856. Polymicrobial Infective Endocarditis
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • shrestha layout 102801.pdf (218.5 kB)
  • Background: A small proportion of cases of infective endocarditis (IE) is polymicrobial in etiology. The purpose of this study was to describe the patient characteristics, treatment and outcome of patients seen in our institution with polymicrobial IE.

    Methods: Patients with definite IE by Duke Criteria admitted to our hospital from July 1, 2007 through July 1, 2014 were screened to identify those who had two or more causative microorganisms. The causative pathogens were determined by evaluating results of blood cultures, valve cultures and valve microbial sequencing, and resolving discrepancies using a predetermined algorithm. The patient characteristics associated with these cases, their treatments and outcomes were examined.

    Results: Nineteen patients with polymicrobial IE were identified. 58% (11) had prosthetic valve endocarditis. The mean patient age was 47 years and 58% (11) were males. The combinations of pathogens are outlined in the table. Enterococcus sp. was the most commonly encountered pathogen, occurring in 58% (11) of the patients. A total of 37% (7) had a history of injection drug use (IDU) and 37% (7) had previously had IE. 16% presented with strokes and 10% with cardiogenic shock. 53% (10) had involvement of the left side valves only, and only 11% (2) had isolated right side involvement. Splenic infarction, pulmonary embolism and cardiogenic shock were each seen in 3 patients (16%). Sixteen patients (84%) underwent surgery; 3 were treated medically. By one year after surgery 3 patients were known to have died, 1 was reoperated for another episode of IE, 6 were alive and free of IE, and there was no information for the remaining 9.

    Conclusion: Polymicrobial IE among patients with IE at our institution is unusual (<5%). Over half of these patients had a prosthetic heart valve, and fewer than half had a history of IDU. The most common pathogens were Enterococcuscoagulase-negative staphylococci and Candida.

    Microorganism combination

    Persons affected

    n (%)

    Enterococci + coag neg staph

    4 (21)

    Enterococci + Candida

    4 (21)

    S aureus + viridans strept

    2 (11)

    S aureus + Candida

    2 (11)

    Enterococci + viridans strept

    1 (5)

    Coag neg staph + viridans strept

    1 (5)

    Coag neg staph + HACEK

    1 (5)

    Coag neg staph + nutritionally variant Strept

    1 (5)

    Candida + Serratia

    1 (5)

    Candida + Pseudomonas

    1 (5)

    Viridans strept + Corynebacteria + Prevotella

    1 (5)

    Shailee Shah, MD1, Nabin Shrestha, MD, MPH, FIDSA, FSHEA2 and Steven Gordon, MD, FIDSA, FSHEA1, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH

    Disclosures:

    S. Shah, None

    N. Shrestha, None

    S. Gordon, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.