Healthcare-associated infective endocarditis: an undesirable effect of healthcare universalization.
Invasive medical technology has led to an increase in the incidence of healthcare-associated infective endocarditis (HAIE). A prospective multicentre cohort study was conducted at seven hospitals in Andalusia, Spain, to establish the characteristics of HAIE and to compare them with those of community-acquired infective endocarditis (CAIE). HAIE was defined as either infective endocarditis (IE) manifesting >48 h after admission to hospital, or IE associated with a significant invasive procedure performed in the 6 months before diagnosis. Seven hundred and ninety-three cases of IE were investigated, and HAIE accounted for 127 (16%). As compared with patients with CAIE, patients with HAIE were older (60.1 ± 14.4 years vs. 53.6 ± 17.5 years) and had more comorbidities (Charlson index 3.3 ± 2.3 vs. 1.8 ± 2.3) and staphylococcal infections (58.3% vs. 24.8%). Vascular manipulation was the main cause of bacteraemia responsible for HAIE (63%). Peripheral vein catheter-associated bacteraemia accounted for 32.8% of the catheter-related bacteraemias. In-hospital mortality (44.9% vs. 24.2%) was higher in the HAIE group. Septic shock (OR 2.2, 95% CI 2.9-30.2) and surgery not performed because of high surgical risk (OR 1.6, 95% CI 1.2-20) were independent predictors of mortality in HAIE. The present study demonstrates that HAIE is a growing health problem associated with high mortality. Careful management of vascular devices is essential to minimize the risk of bacteraemias leading to HAIE.
Lomas
J M
JM
Department of Infectious Diseases, Hospital General Juan Ramón Jiménez, Huelva, Spain. jlomascabezas@yahoo.es
Martínez-Marcos
F J
FJ
Plata
A
A
Ivanova
R
R
Gálvez
J
J
Ruiz
J
J
Reguera
J M
JM
Noureddine
M
M
de la Torre
J
J
de Alarcón
A
A
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000009:adverse effects; D017714:Community-Acquired Infections / Q000150:complications; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification / Q000472:pathogenicity; D014656:Vascular Surgical Procedures / Q000009:adverse effects