title: HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.
abstract: The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.
authors.affiliation: Department of Pathology, University of Otago, Christchurch and Christchurch Hospital, Christchurch, New Zealand. steve.chambers@cdhb.govt.nz
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chambers
authors.forename: David
authors.initials: D
authors.lastname: Murdoch
authors.forename: Arthur
authors.initials: A
authors.lastname: Morris
authors.forename: David
authors.initials: D
authors.lastname: Holland
authors.forename: Paul
authors.initials: P
authors.lastname: Pappas
authors.forename: Manel
authors.initials: M
authors.lastname: Almela
authors.forename: Nuria
authors.initials: N
authors.lastname: Fernández-Hidalgo
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Davide
authors.initials: D
authors.lastname: Forno
authors.forename: Ana
authors.initials: A
authors.lastname: del Rio
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Hannan
authors.forename: John
authors.initials: J
authors.lastname: Harkness
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Kanafani
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.forename: Selwyn
authors.initials: S
authors.lastname: Lang
authors.forename: Nigel
authors.initials: N
authors.lastname: Raymond
authors.forename: Kerry
authors.initials: K
authors.lastname: Read
authors.forename: Tatiana
authors.initials: T
authors.lastname: Vinogradova
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Chu
mesh_terms: D000367:Age Factors; D064206:Aggregatibacter; D044066:Cardiobacterium; D015331:Cohort Studies; D016124:Eikenella corrodens; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology* / Q000628:therapy*; D006190:Haemophilus; D006801:Humans; D017881:Kingella; D016017:Odds Ratio; D015995:Prevalence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome