HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort

Stephen Chambers, David Murdoch, Arthur Morris, David Holland, Paul Pappas, Manel Almela, Nuria Fernández-Hidalgo, Benito Almirante, Emilio Bouza, Davide Forno, Ana del Rio, Margaret Hannan, John Harkness, Zeina A. Kanafani, Tahaniyat Lalani, Selwyn Lang, Nigel Raymond, Kerry Read, Tatiana Vinogradova, Christopher W. WoodsDannah Wray, G. Ralph Corey, Vivian Chu, Liliana Clara, Marisa Sanchez, Francisco Nacinovich, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, José Casabé, Claudia Cortes, Javier Altclas, Sanatorio Silvia Kogan, Denis Spelman, Eugene Athan, Owen Harris, Karina Kennedy, Ren Tan, David Gordon, Lito Papanicolas, Damon Eisen, Leeanne Grigg, Alan Street, Tony Korman, Despina Kotsanas, Robyn Dever, Phillip Jones, Pam Konecny, Richard Lawrence, David Rees, Suzanne Ryan, Michael P. Feneley, John Harkness, Phillip Jones, Suzanne Ryan, Phillip Jones, Suzanne Ryan, Phillip Jones, Jeffrey Post, Porl Reinbott, Suzanne Ryan, Rainer Gattringer, Franz Wiesbauer, Adriana Ribas Andrade, Ana Cláudia Passos de Brito, Armenio Costa Guimarães, Max Grinberg, Alfredo José Mansur, Rinaldo Focaccia Siciliano, Tania Mara Varejao Strabelli, Marcelo Luiz Campos Vieira, Regina Aparecida de Medeiros Tranchesi, Marcelo Goulart Paiva, Claudio Querido Fortes, Auristela de Oliveira Ramos, Giovanna Ferraiuoli, Wilma Golebiovski, Cristiane Lamas, Marisa Santos, Clara Weksler, James A. Karlowsky, Yoav Keynan, Andrew M. Morris, Ethan Rubinstein, Sandra Braun Jones, Patricia Garcia, M. Cereceda, Alberto Fica, Rodrigo Montagna Mella, Bruno Barsic, Suzana Bukovski, Vladimir Krajinovic, Ana Pangercic, Igor Rudez, Josip Vincelj, Tomas Freiberger, Jiri Pol, Barbora Zaloudikova, Zainab Ashour, Amani El Kholy, Marwa Mishaal, Hussien Rizk, Neijla Aissa, Corentine Alauzet, Francois Alla, Catherine Campagnac, Thanh Doco-Lecompte, Christine Selton-Suty, Jean Paul Casalta, Pierre Edouard Fournier, Gilbert Habib, Didier Raoult, Franck Thuny, Francois Delahaye, Armelle Delahaye, Francois Vandenesch, Erwan Donal, Pierre Yves Donnio, Christian Michelet, Matthieu Revest, Pierre Tattevin, Jérémie Violette, Florent Chevalier, Antoine Jeu, Dan M.D. Rusinaru, Claire Sorel, Christophe Tribouilloy, Yvette Bernard, Catherine Chirouze, Bruno Hoen, Joel Leroy, Patrick Plesiat, Christoph Naber, Carl Neuerburg, Bahram Mazaheri, Christoph Naber, Carl Neuerburg, Sofia Athanasia, Efthymia Giannitsioti, Elena Mylona, Olga Paniara, Konstantinos Papanicolaou, John Pyros, Athanasios Skoutelis, Gautam Sharma, Johnson Francis, Lathi Nair, Vinod Thomas, Krishnan Venugopal, Margaret Hannan, John Hurley, Dan Gilon, Sarah Israel, Maya Korem, Jacob Strahilevitz, Ethan Rubinstein, Jacob Strahilevitz, Marie Françoise Tripodi, Roberta Casillo, Susanna Cuccurullo, Giovanni Dialetto, Emanuele Durante-Mangoni, Mattucci Irene, Enrico Ragone, Riccardo Utili, Enrico Cecchi, Francesco De Rosa, Davide Forno, Massimo Imazio, Rita Trinchero, Alessandro Tebini, Paolo Grossi, Mariangela Lattanzio, Antonio Toniolo, Antonio Goglio, Annibale Raglio, Veronica Ravasio, Marco Rizzi, Fredy Suter, Giampiero Carosi, Silvia Magri, Liana Signorini, Tania Baban, Zeina Kanafani, Souha S. Kanj, Jad Sfeir, Mohamad Yasmine, Imran Abidin, Syahidah Syed Tamin, Eduardo Rivera Martínez, Gabriel Israel Soto Nieto, Jan T.M. van der Meer, Stephen Chambers, David Holland, Arthur Morris, Nigel Raymond, Kerry Read, David R. Murdoch, Stefan Dragulescu, Adina Ionac, Cristian Mornos, O. M. Butkevich, Natalia Chipigina, Ozerecky Kirill, Kulichenko Vadim, Tatiana Vinogradova, Jameela Edathodu, Magid Halim, Luh Nah Lum, Ru San Tan, Tatjana Lejko-Zupanc, Mateja Logar, Manica Mueller-Premru, Patrick Commerford, Anita Commerford, Eduan Deetlefs, Cass Hansa, Mpiko Ntsekhe, Manuel Almela, Yolanda Armero, Manuel Azqueta, Ximena Castañeda, Carlos Cervera, Ana del Rio, Carlos Falces, Cristina Garcia-de-la-Maria, Guillermina Fita, Jose M. Gatell, Francesc Marco, Carlos A. Mestres, José M. Miró, Asuncion Moreno, Salvador Ninot, Carlos Paré, Joan Pericas, Jose Ramirez, Irene Rovira, Marta Sitges, Ignasi Anguera, Bernat Font, Joan Raimon Guma, Javier Bermejo, Emilio Bouza, Miguel Angel Garcia Fernández, Victor Gonzalez-Ramallo, Mercedes Marín, Patricia Muñoz, Miguel Pedromingo, Jorge Roda, Marta Rodríguez-Créixems, Jorge Solis, Benito Almirante, Nuria Fernandez-Hidalgo, Pilar Tornos, Arístides de Alarcón, Ricardo Parra, Eric Alestig, Magnus Johansson, Lars Olaison, Ulrika Snygg-Martin, Orathai Pachirat, Pimchitra Pachirat, Burabha Pussadhamma, Vichai Senthong, Anna Casey, Tom Elliott, Peter Lambert, Richard Watkin, Christina Eyton, John L. Klein, Suzanne Bradley, Carol Kauffman, Roger Bedimo, Vivian Chu, G. Ralph Corey, Anna Lisa Crowley, Pamela Douglas, Laura Drew, Vance G. Fowler, Thomas Holland, Tahaniyat Lalani, Daniel Mudrick, Zaniab Samad, Daniel Sexton, Martin Stryjewski, Andrew Wang, Christopher W. Woods, Stamatios Lerakis, Robert Cantey, Lisa Steed, Dannah Wray, Stuart A. Dickerman, Hector Bonilla, Joseph DiPersio, Sara Jane Salstrom, John Baddley, Mukesh Patel, Gail Peterson, Amy Stancoven, Luis Afonso, Theresa Kulman, Donald Levine, Michael Rybak, Christopher H. Cabell, Khaula Baloch, Vivian Chu, G. Ralph Corey, Christy C. Dixon, Vance G. Fowler, Tina Harding, Marian Jones-Richmond, Paul Pappas, Lawrence P. Park, Thomas Redick, Judy Stafford, Kevin Anstrom, Eugene Athan, Arnold S. Bayer, Christopher H. Cabell, Vivian Chu, Bruno Hoen, A. W. Karchmer, David R. Murdoch, Daniel J. Sexton, Andrew Wang, Arnold S. Bayer, Christopher H. Cabell, Vivian Chu, David T. Durack, Susannah Eykyn, Bruno Hoen, Phillipe Moreillon, Lars Olaison, Didier Raoult, Ethan Rubinstein

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Abstract

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

Original languageEnglish
Article numbere63181
JournalPLoS ONE
Volume8
Issue number5
DOIs
Publication statusPublished - 17 May 2013

Cite this

Chambers, S., Murdoch, D., Morris, A., Holland, D., Pappas, P., Almela, M., Fernández-Hidalgo, N., Almirante, B., Bouza, E., Forno, D., Rio, A. D., Hannan, M., Harkness, J., Kanafani, Z. A., Lalani, T., Lang, S., Raymond, N., Read, K., Vinogradova, T., ... Rubinstein, E. (2013). HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort. PLoS ONE, 8(5), [e63181]. https://doi.org/10.1371/journal.pone.0063181