title: Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome.
abstract: BACKGROUND
  Non-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan.
  
  
  METHODS
  A retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined.
  
  
  RESULTS
  Two-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. Staphylococcus aureus was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, p < 0.001), had more MRSA (43.3% vs. 9.5%, p < 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], p < 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, p < 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, p = 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, p < 0.001).
  
  
  CONCLUSIONS
  NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.
authors.affiliation: Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
authors.forename: Kuan-Sheng
authors.initials: KS
authors.lastname: Wu
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Hung-Chin
authors.initials: HC
authors.lastname: Tsai
authors.forename: Shue-Ren
authors.initials: SR
authors.lastname: Wann
authors.forename: Jui-Kuang
authors.initials: JK
authors.lastname: Chen
authors.forename: Cheng-Len
authors.initials: CL
authors.lastname: Sy
authors.forename: Yung-Hsin
authors.initials: YH
authors.lastname: Wang
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Tseng
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D004696:Endocarditis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome