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Health Care–Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition
Open accessAbstract
BACKGROUND: The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined. OBJECTIVE: To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis. DESIGN: Prospective cohort study. SETTING: 61 hospitals in 28 countries. PATIENTS: Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005. MEASUREMENTS: Clinical and echocardiographic findings, microbiology, complications, and mortality. RESULTS: Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]). LIMITATIONS: Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use. CONCLUSION: More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection. PRIMARY FUNDING SOURCE: None.
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“This increase is primarily a consequence of healthcare contact (eg, intravascular catheters, surgical wounds, indwelling prosthetic devices, hemodialysis) 6,8,9”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [9]
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Tong, S. Y. C., Davis, J. S., Eichenberger, E., Holland, T. L., & Fowler, V. G. (2015) · Clinical Microbiology Reviews · doi:10.1128/cmr.00134-14 · Cited by 5,192
Self-citation2015 ESC Guidelines for the management of infective endocarditis
Habib, G., Lancellotti, P., Antunes, M. J., Bongiorni, M. G., Casalta, J., Zotti, F. D., Dulgheru, R., Khoury, G. A. E., Erba, P. A., Iung, B., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv319 · Cited by 5,086
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Preeminence of Staphylococcus aureus in Infective Endocarditis: A 1-Year Population-Based Survey
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Metadata
- Authors
- Benito, N., Miró, J. M., de Lazzari, E., Cabell, C. H., del Río, A., Altclas, J., Commerford, P., Delahaye, F., Dragulescu, S., Giamarellou, H., Habib, G., Kamarulzaman, A., Kumar, A. S., Nacinovich, F. M., Suter, F., Tribouilloy, C., Venugopal, K., Moreno, A., Fowler, V. G., & and the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators*
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- From Hospital de la Santa Creu i Sant Pau, University Autónoma of Barcelona, and Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain; Duke University Medical Center, Durham, North Carolina; Sanatorio Mitre and Instituto Cardiovascular, Buenos Aires, Argentina; Groote Schuur Hospital, Cape Town, South Africa; Hôpital Louis Pradel, Lyon, Faculté de Médecine de Marseille, Marseille, and South Hospital Amiens, Amiens, France;
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2009-05-05
- Volume
- 150
- Issue
- 9
- Pages
- 586-594
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC3625649
- OpenAlex
- W2147390013
- Semantic Scholar
- 4f2fdda6a8f2fc52ae867cf607b24f67ceef339f
- Cited by
- 277
- References
- 58
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 15 · 2023: 17 · 2022: 14 · 2021: 13 · 2020: 15 · 2019: 17 · 2018: 16 · 2017: 18 · 2016: 13 · 2015: 27 · 2014: 16 · 2013: 18 · 2012: 25
- FWCI
- 13.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- HAL (submittedVersion)
- Figshare (submittedVersion, cc-by)
- IRIS (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (R01AI068804)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- native valve endocarditis, nosocomial infections, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, mortality, cardiac surgery, infection source identification, echocardiographic findings
- MeSH terms
- Adult, Aged, Ambulatory Care, Cross Infection, Endocarditis, Bacterial, Female, Renal Dialysis, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Ultrasonography, Treatment Outcome, Community-Acquired Infections
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