title: Epidemiology and the prognosis of healthcare-associated infective endocarditis in China: the significance of non-nosocomial acquisition.
abstract: Limited research has been conducted on healthcare-associated infective endocarditis (HAIE), although it is of increasing importance. The aim of this study is to compare the epidemiology, clinical characteristics, and prognosis of community-acquired IE (CA-IE) with HAIE and non-nosocomial healthcare-associated IE (NNHCA-IE). A retrospective, consecutive case-series analysis was organized and performed during the 20-year study period in Huashan Hospital, Shanghai, China. A total of 154 patients were enrolled, including 126 (81.8%) who had CA-IE and 28 (18.2%) who had HAIE, among whom 20 (71.4%) had non-nosocomial IE. Patients with HAIE compared to patients with CA-IE had poorer clinical conditions (Charlson comorbidity index ≥2: 35.7% vs. 15.1%, P = 0.012; immunosuppressive therapy: 21.4% vs. 4.0%, P = 0.005), underwent more prosthetic valve replacement (35.7% vs. 7.1%, P <0.001), had less streptococcus infection (16.7% vs. 51.1%, P = 0.007) but more atypical bacterial infection (50.0% vs. 21.1%, P = 0.017) and poorer outcomes (17.9% vs. 4.0%, P = 0.019). It is noteworthy that the results were quite similar between the comparison of patients with NNHCA-IE and those with CA-IE. Overall, in-hospital mortality was 6.5%. The IE acquisition site and low serum albumin levels (odds ratio (OR): 0.8; P = 0.04) were significantly associated with an increased risk of mortality. Nosocomial IE patients had an 8.3-fold and NNHCA-IE patients had 6.5-fold increase in the risk of mortality compared to CA-IE patients. In conclusion, HAIE and NNHCA-IE have important epidemiological and prognostic implications. Because NNHCA-IE usually occurs in patients residing in the community, it is suggested that these patients should be identified and treated by the community primary care clinical staff as early as possible.
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Feifei
authors.initials: F
authors.lastname: Yang
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Bingyan
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Shao
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Pu
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Wenhong
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Weng
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Jiming
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Infectious Disease, Huashan Hospital, Fudan University , Shanghai 200040, China.
authors.forename: Yuxian
authors.initials: Y
authors.lastname: Huang
mesh_terms: D000328:Adult; D000375:Aging / Q000473:pathology; D016470:Bacteremia / Q000382:microbiology; D015984:Causality; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D003428:Cross Infection / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D048909:Diabetes Complications; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications; D012307:Risk Factors; D014463:Ultrasonography
keywords: epidemiology; healthcare-associated infections; infective endocarditis; mortality; risk factors