Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome

BMC Infectious Diseases

Research Article

Cheng-Len Sy¹  Yu-Ting Tseng¹  Jui-Kuang Chen¹  Yung-Hsin Wang¹  Shue-Ren Wann¹  Kuan-Sheng Wu¹  Hung-Chin Tsai²  Yao-Shen Chen³  Susan Shin-Jung Lee⁴ 

[1] Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, 813, Kaohsiung, Taiwan;Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, 813, Kaohsiung, Taiwan;School of Medicine, National Yang-Ming University, No.155, Section 2, Linong Street, 112, Taipei, Taiwan;Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, 813, Kaohsiung, Taiwan;School of Medicine, National Yang-Ming University, No.155, Section 2, Linong Street, 112, Taipei, Taiwan;Graduate Institute of Environmental Education, National Kaohsiung Normal University, No.116, Heping 1st Road, 802, Kaohsiung, Taiwan;School of Medicine, National Yang-Ming University, No.155, Section 2, Linong Street, 112, Taipei, Taiwan;Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, 813, Kaohsiung, Taiwan;

关键词: Infective Endocarditis;    Multivariate Logistic Regression Analysis;    Charlson Comorbidity Index;    Rheumatic Heart Disease;    Mitral Valve Prolapse;   

DOI  :  10.1186/1471-2334-11-221

 received in 2011-03-29, accepted in 2011-08-17,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundNon-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan.MethodsA retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined.ResultsTwo-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. Staphylococcus aureus was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, p < 0.001), had more MRSA (43.3% vs. 9.5%, p < 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], p < 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, p < 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, p = 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, p < 0.001).ConclusionsNNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.

【 授权许可】

Unknown   
© Wu et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.