Non-HACEK gram-negative bacillus endocarditis

Susan Morpeth, David Murdoch, Christopher H. Cabell, Adolf W. Karchmer, Paul Pappas, Donald Levine, Francisco Nacinovich, Pierre Tattevin, Núria Fernández-Hidalgo, Stuart Dickerman, Emilio Bouza, Ana Del Río, Tatjana Lejko-Zupanc, Auristela De Oliveira Ramos, Diana Iarussi, John Klein, Catherine Chirouze, Roger Bedimo, G. Ralph Corey, Vance G. FowlerInternational Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators

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Abstract

Background: Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. Objective: To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Design: Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. Setting: 61 hospitals in 28 countries. Patients: Hospitalized patients with definite endocarditis. Measurements: Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. Results: Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). Limitations: Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. Conclusion: In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

Original languageEnglish
Pages (from-to)829-835
Number of pages7
JournalAnnals of Internal Medicine
Volume147
Issue number12
DOIs
Publication statusPublished - 18 Dec 2007
Externally publishedYes

Cite this

Morpeth, S., Murdoch, D., Cabell, C. H., Karchmer, A. W., Pappas, P., Levine, D., Nacinovich, F., Tattevin, P., Fernández-Hidalgo, N., Dickerman, S., Bouza, E., Del Río, A., Lejko-Zupanc, T., De Oliveira Ramos, A., Iarussi, D., Klein, J., Chirouze, C., Bedimo, R., Corey, G. R., ... International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators (2007). Non-HACEK gram-negative bacillus endocarditis. Annals of Internal Medicine, 147(12), 829-835. https://doi.org/10.7326/0003-4819-147-12-200712180-00002