859. Infective Endocarditis due to Bartonella spp and Coxiella Burnetti : Comparative Analysis from Prevalence to Management
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • P 859.pdf (187.8 kB)
  • Background: Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis in humans. We aim to compare patients with infective endocarditis (IE) due to Bartonella spp and Coxiella burnetti regarding their prevalence, clinical presentation and management.

    Methods: A retrospective study gathering 290 patients with IE diagnosed according to modified Duke’s criteria, who were admitted between 1994 and 2013. Comparative analysis was performed between group 1 (25 patients with Bartonella spp EI) and group 2 (12 patients with Coxiella burnetti IE).

    Results: Bartonella and Coxiella IE prevalence was 1.25 and 0.6 cases/year respectively. There was no difference in Men/Women ratio between 2 groups (3.1 in group 1 vs. 3 in group 2; p= NS). Mean age was 40.6 ± 12 and 44 ± 15 years in group 1 and 2 respectively (p= NS). An underlying heart disease was more recorded in group 2 (100% vs. 52%; p= 0.003). Rheumatic heart disease was associated with Coxiella IE (75% vs. 32%; p= 0.032; OR = 6.3). Congenital heart disease was more frequent in group 2 (33.4% vs. 4%; p= 0.03; OR= 12). Delay to consultation exceeded 10 days in 94% patients among group 1 and 50% in group 2 ( p= 0.017).  Fever and heart murmur were comparatively found in 2 groups but pallidness was far more frequent in group 2 (58.3% vs. 8%; p= 0.002; OR= 16). Hemodynamic complication at admission tended to be more seen in group 1 (60% vs. 25%; p= 0.07) while patients in group 2 experienced more renal insufficiency, systemic embolism and neurological complications (41% vs. 28%, 16% vs. 4% and 25% vs. 4% respectively; p= NS). Mean white blood cells counted less in group 2 (9998/mm³ vs. 6600/mm³; p= 0.034). Prosthetic IE was rated in 12% in group 1 and 33.3% in group 2 (p=NS).  Mean period of treatment was far longer in group 2 (742 ± 429 vs. 54 ± 38 days; p<0.0001). Referral to cardiac surgery was noted in 64% in group 1 and 41.7% in group 2 (p= NS). In hospital mortality was equally recorded (24% in group 1 vs. 16% in group 2; p= NS).

    Conclusion: Both Bartonella and Coxiella are intracellular bacteria involved in IE with negative blood cultures. Many differences are exhibited through this study regarding epidemiological and clinical features as well as severity of complications however mortality didn't exhibit any difference between Bartonella and Coxiella burnetti IE.

    Sahar Ben Kahla, MD1, Leila Abid, MD2, Makram Koubaa, MD1, Abir Znazen, MD3, Dorra Abid, MD2, Adnane Hammami, MD3, Mounir Ben Jemaa, MD1 and Samir Kammoun, MD2, (1)Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax, Tunisia, (2)Department of Cardiology, Hedi Chaker University Hospital, Sfax, Tunisia, (3)Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia

    Disclosures:

    S. Ben Kahla, None

    L. Abid, None

    M. Koubaa, None

    A. Znazen, None

    D. Abid, None

    A. Hammami, None

    M. Ben Jemaa, None

    S. Kammoun, 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.