title: Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011.
abstract: BACKGROUND
  Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature.
  
  
  OBJECTIVE
  To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE.
  
  
  METHODS
  Observational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro.
  
  
  RESULTS
  Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%).
  
  
  CONCLUSIONS
  In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.
authors.affiliation: Hospital Municipal do Campo Limpo, São Paulo, SP, Brazil.
authors.forename: Oslan
authors.initials: O
authors.lastname: Francischetto
authors.affiliation: Hospital Geral de Bonsucesso, Rio de Janeiro, RJ, Brasil.
authors.forename: Luciana Almenara Pereira da
authors.initials: LA
authors.lastname: Silva
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Katia Marie Simões e
authors.initials: KM
authors.lastname: Senna
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Marcia Regina
authors.initials: MR
authors.lastname: Vasques
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Giovanna Ferraiuoli
authors.initials: GF
authors.lastname: Barbosa
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Clara
authors.initials: C
authors.lastname: Weksler
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Rosana Grandelle
authors.initials: RG
authors.lastname: Ramos
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Wilma Felix
authors.initials: WF
authors.lastname: Golebiovski
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Cristiane da Cruz
authors.initials: Cda C
authors.lastname: Lamas
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D004452:Echocardiography; D004696:Endocarditis / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult