title: Non-HACEK gram-negative bacillus endocarditis.
abstract: 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.
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27710, USA.
authors: Susan
authors: S
authors: Morpeth
authors: David
authors: D
authors: Murdoch
authors: Christopher H
authors: CH
authors: Cabell
authors: Adolf W
authors: AW
authors: Karchmer
authors: Paul
authors: P
authors: Pappas
authors: Donald
authors: D
authors: Levine
authors: Francisco
authors: F
authors: Nacinovich
authors: Pierre
authors: P
authors: Tattevin
authors: Núria
authors: N
authors: Fernández-Hidalgo
authors: Stuart
authors: S
authors: Dickerman
authors: Emilio
authors: E
authors: Bouza
authors: Ana
authors: A
authors: del Río
authors: Tatjana
authors: T
authors: Lejko-Zupanc
authors: Auristela
authors: A
authors: de Oliveira Ramos
authors: Diana
authors: D
authors: Iarussi
authors: John
authors: J
authors: Klein
authors: Catherine
authors: C
authors: Chirouze
authors: Roger
authors: R
authors: Bedimo
authors: G Ralph
authors: GR
authors: Corey
authors: Vance G
authors: VG
authors: Fowler
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents