title: Endocarditis complicating central venous catheter bloodstream infections: a unique form of health care associated endocarditis.
abstract: BACKGROUND
  Endocarditis complicating central venous catheter blood stream infection (CVC-BSI) is a serious complication and is being seen with increasing frequency.
  
  
  METHODS
  All patients discharged from our institution with International Classification of Disease (ICD-9) codes of endocarditis and CVC-BSI were identified. The medical records of those meeting our inclusion criteria were reviewed.
  
  
  RESULTS
  From October 1, 1998 until December 31, 2006, 24 patients were identified with inpatient mortality of 20.8%. Nine cases were nosocomial and 15 were non-nosocomial. The most common comorbidities were diabetes mellitus (45.8%), chronic kidney disease (58.4%), prior valvular abnormalities (37.5%), and multiple prior hospitalizations (65.2%). There were 13 external lines, 9 tunneled lines, and 2 implantable ports. Responsible microorganisms included Staphylococcus aureus in 54.6%, coagulase-negative staphylococci in 37.5%, Candida species (spp.) in 16.6%, and enterococci in 12.5%. Five cases were polymicrobial. The line tip was within the right atrium (RA) in 37.5%, the superior vena cava (SVC)-RA junction in 20.8%, the SVC in 33.3%, and the pulmonary artery in 4.2% of patients. Sites of endocardial involvement were the aortic valve in 6 patients, mitral valve in 7 patients, tricuspid valve in 6 patients, right atrial wall in 11 patients, and pacemaker wire in 2 patients. Isolated right-sided involvement occurred in 50% of cases, isolated left-sided in 33.4%, and bilateral involvement in 16.6%. Transesophageal echocardiography (TEE) was necessary for diagnosis in 10 cases (41.6%).
  
  
  CONCLUSIONS
  Endocarditis complicating CVC-BSI more often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires TEE for diagnosis, and has significant inpatient mortality.
authors.affiliation: Section of Cardiology Hospital of Saint Raphael, New Haven, CT 06511, USA. mchrissoheris@srhs.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Chrissoheris
authors.forename: Claudia
authors.initials: C
authors.lastname: Libertin
authors.forename: Ronan G
authors.initials: RG
authors.lastname: Ali
authors.forename: Andre
authors.initials: A
authors.lastname: Ghantous
authors.forename: Amenuve
authors.initials: A
authors.lastname: Bekui
authors.forename: Thomas
authors.initials: T
authors.lastname: Donohue
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology*; D055499:Catheter-Related Infections / Q000150:complications* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015897:Comorbidity; D003428:Cross Infection / Q000150:complications; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000382:microbiology; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents