title: Endocarditis due to gram-negative bacilli at a French teaching hospital over a 6-year period: clinical characteristics and outcome.
abstract: BACKGROUND
  Infective endocarditis (IE) due to gram-negative bacilli (GNB) is rare. However, several studies described a change in the epidemiological profile of patients within the past few years.
  
  
  METHODS
  We reviewed all cases diagnosed and followed in the infectious diseases ward of a French teaching hospital in Paris between 2009 and 2014, inclusive.
  
  
  RESULTS
  Among the 17 patients with definite GNB-IE (11 male, mean age 54 years), 12 (70%) were due to non-HACEK GNB and 5 (30%) to HACEK group GNB. A prosthetic valve was involved in 10 cases (8 in non-HACEK and 2 in HACEK group). Escherichia coli (4/12 patients) and Pseudomonas aeruginosa (3/12 patients) were the most common pathogens in the first group; all the pathogens in the second group were Haemophilus spp. One-third of the patients with non-HACEK GNB had nosocomial IE, whereas injection drug use-related infections were rare (2/12). All patients with HACEK infection had at least one complication (intracardiac abscess, stroke or other systemic embolization). All patients were treated by antibiotic combination therapy during a median time of 42 days (interquartile range (IQR) = 42-42) and 10 (59%) underwent cardiac surgery. One death at 9 months was observed in the non-HACEK group.
  
  
  CONCLUSIONS
  Regarding HACEK IE, this report supports the frequent association with vascular complications. Regarding non-HACEK GNB IE, this report supports the increasing proportion of nosocomial infections. We reported a high proportion of surgery in the therapeutic management of both HACEK and non-HACEK groups associated with no in-hospital mortality.
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.
authors.forename: Paul
authors.initials: P
authors.lastname: Loubet
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.|b INSERM, IAME, UMR 1137 , Paris , France.|c Université Paris Diderot, IAME, UMR 1137 , Paris , France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lescure
authors.affiliation: d Service de Chirurgie Cardiaque , Paris , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.affiliation: d Service de Chirurgie Cardiaque , Paris , France.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.affiliation: b INSERM, IAME, UMR 1137 , Paris , France.|c Université Paris Diderot, IAME, UMR 1137 , Paris , France.|e Laboratoire de Bactériologie , Paris , France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefevre
authors.affiliation: f Service de Réanimation Médicale, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lariven
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.|b INSERM, IAME, UMR 1137 , Paris , France.|c Université Paris Diderot, IAME, UMR 1137 , Paris , France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.|b INSERM, IAME, UMR 1137 , Paris , France.|c Université Paris Diderot, IAME, UMR 1137 , Paris , France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Joly
mesh_terms: D000038:Abscess / Q000382:microbiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006190:Haemophilus / Q000302:isolation & purification; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Endocarditis; Enterobacteriaceae; HACEK; gram-negative bacilli; non-HACEK