Despite recent changes in the epidemiology of infective endocarditis (IE) in industrialized countries over the past decades, data about healthcare-associated infective endocarditis (HAIE) remain rare. In this study, we described a population diagnosed and treated for a HAIE at the Bordeaux University Hospital.
Between 2013 and 2015, we conducted a retrospective observational study in the three teaching hospitals of our center. A multidisciplinary endocarditis team reviewed all patients’ medical charts. IE was defined as HAIE according to the following criteria: onset of IE > 48h after hospitalization or within 6 months after hospital discharge or diagnostic or therapeutic manipulations. We included all HAIE cases that were referred to our center during the study period. We extracted detailed demographic, diagnostic, treatment, and follow-up (in-hospital mortality) data from patients’ charts and medical records and compared them with community-acquired IE (CAIE) patients admitted in the same period.
During the study period, 96 patients were included and compared with 134 CAIE patients (mean age of patients: 66 years). Thirty-six patients (37%) had native-valve endocarditis and 60 (63%) had prosthetic-valve endocarditis. Fourteen patients (15%) had implantable heart devices. The aortic (60%) and mitral (21%) valves were most commonly infected; in 6% of patients both valves were infected. The most common pathogens were staphylococci (39%; methicillin-resistant in 46% of patients), Streptococcus (25%), and Enterococcus (18%); in 8% of IE patients the pathogens were not documented. Thirty-seven (39%) and 56 (58%) patients underwent surgical treatment respectively for HAIE and CAIE (p = 0.01). The hospital mortality rate of the HAIE patients was 15.6% (12.1% with surgery and 18.6% without surgery) and reached 47% in the presence of heart failure (p = 0.002). In the same period, the in-hospital mortality rate of the 134 CAIE patients was 12.7% (p = 0.5).
The epidemiology of IE has changed significantly: older patients, more prosthetic valves and increased prevalence of staphylococci, probably in part due by an increase in HAIE. Nevertheless, in this study, the mortality rate of HAIE was quite similar to the mortality rate of CAIE, despite less surgical treatment.
C. Greib, None
M. Dijos, None
S. Yeim, None
P. Poustis, None
O. Peuchant, None
N. Issa, None