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Ann Intern Med. 2007 Dec 18;147(12):829-35.

Non-HACEK gram-negative bacillus endocarditis.

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1
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27710, USA.

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.

[Indexed for MEDLINE]

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