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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Health care-associated native valve endocarditis: Importance of non-nosocomial acquisition
Annals of Internal Medicine, Volume 150, No. 9, Year 2009
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Description
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. © 2009 American College of Physicians.
Authors & Co-Authors
Benito, Natividad
Spain, Cerdanyola Del Valles
Universitat Autònoma de Barcelona
Miró, José María
Spain, Barcelona
Universitat de Barcelona
de Làzzari, Elisa
Spain, Barcelona
Universitat de Barcelona
Cabell, Christopher H.
United States, Durham
Duke University Medical Center
del Río, Ana I.Quintero
Spain, Barcelona
Universitat de Barcelona
Altclas, Javier David
Argentina, Buenos Aires
Sanatorio Mitre
Commerford, Patrick Joseph
South Africa, Observatory
Groote Schuur Hospital
Delahaye, Franc¸ois
France, Lyon
Hopital Louis Pradel
Drãgulescu, Ştefan Iosif
Romania, Timisoara
Institute of Cardiovascular Diseases
Giamarellou, Helen
Greece, Athens
Attikon University Hospital
Habib, Gilbert B.
France, Marseille
Aix Marseille Université
Kamarulzaman, Adeeba Binti
Malaysia, Kuala Lumpur
Universiti Malaya
Kumar, Arkalgud Sampath
India, New Delhi
All India Institute of Medical Sciences, new Delhi
Nacinovich, Francisco M.
Argentina, Buenos Aires
Icba Instituto Cardiovascular
Suter, Fredy
Italy, Bergamo
Ospedali Riuniti Di Bergamo
Tribouilloy, Christophe M.
France, Amiens
Amiens North Hospital
Venugopal, Krishnan
India, Kozhikode
Calicut Medical College
Moreno, Asunciõn Pizarro
Spain, Barcelona
Universitat de Barcelona
Fowler, Vance G.
United States, Durham
Duke University Medical Center
Statistics
Citations: 236
Authors: 19
Affiliations: 15
Identifiers
Doi:
10.7326/0003-4819-150-9-200905050-00004
ISSN:
00034819
e-ISSN:
15393704
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study
Study Approach
Quantitative