RESULTS
Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%).


CONCLUSIONS
Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make.


CONCLUSIONS
In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.
Morpeth
Susan
S
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27710, USA.
Murdoch
David
D
Cabell
Christopher H
CH
Karchmer
Adolf W
AW
Pappas
Paul
P
Levine
Donald
D
Nacinovich
Francisco
F
Tattevin
Pierre
P
Fernández-Hidalgo
Núria
N
Dickerman
Stuart
S
Bouza
Emilio
E
del Río
Ana
A
Lejko-Zupanc
Tatjana
T
de Oliveira Ramos
Auristela
A
Iarussi
Diana
D
Klein
John
J
Chirouze
Catherine
C
Bedimo
Roger
R
Corey
G Ralph
GR
Fowler
Vance G
VG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D017714:Community-Acquired Infections / Q000382:microbiology / Q000628:therapy; D003428:Cross Infection / Q000382:microbiology / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D006090:Gram-Negative Bacteria; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000382:microbiology; D015819:Substance Abuse, Intravenous / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents