title: Pseudomonas aeruginosa infective endocarditis in patients who do not use intravenous drugs: Analysis of risk factors and treatment outcomes.
abstract: BACKGROUND
  Infective endocarditis (IE) due to Pseudomonas aeruginosa is rare and accounts for only about 3% of all patients with this disease. Most infections are associated with the use of intravenous drugs. Patients with P. aeruginosa-related IE who do not use intravenous drugs are extremely rare. We carried out a review of the literature to identify the nature and risk factors of this disease.
  
  
  METHODS
  Patients with IE reported between 1993 and 2013 were reviewed by searching the Medline database using the keywords "endocarditis" and "Pseudomonas aeruginosa". All of the patients included met the definition of the modified Duke criteria.
  
  
  RESULTS
  Twenty-seven patients in 22 reports were reviewed. IE associated with health care accounted for 20 patients (74%). The mean age of the patients was 53.4 years and there was a predominance of men (81.5%). Native valve endocarditis was seen in 20 (74.1%) patients. Surgery for infection control was performed in 15 (55.6%) patients and the mortality rate in patients who underwent surgery was 33.3% (five patients). A relapse of IE after adequate treatment was seen in nine (33.3%) patients. The mortality rate in all 27 patients was 28.6% (2/7) for those with community-acquired IE and 40% (8/20) for those with IE associated with health care. Univariate analysis showed a higher mortality rate in patients aged >60 years and in those whose source of endocarditis was related to a prosthetic device.
  
  
  CONCLUSIONS
  P. aeruginosa endocarditis has substantial morbidity and mortality. It is characterized by easy relapse and is highly associated with prosthetic devices.
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Ting-I
authors.initials: TI
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: yf5012@hotmail.com.
authors.forename: Yung-Feng
authors.initials: YF
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Po-Yen
authors.initials: PY
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Chin-An
authors.initials: CA
authors.lastname: Chou
authors.affiliation: Department of Internal Medicine, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung, Taiwan, ROC.
authors.forename: Yu-Shen
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Ying-Yao
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Pseudomonas aeruginosa; infective endocarditis; risk factors