Health care-associated native valve endocarditis: importance of non-nosocomial acquisition.
BACKGROUND
The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined.


OBJECTIVE
To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis.


METHODS
Prospective cohort study.


METHODS
61 hospitals in 28 countries.


METHODS
Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005.


METHODS
Clinical and echocardiographic findings, microbiology, complications, and mortality.


RESULTS
Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]).


CONCLUSIONS
Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use.


CONCLUSIONS
More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection.


BACKGROUND
None.
Benito
Natividad
N
Hospital de Santa Creu i Sant Pau, University Autónoma of Barcelona, and Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Miró
José M
JM
de Lazzari
Elisa
E
Cabell
Christopher H
CH
del Río
Ana
A
Altclas
Javier
J
Commerford
Patrick
P
Delahaye
Francois
F
Dragulescu
Stefan
S
Giamarellou
Helen
H
Habib
Gilbert
G
Kamarulzaman
Adeeba
A
Kumar
A Sampath
AS
Nacinovich
Francisco M
FM
Suter
Fredy
F
Tribouilloy
Christophe
C
Venugopal
Krishnan
K
Moreno
Asuncion
A
Fowler
Vance G
VG
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography